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Title: Anatomy and Embalming - A Treatise on the Science and Art of Embalming, the Latest - and Most Successful Methods of Treatment and the General - Anatomy Relating to this Subject
Author: Nunnamaker, Albert John, Dhonau, Charles O.
Language: English
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Copyright Status: Not copyrighted in the United States. If you live elsewhere check the laws of your country before downloading this ebook. See comments about copyright issues at end of book.

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                                ANATOMY
                             AND EMBALMING

            A Treatise on the Science and Art of Embalming,
                 the Latest and Most Successful Methods
                      of Treatment and the General
                          Anatomy Relating to
                             This Subject.

                                   BY

                     ALBERT JOHN NUNNAMAKER, A. B.
                                  AND
                           CHARLES O. DHONAU

           PROFESSORS OF ANATOMY AND SANITARY SCIENCE AT THE
           CINCINNATI COLLEGE OF EMBALMING, CINCINNATI, OHIO.


                             _Illustrated_


                           CINCINNATI, OHIO.
                      THE EMBALMING BOOK COMPANY.
                                  1913



                          COPYRIGHT, 1913, BY

                      THE EMBALMING BOOK COMPANY.



                               DEDICATED
                                   TO
                        THOSE WHO ARE ADVANCING
                             THE STANDARDS
                                 OF THE
                               PROFESSION



PREFACE


This book is the result of many years of contact with embalmers
in training and in practice. We have included in this work a
crystallization of essential information without which, the embalmer
must be poorly equipped to carry out the many duties incident to his
calling in a manner satisfactory to his patrons and to himself.

Having been thrown in contact with the many problems surrounding the
education of the embalmer, the authors have gained many ideas as to
just how to place the information before the embalmer so that the
result will be reflected in an increased capacity for good work on the
part of the individual embalmer.

In prescribing information for the embalmer in this manner, we know
clearly just what is to be expected from the application of the
sciences herein described, and wish for the novitiate and practitioner
the same enthusiasm for actual knowledge that has helped us thus far in
arranging the information.

In =Part One=, we have chronicled, from the word of historians and men
of the present day, a condensed, yet complete exposition of the funeral
customs relating to the care of the dead, giving our readers a better
understanding of present methods by reason of an opportunity to compare
them with those of the past.

In =Part Two=, we have placed the ground work or foundation for the
securing of the proper education in embalming. The work on Anatomy,
which, if mastered by the student or practitioner, is by far the
greatest lever in helping him to master his lifework.

In =Part Three=, we have placed the practical application of the
principles of modern embalming, tempered by the use of the sciences of
pathology, bacteriology, and chemistry in our own application of the
work and in its transcription to these pages.

In formulating the technical part of the work, we have been greatly
assisted by many authorities among whom are:—Green, Howell, Thomas,
Piersol, Gray, Spalteholz, Myers, Barnes, Renouard, Clarke, and those
authors who have from time to time contributed articles to the current
embalmers journals. We are deeply indebted to these men for the results
of their work.

We have based the treatments given herein on the following
classification of embalming fluid as expressed in the percentage
strength of formaldehyde gas contained within the fluid.

       ½ strength = standard fluid of 5% diluted to 2½%
       ¾ strength = standard fluid of 5% diluted to 3¾%
  Normal strength = standard fluid 5%
      1¼ strength = standard fluid of 5% raised to 6¼%

As the existence of a calling or profession depends on a constant
assimilation of newly discovered information counterbalanced by the
throwing off of that which has been found faulty, we commend this book
to the embalmer and hope that it will meet with all the requirements of
the higher education, for which we are constantly battling.

                                                         THE AUTHORS.



TABLE OF CONTENTS


  PART I.
  HISTORY OF EMBALMING.

  CHAPTER I.

  History of Embalming:                                      PAGE
    Guanch Embalming                                            3
    Egyptian Embalming                                          5

  CHAPTER II.

  Embalming from Egyptians down to the Civil War:
    Jews                                                       15
    Persians                                                   16
    Babylonians                                                17
    Scythians                                                  17
    Ethiopians                                                 17
    Romans                                                     17
    Greeks                                                     17
    Norsemen                                                   18
    Hindoos                                                    18
    French and Belgians                                        18
    Britains                                                   18
    Peruvians                                                  19
    Aztecs                                                     19
    North American Indians                                     19
    Early Christians                                           20
    Later European Embalming                                   20

  CHAPTER III.

  Embalming in America after the Civil War:
    Holmes                                                     25
    Billow                                                     26
    Clarke                                                     26
    Renouard                                                   27
    Sullivan                                                   27
    Meyers                                                     27
    Barnes                                                     27

  PART II.
  ANATOMY.

  CHAPTER IV.

  Histology:
    Definition                                                 35
    A Cell                                                     35
    Tissues                                                    37
    Skin                                                       37
    The Nails                                                  40
    The Hair                                                   41
    The Fascia                                                 43
    The Lymphatics                                             44
    Glands                                                     47
    Cartilage                                                  48
    Bones                                                      48
    Teeth                                                      52
    Nerves                                                     53
    Muscles                                                    54
    Tendons                                                    55
    Aponeuroses                                                55
    Ligaments                                                  55
    Fat                                                        56
    Mucous Membranes                                           57
    Serous Membranes                                           57
    Synovial Membranes                                         57
    Arteries                                                   58
    Veins                                                      60
    Blood                                                      61

  CHAPTER V.

  Osteology:
    Definition                                                 69
    The Skeleton                                               69
    The Spine                                                  71
    The Skull                                                  72
    The Bones of the Cranium                                   74
    The Bones of the Face                                      74
    The Hyoid Bone                                             75
    The Bones of the Thorax                                    76
    The Bones of the Upper Extremities                         77
    The Bones of the Lower Extremities                         77

  CHAPTER VI.

  Organology:
    The Cavities                                               79
    The Cerebro-Spinal Cavity                                  79

  CHAPTER VII.

  Organology,—Continued:
    The Thoracic Cavity                                        83
    Larynx                                                     84
    The Trachea                                                85
    The Pleurae                                                87
    The Lungs                                                  88
    The Mediastinum                                            91
    The Pericardium (Heart Sac)                                92
    The Heart                                                  92
    The Alimentary Canal                                       96
    The Mouth                                                  97
    The Teeth                                                  97
    The Palate                                                 97
    The Salivary Glands                                        98
    The Pharynx                                                98
    The Esophagus                                              99
    The Diaphragm                                              99

  CHAPTER VIII.

  Organology,—Continued:
    The Abdomen                                               101
    The Stomach                                               103
    The Small Intestines                                      106
    Duodenum                                                  107
    Jejunum                                                   107
    Ileum                                                     108
    The Large Intestines                                      108
    Caecum                                                    109
    The Colon                                                 111
    The Rectum                                                112
    Liver                                                     112
    The Gall Bladder                                          114
    The Pancreas                                              115
    The Spleen                                                116
    The Kidneys                                               116
    The Ureters                                               117
    The Suprarenal Capsules                                   117
    The Pelvic Cavity                                         118
    The Bladder                                               118
    The Uterus                                                118
    Prostate                                                  119
    The Peritoneum                                            120

  CHAPTER IX.

  The Vascular System:
    The Vascular System                                       123
    The Blood Vascular System                                 123
    The Systemic Circulation                                  125
    The Arterial System                                       125
    The Capillary Circulation                                 132
    The Venous System                                         134
    The Pulmonary Circulation                                 141
    The Coronary Circulation                                  142
    The Portal Circulation                                    144
    The Foetal Circulation                                    144
    The Collateral Circulation                                147
    The Lymphatic Circulation                                 147

  PART III.
  EMBALMING.

  CHAPTER X.

  Modes Signs and Tests of Death:
    Modes of Death                                            156
    Signs of Impending Death                                  157
    Tests of Actual Death                                     158
    Later and More Positive Signs                             162

  CHAPTER XI.

  Premature Burial:
    Premature Burial                                          164

  CHAPTER XII.

  Changes in Blood after Death:
    Cooling of the Body                                       167
    Cadaveric Lividity                                        168
    Putrefactive Changes                                      169
    Skin Slip                                                 175
    Rigor Mortis                                              177
    Fermentation and the Production of Gas                    179
    Spirituous Fermentation                                   180
    Digestive Fermentation                                    180
    Metabolic Fermentation                                    181
    Putrefactive Fermentation                                 181
    Abdominal Fermentation                                    182
    Gastric Fermentation                                      184
    Intestinal Fermentation                                   185

  CHAPTER XIII.

  Discolorations:
    Discolorations                                            187
    Discolorations Occurring before Death                     188
    Yellow Jaundice                                           188
    Pigmentary Atrophy                                        189
    Cancerous Spots                                           190
    Gangrene                                                  191
    Ecchymosis                                                191
    Wounds                                                    193
    Fractures                                                 194
    Scars and Tattoo Marks                                    194

  CHAPTER XIV.

  Discolorations,—Continued:
    Discolorations Occurring after Death                      196
    Desiccation                                               196
    Greenish Tinge of Putrefaction                            200
    Chemical Action                                           202
    Postmortem Discoloration                                  203
    Postmortem Staining                                       204
    Capillary or Venous Congestion                            204

  CHAPTER XV.

  Arterial Embalming:
    Making the First Call                                     205
    The Position of the Body on the Embalming Board           210
    Selection of an Artery                                    211
    How to Raise an Artery                                    214
    How to tell an Artery from a Vein or Nerve                215
    How to Cut an Artery for Injection                        216
    The Injection of Fluid                                    218
    Approved Disinfectants                                    221
    Embalming Fluids                                          221
    Wrapping a Body in Cotton                                 221
    The Charge of Embalming                                   222

  CHAPTER XVI.

  The Anatomical and Linear Guides for Special Arteries:
    How to Locate and Inject the Carotid Artery               225
    How to Locate and Inject the Axillary Artery              231
    How to Locate and Inject the Brachial Artery              234
    How to Locate and Inject the Radial Artery                237
    How to Locate and Inject the Ulnar Artery                 240
    How to Locate and Inject the Femoral Artery               241

  CHAPTER XVII.

  Cavity Embalming:
    Cavity Embalming                                          247
    The Cerebral Cavity                                       247
    Purging                                                   249
    The Thoracic or Chest Cavity                              252
    The Abdominal Cavity                                      254
    The Direct Incision                                       257
    Embalming of the Subcutaneous Tissue                      260
    Plugging Orifices of the Body                             262
    Removal of Urine                                          263

  CHAPTER XVIII.

  The Removal of Blood:
    The Removal of Blood                                      264
    Right Auricle of Heart.—Direct Method                     273
    Right Ventricle of Heart.—Direct Method                   274
    Right Auricle of Heart.—Indirect Method                   274
    Femoral Vein                                              276
    Axillary Vein                                             277
    Basilic Vein                                              278
    Internal Jugular Vein                                     279

  PART IV.
  TREATMENT.

  CHAPTER XIX.

  Treatment of Special Diseases:
    Anthrax                                                   285
    Cerebro-Spinal Fever                                      286
    Erysipelas                                                287
    Glanders                                                  288
    Hydrophobia                                               289
    Relapsing Fever                                           290
    Syphilis                                                  290
    Tetanus                                                   292
    Actinomycosis                                             293
    Dengue                                                    294
    Malarial Fever                                            295
    Yellow Fever                                              296
    Diptheria                                                 297
    Tuberculosis                                              298
    Typhoid Fever                                             299
    Leprosy                                                   301
    Influenza                                                 301
    Cholera                                                   302
    Bubonic Plague                                            303
    Scarlet Fever                                             304
    Variola                                                   305
    Measles                                                   306
    Parotitis                                                 307
    Pertussis                                                 308
    Typhus Fever                                              308
    Varicella                                                 309
    Septicemia                                                310
    Pyemia                                                    311

  CHAPTER XX.

  Treatment of Special Diseases,—Continued:
    Diseases of the Respiratory System                        312
    Gangrene of the Lung                                      312
    Pulmonary Hemorrhage                                      312
    Pulmonary Abscess                                         314
    Pneumonia                                                 314
    Hydrothorax                                               317

  CHAPTER XXI.

  Treatment of Special Diseases,—Continued:
    Diseases of the Circulatory System                        318
    Pericarditis                                              318
    Hydropericardium                                          318
    Hemopericardium                                           319
    Pneumo-Pericardium                                        319
    Endocarditis                                              320
    Aortic Incompetency                                       321
    Aortic Stenosis                                           321
    Mitral Incompetency                                       321
    Mitral Stenosis                                           322
    Tricuspid Incompetency                                    322
    Tricuspid Stenosis                                        323
    Pulmonary Incompetency                                    323
    Pulmonary Stenosis                                        323
    Cardiac Thrombosis                                        323
    Hypertrophy of the Heart                                  324
    Cardiac Dilatation                                        324
    Cardiac Atrophy                                           324
    Arterio Sclerosis                                         325
    Fatty Degeneration of the Arteries                        326
    Aneurism                                                  328

  CHAPTER XXII.

  Treatment of Special Diseases.—Continued:
    Diseases of the Digestive System                          329
    Jaundice                                                  329
    Cirrhosis of the Liver                                    333
    Carcinoma of the Liver                                    335
    Appendicitis                                              336
    Peritonitis                                               336
    Dropsy                                                    337
    Ascites                                                   337
    Anasarca                                                  339

  CHAPTER XXIII.

  Treatment of Accident Cases:
    Broken Neck                                               341
    Hanging                                                   341
    Strangulation                                             341
    Body Severed                                              342
    The Arm Severed                                           343
    The Leg Severed                                           344
    The Head Severed                                          344
    The Head Crushed                                          345
    The Foot Crushed                                          345
    The Chest Crushed                                         346
    Gun-shot in the Abdomen                                   347
    Burns and Scalds                                          347

  CHAPTER XXIV.

  Treatment of Posted Cases:
    Cranial Evisceration                                      351
    Thoracic Autopsy                                          351
    Abdominal Post                                            351
    Posted Cases                                              352

  CHAPTER XXV.

  Treatment of Miscellaneous Cases:
    Alcoholism                                                354
    Morphinism                                                356
    Plumbism                                                  356
    Arsenicism                                                357
    Mercurialism                                              357
    Heat-Stroke                                               357
    Obesity                                                   358
    Elephantiasis                                             359
    Drowned Cases                                             359
    Floater                                                   359
    Mother and Unborn Child                                   360
    Senility                                                  361
    Gangrene                                                  362



LIST OF ILLUSTRATIONS


                                                             PAGE

   1. View of the skin                                         36
   2. A cross section of the skin                              37
   3. Lymphatics of the head and neck                          45
   4. Lymphatics of the leg                                    46
   5. Cross section of the bone                                50
   6. Section of a nerve fiber                                 53
   7. View of muscle fibers                                    54
   8. Section of artery                                        58
   9. Valves of the veins                                      60
  10. Cross section through a small artery and vein            60
  11. Human blood                                              61
  12. The skeleton                                             69
  13. The spine                                                71
  14. The skull                                                73
  15. Brain and spinal cord                                    80
  16. Front view of the thorax                                 83
  17. The cartilages of the larynx, the trachea and bronchi    86
  18. The root of the left lung                                89
  19. A cross section of the heart showing valves              93
  20. The right auricle and ventricle laid open                94
  21. Passage into trachea and esophagus                       98
  22. The regions of the abdomen and their contents           102
  23. The coeliac axis and its branches                       104
  24. The caecum and colon laid open to show the ileocaecal
        valve                                                 110
  25. Excretory apparatus of the liver                        114
  26. The abdominal aorta and its branches                    116
  27. The peritoneum                                          120
  28. The arch of the aorta and its branches                  126
  29. The internal carotid and vertebral arteries             127
  30. The circle of Willis                                    128
  31. The arteries of the face and scalp                      129
  32. The external carotid and its branches                   129
  33. The anterior tibial artery                              130
  34. The popliteal, posterior tibial, and peroneal arteries  130
  35. Capillaries                                             133
  36. Superficial veins of the head and neck                  135
  37. The internal long saphenous vein                        136
  38. The superficial veins of the arm                        137
  39. Vertical section of the skull, showing the sinuses of
        the duramater                                         138
  40. The sinuses at the base of the skull                    139
  41. The azygos system and the venae cavae with branches     141
  42. The front view of the heart                             143
  43. The back view of the heart                              143
  44. Plan of the foetal circulation                          145
  45. Collateral anastomosis of veins                         147
  46. The arteries of the neck                                226
  47. The axillary artery and its branches                    232
  48. The brachial artery                                     235
  49. The radial and ulnar arteries                           240
  50. The femoral artery                                      243



PART I.

HISTORY OF EMBALMING



Ancient Embalming



CHAPTER I.

HISTORY OF EMBALMING.


=Guanch Embalming.=—The Guanches with the Egyptians are the only
nation among whom embalming had become national, and there exists in
the process and mode of preservation of both such striking analogy,
that the study of the Guanch mummies is, probably, the surest means of
arriving at some positive notions of their origin and relationship.
The details known of the mode of embalming among the Guanches will
enlighten and complete the descriptions that ancient authors have left
to us of the Egyptian processes. They were silent on desiccation in
the act of mummification, but it is to be regarded as a simple omission
on their part. This desiccation was continued during the seventy days
of preparation, and it constituted the principle part of the process
adopted.

The details that I am about to give are extracted from the work of M.
Bory de Saint Vincent on the fortunate Isles.

“The arts of the Guanches were not numerous, the most singular without
doubt is that of embalming. The Guanches preserved the remains of their
relations in a scrupulous manner and spared no pains to guarantee them
from corruption. As a moral duty each individual prepared for himself
the skins of goats, in which his remains could be enveloped, and which
might serve him for sepulture. These skins were often divested of their
hair, at other times they permitted it to remain, when they placed
indifferently the hair side within or without. The processes to which
they resorted to make perfect mummies, which they named _xaxos_, are
nearly lost.

With the Guanches, the embalmers were abject beings; men and women
filled this employment respectively, for their sexes; they were well
paid, but their touch was considered contamination; and all who were
occupied in preparing the xaxos lived retired, solitary, and out of
sight.

There were several kinds of embalming, and several different
employments for those who had charge of it. When they had need of
the services of the embalmers, they carried the body to them to be
preserved, and immediately retired. If the body belonged to persons
capable of bearing the expenses, they extended it at first on a stone
table, the operator then made an opening in the lower part of the
belly with a sharpened flint, wrought into the form of a knife and
called _tabona_; the intestines were withdrawn, which other operators
afterwards washed and cleaned; they also washed the rest of the body,
and particularly the delicate parts, as the eyes, interior of the
mouth, the ears, and the nails, with fresh water saturated with salt.
They filled the large cavities with aromatic plants; they then exposed
the body to the hottest sun, or placed it in stoves, if the sun was not
hot enough. During the exposition they frequently endued the body with
an ointment, composed of goats' grease, powder of odoriferous plants,
pine bark, resin, tar ponce stone, and other absorbing material.

On the fifteenth day the embalming should be completely terminated; the
mummy should be dry and light; the relatives send for it and establish
the most magnificent obsequies in their power. They sew up the body in
several folds of skin, which they had prepared while living, and they
bind it with straps.

The kings and the grandees were besides placed in a case or coffin of a
single piece, and hollowed out of the trunk of a juniper tree, the wood
of which was held as incorruptible.

They then finally carried the xaxos, thus sewed and encased, to
inaccessible grottoes consecrated to this purpose.


=Egyptian Embalming.=—The Egyptians embalmed their dead, and the
processes which they employed were sufficiently perfect to secure
them an indefinite preservation. This is a fact which the pyramids,
the cavern, and all the sepultures of Egypt offer us irrefragible
proof. But what were the causes of the origin of this custom? We have
in answer only hypothesis and conjecture. In the absence of valid
documents, each one explains according to the bias of his mind, or
the nature of his studies, a usage, the origin of which is lost in the
night of time. One of the ancients informs us that the Egyptians took
so much pains for the preservation of the body, believing that the
soul inhabited it so long as it subsisted. Cassien, on the other hand,
assures us that they invented this method because they were unable
to bury their dead during the period of inundation. Herodotus, in his
third book, observes, that embalming had for its object the securing
of bodies from the voracity of animals; they did not bury them, says
he, for fear they would be eaten by worms, and they did not burn them,
because they considered fire like a wild beast that devours everything
it can seize upon. Filial piety and respect for the dead, according
to Sicculus, were the sentiments which inspired the Egyptians with the
idea of embalming the dead bodies. De Maillet, in his tenth letter upon
Egypt, refers only to a religious motive as the origin of embalming:
The priests and sages of Egypt taught their fellow citizens that,
after a certain number of ages, which they made to amount to thirty
or forty thousand years, and at which they fixed the epoch of the
grand revolution when the earth would return to the point at which it
commenced its existence, their souls would return to the same bodies
which they formerly inhabited. But in order to arrive, after death, to
this wished for resurrection, two things were absolutely necessary;
first that the bodies should be absolutely carefully preserved from
corruption, in order that the souls might re-inhabit them; secondly,
that the penance submitted to during this long period of years, that
the numerous sacrifices founded by the dead, or those offered to their
names by their friends, or relation, should expiate the crimes they had
committed during the time of their first inhabitation on earth.

With these conditions exactly observed, these souls separate from their
bodies, should be permitted to re-enter at the arrival of this grand
revolution which they anticipated—remember all that had passed during
their sojourn, and become immortal like themselves. They had further
the same privilege of communicating this same happiness to the animals
which they had cherished, provided that their bodies inclosed in the
same tomb with themselves, were equally well preserved. It is in virtue
of this belief that so many birds, cats, and other animals are found
embalmed with almost the same care as the human bodies with which they
have been deposited.

Such was the idea of perfect happiness which they hoped to enjoy
in this new life. Surely superstition alone, it could scarcely be
believed, would induce men to save from destruction the mortal spoils
of individuals whom they had loved whilst living. We much prefer
looking for the source of this usage in the sentiment which survives
a cherished object snatched from affection by the hand of death.
Since death levels all distinctions—respecting neither love nor
friendship—since the dearest and most sacred ties are relentlessly
broken asunder, it is the natural attribute of affection, to seek to
avoid in some degree, a painful separation, by preserving the remains
of those they loved and by whom they were beloved. This according to
Saint Vincent. Volney and Paraset write as follows as to the probable
cause of the origin of the custom: In a numerous population, under a
burning climate, and the soil profoundly drenched during many months
of the year, the rapid putrefaction of bodies, is a leaven for plague
and disease. Stricken by these numerous pests, Egypt at an early
day, struggled to obviate them; hence have arisen, on the one hand a
custom of burying their dead at a distance from their habitations; and
on the other an art so ingenious and simple to prevent putrefaction
by embalming. One individual may be induced to embalm the bodies of
his relatives and friends by motives of superstition; another from
egotism and personal interest; a third from motives of salubrity or
common interest; another is impelled to perform the sacred duty of
preserving the remains of those who were dear to him by an instinctive
affection. Caylus says that the Egyptians, according to appearances owe
the idea of their mummies, to the dead bodies which they found buried
in the burning sands which prevail in some parts of Egypt, and which,
carried away by the winds, bury travelers and preserve their bodies, by
consuming the fat and flesh without altering the skin.

The mourning, embalming and funerals were conducted as follows: When
a man of consideration dies, all the women of his house, cover the
head and even the face with mud; they leave the deceased in the house,
girdle the middle of their bodies, bare the bosom, strike the breast,
and overrun the city, accompanied by their relations. On the other
side, the men also girdle themselves, and strike their breasts; after
this ceremony they carry the body to the place where it is to be
embalmed.

Certain men according to the law have charge of the embalming, and
make a profession of it. When a body is brought to them, they show
the bearers models of the dead in wood. The most renowned represents,
they say, _Him whose name I am scrupulous to mention_. This model
was probably the figure of some divinity. To be prepared after this
model would cost one talent, (about nine hundred dollars of our
money). They show a second which is inferior to the first, and which
is not so costly, twenty mina, (or about three hundred dollars in our
money). They also show a third of lower price, the price of which was
considered by Herodotus as a trifle, which we would infer to mean from
fifty to seventy-five dollars of our money. The exhibition of models
on the part of the embalmers, had reference to the richness of the
work demanded, and to the expense of the chosen form. They demand after
which of the three models they wish the deceased to be embalmed. After
agreeing about the price, the relatives retire; the embalmers work
alone and proceed as follows, in the most costly embalming.

They first withdraw the brain through the nostrils, in part with a
curved iron instrument, and in part by means of drugs, which they
introduce into the head. They now make an incision in the flank with
a sharp Ethiopian stone. The body is extended upon the earth, the
scribe traces on the left flank the portion to be cut out. He who
is charged with making the incision cuts with an Ethiopian stone, as
much as the law allows; which, having done, he runs off with all his
might, the assistants follow, throwing stones after him, loading him
with imprecations, as if they wished to put upon him this crime. They
regard, indeed, with horror, whoever does violence to a body of the
same nature as their own.

They withdraw the intestines through this opening, clean them, and pass
them through palm wine, place them in a trunk; and among other things
they do for the deceased, they take this trunk, and calling the sun to
witness, one of the embalmers on the part of the dead, addresses that
luminary in the following words, which Euphantus has translated: “Sun
and ye too, Gods, who have given life to men, receive me, and grant
that I may live with the eternal Gods: I have persisted all my life
in the worship of those Gods, whom I hold from my fathers, I have ever
honoured the Author of my being, I have killed no one, I have committed
no breach of trust, I have done no other evil: if I have been guilty of
any other fault during life, it has not been on my own account, but for
these things.” The embalmer in finishing these words, shows the trunk
containing the intestines, and afterwards casts it into the river. As
to the rest of the body when it is pure they embalm it.

Afterwards they fill the body with pure bruised myrrh, with cannella
and other perfumes, excepting incense, it is then sown up. When that
is done they salt the body by covering it with natrum for seventy days.
The natrum carries off and dries the oily, lymphatic, and greasy parts.
After the seventy days the body is not permitted to remain longer in
the salt. The seventy days elapsed, they wash the body and entirely
envelope it in linen and cotton bandages, soaked with gum Arabic. The
relatives now reclaim the body, they have made a wooden case for the
human form, in which they enclose the corpse, and put it in a chamber
destined for this purpose, standing erect against the wall. Such is the
most magnificent method of embalming the dead.

Those who wish to avoid the expense, choose this other method; they
fill syringes with an unctious liquor which they obtain from the
cedar, with this they inject the belly of the corpse without making any
incision, and without withdrawing the intestines; when this liquor has
been introduced into the cavity, they cork it; the body is then salted
for the prescribed time. The last day they draw off from the body the
injected liquor, it has such strength that it dissolves the ventricles
and intestines, which come away with the liquid. The natrum destroys
the flesh, and there remains of the body only the skin and the bones.
This operation finished, they return the body without doing anything
further to it.

The third kind of embalming is only for the poorer classes of society,
they inject the body with a fluid called surmata, they put the body
in natrum for seventy days, and they afterwards return it to those who
brought it.

As to the ladies of quality, when they are dead, they are not
immediately sent to the embalmers, any more than such as are beautiful
or highly distinguished; they are reserved for three or four days after
death. They take this precaution lest the embalmers might pollute the
bodies confided to their care.

The relatives now fix the day for the obsequies in order that the
judges, the relations, and the friends of the dead may be present,
and they characterize it by saying that he is going to pass the lake;
afterwards the judges, to the number of more than forty arriving,
place themselves in the form of a semicircle beyond the lake. A bateau
approaches, carrying those who have charge of the ceremony, and in
which is a sailor whom the Egyptians name in their language, Charon.
Before placing in the bateau the coffin containing the body of the
deceased, it is lawful for each one present to accuse him. If they
prove that he has led a sinful life, the judges condemn him, and he
is excluded from the place of his sepulture, if it appear that he has
been unjustly accused, they punish the accuser with severity. If no
accuser presents himself or if the one who does so is known to be a
calumniator, the relatives, putting aside the signs of their grief,
deliver an eulogism, on the deceased without mentioning his birth,
because they consider all Egyptians equally noble. They enlarge on the
manner in which he has been schooled and instructed from his childhood;
upon his piety, justice, temperance, and his other virtues since he
attained manhood, and they pray the Gods of hell to admit him into the
dwelling of the pious. The people applauded and glorified the dead who
were to pass all eternity in the abodes of the happy. If any one has a
monument destined for his sepulture, his body is there deposited; if
he has none, they construct a room in his house, and place the bier
upright against the most solid part of the wall. They place in their
houses those to whom sepulture has not been awarded, either on account
of crimes, of which they are accused, or on account of the debts which
they may have contracted; and it happens sometimes in the end that they
obtained honorable sepulture, their children or descendants becoming
rich, pay their debts or absolve them.

The Egyptian embalmers knew how to distinguish from the other viscera,
the liver, the spleen, and the kidneys, which they did not disturb;
they had discovered the means of withdrawing the brain from the
interior of the body without destroying the bones of the cranium;
they knew the action of alkalies upon animal matter, since the time
was strictly limited that the body could remain in contact with these
substances; they were not ignorant of the property of balsams, and
resins to protect the bodies from the larvae of insects and mites;
they were likewise aware of the necessity of enveloping the dried and
embalmed bodies, in order to protect them from the humidity, which
would interfere with their preservation.

The preceding is a description of ancient Egyptian embalming as given
by Herodotus, and has been the subject of numerous commentations,
discussions and researches. It is almost a positive fact that Herodotus
has omitted desiccation, and that it naturally took place during
the time consecrated to preparation. From the mummies examined it is
believed now that the body was first salted for seventy days, then
dried, and that it was not until after this desiccation that the
resinous and balsamic substances were applied. A simple inspection
of the mummies is sufficient to confirm this opinion and besides what
use would have been these resinous matters, with which the alkali of
the natrum would soon form a soapy mass, which the lotions would have
carried off, at least in great part? It is much more reasonable to
suppose that these balsamic and resinous substances were not applied to
the bodies until after they were withdrawn from the natrum.

All the ancients agree, in saying that the Egyptians made use of
the various aromatics to embalm the dead; that they employed for the
rich myrrh, aloes, canella, and cassia lignea; and for the poor, the
cedria, bitumen, and natrum. The natrum was a mixture of carbonate,
sulphate, and muriate of soda. It was a fixed alkali, which acted after
the manner of quicklime; despoiling the bodies of their lymphatic,
and greasy fluids, leaving only the fibrous and solid parts. The
odoriferous resins and bitumen not only preserved from destruction, but
also kept at a distance the worms and beetles which devour dead bodies.

The embalmers, after having washed the bodies with palm wine, and
having filled them with odoriferous resins or bitumen, they place them
in stoves, where by means of convenient heat these resinous substances
united intimately with the bodies, and these arrive in a very little
time to that state of perfect preservation which we find them at
the present day. This operation of which no historian has spoken,
was, without doubt, the principle and most important part of their
embalming.



CHAPTER II.

EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR.


Here facts are almost entirely wanting and the history of the art we
are studying, can only be followed in the recitals of historians, to
control whose veracity we have no longer those monuments which Egypt
offers us in such great numbers. Among the Jews, the Greeks, the
Romans, and all modern nations, we see the honors of embalming accorded
to Kings, Princes and men of distinction, but no tomb that has been
opened, has rendered a single mummy so perfect, as those which we
admire among the Egyptians.


=Jews.=—The Jewish people, who, like others, testified their respect
for the dead, never admit the care of embalming the body as a common
usage. Thus Abraham purchased the field where Sarah was buried;
Joseph had the body of his father magnificently embalmed; Moses only
carried away the bones of Joseph; David praised the people of Gilead,
for having buried with pomp Saul and his sons, etc. In most of these
examples, no mention is made of embalming; nevertheless, the body of
Jesus Christ was embalmed. It is written that Joseph of Arimathea,
a secret disciple, and Nicodemus, ministered unto him, after the
crucifixion, and that 100 lbs. of myrrh and aloes were used. In this
action the greatest secrecy had been observed, for “when the Sabbath
was over, very early on the first day of the next week, came the
faithful women who had loved him, with spices and ointment they had
prepared where with to annoint him, not knowing that, already, this
loving service had been performed by the hand of pious affection.”

The following is nearly the method used by the Jews: Each sex took
care of its dead; they first of all, close the mouth and eyes of the
exposed person, afterward they washed the body and then rubbed it with
perfumes, tied it with bands, and then bandaged it in several cloths of
very fine linen or woolen; and finally, they put it into the sepulture.
It is thought that the myrrh and aloes which they employed had very
little virtue to resist putrefaction, and that the great quantities of
aromatics which they consumed, was rather for pomp, than for the long
preservation of the subject. They took no pains to dry the body; they
did not take away the intestines, and in spite of all these odoriferous
drugs, decomposition must have soon revealed itself as was testified by
the body of Lazarus when resurrected.


=Persians.=—Neither did the Persians possess a very great knowledge
of preservation. Cyrus, King of Persia, said to his children: “when I
have ceased to live, place my body neither in silver nor in gold, nor
in any other coffin, but return it immediately to the earth, etc.” It
will be perceived that Cyrus, in forbidding that any care should be
taken with his body, does not allude to embalming, which, of all other
means, would have been the most efficient in preventing its elements
from returning to the Common Mother.


=Babylonians.=—The Babylonians, anointed the bodies of their dead
with honey, after which, they were immersed in the same substance. It
is highly improbable that this process was successful for long time
preservation, for the preservative power of honey was only equal to its
ability to keep the air from the body.


=Scythians.=—The Scythians coated the bodies of their dead with
wax. This process could not have been successful excepting to retard
decomposition through shutting off all communication between the body
and the air.


=Ethiopians.=—The Ethiopians coated the bodies of their dead with waxy
covering called parget. The same comment given on the Babylonian and
Scythian processes must also be used here.


=Romans.=—The disposition of the dead among the Romans embraced the
following treatment: the deceased was first washed with hot water
varied with oil, at intervals, for seven days; was dressed and embalmed
with the performance of a variety of singular ceremonies. Cremation
was then the means of ultimate disposal of the dead, the ashes being
gathered and placed in urns and then the urns, in turn, were placed in
tombs.


=Greeks.=—Homer describes cremation, as an honorable mode of sepulture
practiced in the heroic ages. Later from their many conquests, the
Greeks acquired the art of embalming patterned after the Arabian and
Assyrian-Persian methods, of which we have no record.


=Norsemen.=—It appears from the sages that a form of cremation was used
by the early Norsemen, who used to place the viking in his ship and
send him “flaming out to sea.” Later it became the custom to place him,
with all his belongings, in his vessel set on an even keel, and entomb
him beneath a mound of earth.


=Hindoos.=—Suttee (from Sati-a virtuous wife), an Indian custom,
involving the burning of widows on the same funeral pyre as the
husband, was the rule until 1829 A. D.


=French and Belgians.=—Paleolithic cave dwellers of France and
Belgium buried their dead in natural caves or crevices, like those in
which they lived. Later stone-age people throughout Europe buried in
chambered barrows or cairns. Bronze age people buried in unchambered
barrows or in cemeteries of stone cists set in the ground often on a
natural eminence, and surrounded by circles of standing stones. The
cist was formed of a double row of stones covered with rude stone
slabs.


=Britains.=—Neolithic tribes in Britain buried either in caves or in
chambered tombs, probably representing the huts of the living. Some of
these barrows are very elaborate and massive; that of West Kennett is
said to be 350 feet long. The dead were buried in the British tombs as
they died, or in a contracted posture, probably due to their habit of
sleeping in this position, and not at full length on a bed. Many cleft
skulls are found in these tombs, suggesting human sacrifice, which as
Caesar tells us, was prevalent among the Gauls. The bronze age usages
were divided between burying and cremation. In burying, the contracted
posture was followed. In cremation, the body was placed in a coffin
made of the hollow trunk of an oak, split in two. In cremation, the
ashes were collected in a funeral urn, twelve to eighteen inches high
and were placed in a chamber. Articles of daily use were thrown into
the fire.


=Peruvians.=—The aborigines of the western continent were familiar with
embalming. Prescott's “Conquest of Peru” tells that the royal “Incas”
of Peru, were preserved by some process which did not give evidence
of an external application. These bodies were then secreted under
mounds of earth and in the interior of the temples. Prescott presents
highly interesting pictures of these embalmed Peruvian monarchs sitting
“natural as life,” in the chairs of the temples of the sun, at Cusco.
They were clothed as in life, the raven black hair on their heads was
still unchanged, and their hands were crossed upon their bosoms in the
grim dignity of death.


=Aztecs.=—The Aztecs, who were highly civilized, and were one of
the most interesting and powerful tribes of early America, inhabited
Mexico. The Aztecs were conquered by Cortez in 1519. Their history
has been traced back to the twelfth century. The bodies of their dead,
especially of those who could claim royal descent, were embalmed. It
is related in Aztec legends how, after the deluge, seven persons came
forth from the tomb to which their mummified bodies had been committed,
and, in renewed existence, repeopled the earth.


=North American Indians.=—Even our own North American Indians knew
the art of embalming. Mummies remarkably well preserved have been
found among the Flat Heads, Dakotas and Chinooks; and the Florida and
Virginia Indians preserved the bodies of their Kings in the same way.
The Kentucky caves have given up some remarkable specimens of this
kind. The bodies of a woman and child were, in 1899, found in a cave
in the Yosemite valley, and which, on account of its size (six feet and
eight inches), some authorities believe to be a relic of the lost tribe
of the stone age, possibly antedating the Christian era 3,000 years.


=Early Christians.=—For a time the early Christians embalmed the bodies
of their dead, using these forms with which they were familiar in
Palestine. After a time, however, they gave up the practice. It has
been said that they feared by the continuation of the process to cast
discredit upon the power of God to call together the scattered dust of
the body which had returned to its native element, and present it, like
unto Christ's own glorious body, on the morning of the resurrection. No
word spoken by Jesus, would indicate that he disapproved of methods,
with which he as a Jew was familiar, to preserve the body from decay.
During the first four centuries of the Christian era, the catacombs
at Rome were used for burial. These catacombs consist of subterranean
excavations, long horizontal passages with recesses on either side,
arrayed in tiers for the reception of bodies, closed in by slabs
bearing inscriptions and emblems of the faith.


=Later European Embalming.=—After the previous discussion of the care
of the dead affecting prehistoric as well as the earliest historic
usages, we are brought forward to the seventeenth century. All
embalming processes of the earlier days having been forgotten during
the dark ages. The slow but sure development of the medical profession
having manifested a dire necessity for the preservation of anatomical
material, this necessity was first met by Dr. Frederick Ruysch,
who occupied the chair of anatomy at Amsterdam, Holland, during the
close of the seventeenth and early years of the eighteenth century
(1665-1717).

Dr. Ruysch was probably the first to practice a successful system of
arterial injection, in order that his anatomical specimens might resist
the processes of decay. The reader should understand that embalming
as a convenient process for preserving human dead bodies for funeral
purposes had not been thought of at this time, and the principal
interest in embalming was for its successful preservation of anatomical
specimens. The method followed by Dr. Ruysch, was first an arterial
injection, then allowing the diffusion of the fluid for some hours,
after which, he proceeded to open the body as in making a postmortem
examination, removing the viscera, cleaning them and replacing them
surrounded with a preservative solution. Dr. Ruysch died, leaving his
secrets buried with him, and they were lost to science.

Dr. William Hunter, an eminent Scottish physician, anatomist and
physiologist of the eighteenth century (1718-1783) is given credit
by many as being the original inventor of the injection system, for
he published his plan of injection in minute detail, so that science
might benefit thereby. The artery usually selected by Dr. Hunter was
the femoral and his solution was composed of oil of turpentine five
pints; Venice turpentine, one pint; oil of lavender, two fluid ounces;
oil of rosemary, two fluid ounces; and vermillion. This was forced
into the vessel until it reached over the whole body, giving the skin
a general reddish appearance. As in Dr. Ruysch's method, the body
was left untouched for a time, and was then opened, the viscera being
treated and placed back again. After treating the exterior of the body
in some cases, a coffin was prepared and the body was placed on a bed
of dry plaster of paris in order that desiccation might set in. The
body was then left for four years and if dryness had not set in by that
time, was placed upon another bed of plaster of paris. Some of Hunter's
specimens are to be seen today in the museum of the Royal College of
Surgeons, London.

Dr. John Hunter, a younger brother of William, was also very active
in experimentation along these lines, and his work was little less
renowned along the same lines. The Hunterian method was used for years
by English anatomists with little if any alteration.

M. Boudet, attempted to use the Egyptian form of procedure in
embalming, using as preservative agents corrosive sublimate, tan, salt,
asphalt, Peruvian bark, camphor, cinnamon, and other aromatics. He
completely enveloped the body in bandages, varnish being coated over
the body and cavities and outer bandages.

M. Franchini, injected the common carotid artery with a solution made
up of eight decigrams of arsenious acid, combined with a small quantity
of cinnabar, dissolved in nine kilograms of spirits of wine. By this
method bodies could be kept odorless and natural in color for sixty
days, after which desiccation set in.

Jean Nicholas Gannal, and his son Dr. Gannal of Paris, injected
chloride of alumina with success, J. N. Gannal, had previously, a
formula containing arsenic, which the French Government compelled him
to discontinue by prohibiting the sale of the arsenic. In addition
to the above treatment the body was placed in a lead coffin and four
or five litres of various essences were poured over the body and
the casket was soldered. In this way preservation was said to be
indefinite.

M. Sucquet, injected a solution of chloride of zinc arterially, and
in one body which was taken up after being buried 14 months achieved
remarkable success, the incident being the result of a contest between
M. Gannal, M. Dupre, and M. Sucquet. This led to the use of the zinc
salts in fluid, not only in Europe but in this country as well.

M. Falcony, desiccated the body in a mixture which was composed of saw
dust and powdered zinc sulphate. Bodies so preserved remained flexible
for about forty days, after which they dried up, although still
retaining their natural color.

Franciolli, used arsenic acid, four ounces; carbonate of potash, two
ounces; powdered alum, eight ounces. He completely eviscerated the body
and then injected it in all directions, afterwards replacing the organs
and surrounding them with liquid preparation composed of corn starch,
water, alcohol, and corrosive sublimate, which after hardening, would
prevent the sinking of the parts.

Many processes are noted in the various histories of the art, all
using the arterial injection, which by this time had become universally
accepted as the only true way of reaching the body tissues completely.
The reader has noted absolutely nothing as to embalming being the most
convenient process for funeral purposes. This is left to the following
matter which begins with the embalming done by Dr. Thomas Holmes during
the civil war (1861-1865 A. D.)



CHAPTER III.

EMBALMING IN AMERICA AFTER THE CIVIL WAR.


Dr. Holmes was authorized by the U. S. Government to prepare the bodies
of slain troops, so that they could be transported to their former
homes. The practice of embalming for funeral purposes received its
greatest impulse during the regime of Dr. Holmes, and it opened up an
era of unprecedented discovery and success in preserving the dead body.

After Holmes, the man who cared for the dead began to feel that his
was a professional work worthy of the name. The average undertaker,
at the time just after the civil war, was a cabinet maker, whose chief
function was to make the coffin or casket for the body, take the casket
to the house and place the body in it. Then the larger undertakers in
the larger cities found that they were compelled to preserve some of
the bodies in some way so that distant relatives could reach the scene
before the funeral. This probably was the result of betterments in
transportation facilities which led people to travel more. Along with
this, travelers frequently died away from home and had to be shipped.
The baggage men rightfully objected to remaining in the same enclosed
space with an unembalmed body and, altogether, a condition arose in
which it was necessary to have some way to preserve the body.

As evolution is always a slow process, we cannot as we would like to
do, chronicle the introduction of chemical embalming at this time,
for refrigeration was the first thing thought of. The ice box, was
the means by which bodies were kept for several days; the body being
covered and left that way until a few hours before the funeral. This
became so unsatisfactory specially when the sensibilities of the
undertaker became sharpened, that they immediately looked about for a
more convenient way to handle the situation. Spurred on by this demand,
several concerns came into the market with preservative solutions
with an arsenical base, and which were used principally for external
application and cavity injection. All kinds of instruments were used
with which to introduce the fluid into the body cavities until Captain
George Billow, of Akron, Ohio, a civil war veteran, and at present a
member of the Ohio State Board of Embalming examiners, contrived the
pen point trocar, which is still in use among the profession.

With the introduction of the trocar, and the campaigns of the fluid
manufacturers, trade periodicals and traveling men, cavity embalming
became the means of preservation, until its limitations were learned.

Joseph Henry Clarke, who first traveled for fluid houses, and who was
interested in the anatomy of the human body, since his connection with
the U. S. hospital service in the Civil war, determined to introduce
the arterial injection as the means of placing the fluid through the
body. In collaboration with Dr. C. M. Lukens, the occupant of the chair
of Anatomy at the Pulte Medical College of Cincinnati, Prof. J. H.
Clarke opened a school of embalming naming it the Cincinnati School of
Embalming. This took place during the year 1882. Prof. Auguste Renouard
of Denver, Colorado, came into the field about the same time. Thus we
have the beginning of the greatest revolution of all times in the care
of the dead human bodies.

After Prof. Clarke and Prof. Renouard, came Prof. Frank Sullivan, and
from time to time the list was augmented by the addition of others,
a few of whom being Dr. Eliab Meyers, of Springfield, Ohio, Dr. Carl
L. Barnes of Chicago, etc. With the efforts of all these men, the
undertakers were led to use the arteries more and more until now, at
the present time, this form of embalming is used exclusively through
the United States, and Canada; European countries not having, as yet
progressed as rapidly in that direction. The additions to the work
from the time just previous to the start given to it by Prof. Clarke,
number all the methods which we use today, including, the injection
of any large artery in the body; the drainage of blood to further the
obtaining of a complete circulation; the various processes by which
discolorations are prevented and cured; the various processes by which
bodies are disinfected; the various processes by which features are
restored and many other of the vital operations of the present time.
The undertaker having progressed from the cabinet maker, to a man of
professional bearing having a good knowledge of all things pertaining
to the dead human body, is now a man in whom the greatest reliance
may be placed. Where previously, he was uneducated and uncultivated
in matters pertaining to the body, he is now an authority to a great
extent.

As a part of this historical contribution, we cannot overlook the very
great advance made in the nature and composition of the preservative
solutions used today. When formaldehyde was introduced, the high cost
of it prevented its immediate use; but, later on, improved methods
of manufacture brought the cost down to such a point where it became
an essential ingredient in the fluids. Later when, on medico-legal
grounds, arsenic was prohibited in the fluid (this action paralleling
the action taken by France in the case of J. N. and Dr. Gannal),
formaldehyde was depended upon for the maximum preservative action.
Thus it still remains the base of most of the modern fluids. Several
compounders have discontinued its use, preferring phenol, creosote,
etc., but these chemicals have not as yet, made much progress against
the formaldehyde.

In the early days, when the fluids were likely to be inadequate to care
for certain conditions, the question as to which fluid is to be used
was the principal care of the embalmer. Today, when the standard fluids
are of the highest possible efficiency, it is a question of knowledge
and technic on the part of the embalmer; it being a recognized fact
that there is only about 1 chance in 1,000 for a standard fluid to
contain inferior elements. In this way we may state that the burden of
obtaining success has been shifted from the fluid, to the man using
it; and it is then unnecessary to state that the best preparation
along the line of education for the embalmer is advised, so that by his
knowledge, he may do what he is expected to do by the people whom he is
serving.



PART II.

ANATOMY



Anatomy


The word anatomy is derived from two Greek words, meaning, to cut
apart, which literally means dissection.

Anatomy is used to indicate the study of the physical structure of
organized bodies.

_Anatomy_ is the science of organization or the science of organic
structure.

Human anatomy is divided into two great divisions, known as (a) general
or descriptive anatomy and (b) surgical or regional anatomy.

_Descriptive anatomy_ deals with the separate parts of the human body.

_Histology_ is that part of descriptive anatomy where the separate
parts of the human body are studied by means of the microscope.

_Osteology_ is that part of descriptive anatomy describing the number,
form, structure and uses of bone.

_Myology_ is that part of descriptive anatomy which treats of muscles.

_Neurology_ is that part of descriptive anatomy which treats of nerves.

_Syndesmology_ is that part of descriptive anatomy which treats of
ligaments.

_Angiology_ is that part of descriptive anatomy which treats of the
blood-vessels and lymphatics.

_Surgical or regional anatomy_ describes the relation which certain
parts,—muscles, nerves, arteries, etc.,—bear to each other.



CHAPTER IV.

HISTOLOGY.


=Definition.=—Histology is that part of descriptive anatomy which
treats of the intimate structure of the tissues as seen under the
microscope.

Histology as taught in most professional schools constitutes a one
year's course, but for the embalmer this is not entirely necessary
and with the short term of schooling now existing it is quite
impossible, but certain of the fundamental principles of histology are
important. For this reason a few of the more important tissues have
been discussed, not, however, in great detail, but only superficially,
merely to have the embalmer acquainted with them.


=A Cell.=—A cell is defined as a nucleated mass of protoplasm endowed
with the attributes of life.

_Protoplasm_ is the name applied to the semi-fluid, granular substance
contained within the cell.

The simplest forms of animal life are organisms consisting of only one
cell which are called _protozoa_.

Cells having similar shape and similar functions are grouped to form
tissues.

Tissues are grouped together to form organs.

Every cell consists of a cell body and a nucleus. The cell body
consists of a substance known as protoplasm. The nucleus is the
essential part of a typical cell and is the controlling center of its
activity.

   [Illustration: FIG. 1—A, A vertical section of the cuticle; B,
   the lateral view of the cells; C, the flat side of scales like
   (d) magnified 250 diameters.]

Cells divide or reproduce themselves by means of direct or indirect
division. In direct division the nucleus and the cell wall simply
divide into two equal divisions and results in the formation of two
new cells. In indirect division the process is much more complicated,
and several stages must be passed through before there is a complete
division.

The process of fertilization consists in the conjugation of two sexual
cells. The male sexual cell is called the spermatazoon, and the female
sexual cell is called the ovum.

The nucleus of the ovum in its earlier development stages is known as
the germinal vessicle.

In the living organism many cells are destroyed during the various
physiologic processes and are replaced by new ones. When a cell
dies, changes take place in the nucleus which result in its gradual
disappearance. This process is known as chromatolysis.


=Tissues.=—A _tissue_ is an aggregate of cells all having a common
function.

Those important tissues with which the embalmer should be more or less
acquainted are the following:

Skin, nails, hair, superficial fascia, deep fascia, lymphatics,
glands, cartilage, bone, teeth, nerves, muscles, tendons, aponeuroses,
ligaments, fat, mucous membranes, serous membranes, synovial membranes,
arteries, veins and blood.


=The Skin.=—The skin or integument (intego, to cover) is the outside
covering of the human body. It is the first tissue that is cut when
operating upon the body.

   [Illustration: FIG. 2—A cross section of the skin. (Gray)]

The skin is the seat of the organs of touch. The multitudes of sensory
nerve endings convey the sensations of temperature, pressure and pain
to the brain, thus informing the brain at all times, to keep the body
from harm, and in a strong and healthful condition.

The skin is also the regulator of the body temperature, for connected
with the skin are sweat glands, and sebaceous glands, each having
important excretory functions.

The skin is also a protective coat, very elastic, and varies greatly
in thickness. It is thinnest in the eyelids and thickest over the back
of the neck, back of the shoulders, palms of the hands and the soles of
the feet.

The color of the skin depends upon two things, first, on the pigment,
which is found, one of the discriminating points between the races,
named by the color of the skin as white, black, yellow, etc.; second,
the color depends upon the amount of blood in circulation, the deepest
hue being in the parts exposed to the air, light and the varied
temperatures. Besides these the color of the skin varies with age,
pinkest in the infant and becoming yellow with old age. It varies with
exposure and with climate, the people living in the north having a much
different complexion than those living in the south under the tropical
sun. The color of the skin also varies with certain diseases, being
extremely pale in anaemia, brown in Addison's disease, and yellow in
jaundice.

The skin can be said to be moveable, although in places it is attached
firmly to the underlying structures, especially on the scalp, the soles
of the feet, and the palms of the hands.

Upon close examination the skin discloses a multitude of openings,
creases, furrows, depressions, folds and hairs.

A dimple is a permanent pit or depression due to the adhesion of the
surface to parts beneath.

_Structure._—The skin consists of two intimately connected structures,
the one is the _true skin_, _corium_, or _dermis_ and is the deepest
layer of the skin; and the other is the _false skin_, _cuticle_, or
_epidermis_, and is the outermost layer of the skin.

_The true skin_, is composed mostly of connective tissues and elastic
fibers. It is the real seat of the sense of touch, for it is here that
the sensory nerves have their termination. In this layer we also have
the termination of the minute capillaries of the skin.

_The false skin_, contains no blood vessels or nerves, and being
without these it is practically dead tissue, and to illustrate this
fact one can take a needle and run it through this outside layer
without the least pain or the drawing of blood.

The false skin is the part which slips off in case of skin slip. In
as much as the minute capillaries end at the termination of the true
skin, when putrefaction and fermentation begin there is an oozing of
water from the capillaries and the surrounding tissues, between the two
layers of skin, causing a blister to form, and known as skin slip.

At the lowest part of the false skin is a layer of germinal cells, from
which all the other cells are derived, and becoming more flattened and
horny as they are pushed farther away from the blood supply; and also
a layer of pigment cells, which give the discriminating color to the
skin.

In the skin are seen numerous sebaceous and sweat glands.

_The sweat glands_ are the organs by which a large portion of the
aqueous and gaseous materials are excreted by the skin. Sweat glands
are found in almost every portion of the skin, and are situated in
small pits below the surface of the skin, surrounded by a quantity
of adipose tissue or fat. They are small, round, reddish bodies,
consisting of a single tubule, convoluted in form, which extends up
through the skin and opens on the surface. The size of these glands, of
course, vary, being especially large in those regions where the flow of
perspiration is copious as in the axilla.

_The sebaceous glands_ are small, sacculated, glandular organs, lodged
in the substance of the skin. They are found in most parts of the skin
and are usually connected with the hair follicles. Each gland consists
of a single duct, more or less capacious, which terminates in a cluster
of small secreting pouches or saccules. These glands secrete an oily
fluid, which keeps the skin soft and also oils the shaft of the hair.


=The Nails.=—The nails are a peculiar modification of the epidermis and
have the same cellular structure as that of the epidermis. The nails
are found on the dorsal surface of the fingers and toes and act as a
protection, and enable one to pick up small objects, or to grasp more
firmly any object. Were it not for the nails it would be impossible for
one to pick up a needle from off the floor.

Each nail is convex on its outer surface, and its chief mass which is
called _the body_ lies upon the nail bed, or true skin; the free end
projects out over the surface of the finger, and is that part which is
not attached below, and since it is the continuation of the epidermis,
it likewise will have no nerve or blood supply and therefore can be
trimmed without pain to the individual.

_The root_ is implanted in a groove in the skin and is composed of
cells which have not become horny. The root is white in color and is
the little half moon which you can see next to the skin.

_The matrix_ is that part of the true skin beneath the body and the
root of the nail, and is so called, because, it is that part from which
the nail is produced and so long as the matrix at the root of the nail
is uninjured, the nail will be reproduced after an accident.

After death the nail turns black, due to the infiltration of blood into
the matrix.

_Treatment by the Embalmer._—The blackened condition of the nail due to
the infiltration of blood into the matrix can in many cases be overcome
by carefully rubbing the nail at the time the body is being injected.
After the discoloration is removed the fingers should be kept elevated
so that the blood will not settle there again.


=The Hair.=—The hair, like the nails, is a peculiar modification of the
epidermis and consists of practically the same cellular structure as
the epidermis. Hair is found on nearly every part of the body excepting
the palms of the hands and the soles of the feet, the borders of the
lips, etc. It varies much in length, thickness and in the different
races of mankind. In the eyelids it is short, on the scalp it is of
considerable length. In other parts as the eye-lashes, the hair of the
pubis region, the whiskers and beard the thickness is remarkable.

A hair consists of the root and the shaft. The root of the hair or
that part implanted in the skin presents at its extremity a bulbous
enlargement, called the hair bulb. Into this bulb we find the small
arterial capillary circulating and at its termination the beginning
of the venous capillary. In this way the hair is nourished in life.
We also find a small nerve going to the hair bulb. The shaft is the
remaining part or that part coming out from the skin.

The hair grows from its roots and as it grows it pushes itself out
from the skin and owes its growth to the small capillary circulation,
carrying pure arterial blood to each and every hair, and for this
reason you can understand for yourself the erroneous idea of what is
termed the “post-mortem growth of hair.” Only a few weeks ago one of
the students declared that he had actually seen a subject shaved and
the body at the time of the funeral was placed in a vault to await the
arrival of a close relative who had to come from Europe.

Three weeks later the student, together with the undertaker and
relatives, went to the vault to view the remains. The body was in a
perfect state of preservation, only for a large growth of beard as
the student supposed. This student had observed rightly, but he did
not go far enough. He did not think of how the hair actually got its
nourishment. The hair owes its life to the circulation of the blood,
just as much as the heart or any other organ does, and will die and
cease to grow just as soon as the body dies and the circulation is cut
off. What this student saw was only an apparent growth, for after the
body dies the tissues begin to shrink, squeezing the blood and fluid
substances out of them, thus giving the hair cylinder a more projected
appearance.

The student was very much surprised at his mistake, but after the
explanation he saw that the hair owed its life to the circulation and
that when this circulation was cut off, the hair must cease to grow.

The chief function of hair is that of protection from heat or cold and
to help shield the brain from the effect of a blow upon the head.

The hair, next to the teeth and bones, is the least destructible part
of the body.


=The Fascia.=—The fascia (fascia, a bandage) is areolar or aponeurotic
tissue of variable thickness and strength found in all regions of the
body and invests or surrounds the softer and more delicate organs.
From its situation in the body the fascia is divided into two groups,
superficial and deep.

_Superficial fascia_ is found immediately beneath the skin over almost
the entire surface of the body. It connects the skin with the deep
fascia and consists of areolar tissue.

The superficial fascia varies in thickness in different parts of the
body and some places, especially in the groin is capable of being
subdivided into several different layers. The first layer of the
superficial fascia, which is just beneath the skin, usually contains
a great amount of fat or adipose tissue. This, in most text books, has
been termed the subcutaneous tissue. The second layer is comparatively
devoid of adipose or fatty tissue and in this we find the trunks of the
subcutaneous vessels and nerves, as for example, the radial and ulnar
veins in the arms and the saphenous vein in the leg.

The superficial fascia facilitates the movement of the skin, serves as
a soft medium for the passage of the vessels and nerves to the skin and
retains the warmth of the body, since the fat contained in its meshes
is a had conductor of heat.

_Deep fascia_ or aponeurotic fascia is a dense inelastic, unyielding
fibrous membrane, forming a sheath for the muscles and affording them
broad surfaces for attachment. On removal of the superficial fascia,
the deep fascia is usually exposed and can be seen as a dense, tough
membrane, which not only binds down the muscles to each region, but
gives to each a separate sheath as well as to the blood vessels and
nerves.

Thus, on going down into the arm between the biceps and triceps muscles
to raise the brachial artery, you would first cut through the skin,
then the subcutaneous tissue, the superficial fascia and then you would
come to a membrane investing the artery, vein and nerve. This membrane
is the part of the deep fascia which covers the vessels, making a
distinct sheath for them and you must go through this sheath before you
can hope to raise the artery.

   [Illustration: FIG. 3—Lymphatics of the head and neck. B, the
   thoracic duct.]


=The Lymphatics.=—The lymphatics occur in all parts of the body, and in
many respects resemble the veins, one of the most striking similarities
being that the lymphatics contain valves just the same as the venous
system. The lymphatic capillaries are arranged in the form of a net
work and resemble closely in structure the blood capillaries. These
capillaries then unite to form the lymph vessels and these then convey
the lymph to the subclavian veins. The lymph is a colorless fluid and
contains numerous blood corpuscles known as lymphocytes. But in those
lymphatic vessels, which have their origin in the walls of the small
intestines, the lymph, especially during digestion, contains a great
amount of fat, so that it has a milky appearance, and for this reason
the lymphatics of this region, have been termed lacteals. There are two
main lymphatic trunks, the one on the left side is called the thoracic
duct. This duct extends from the lower border of the second lumbar
vertebra, through the entire length of the thorax, and opens into the
left subclavian vein, close to the point where it is joined to the
left internal jugular. It receives the lymph from the lower limbs, the
pelvic walls and viscera, the abdominal walls and viscera; the lower
part of the right half and the whole of the left half of the thoracic
viscera, the left side of the neck and head and the left arm.

   [Illustration: FIG. 4—Lymphatics of the leg.]

The other duct is called the right lymphatic duct and receives lymph
from the upper part of the right side of the thoracic wall, part of
the right side of the diaphragm and the right lobe of the liver, the
whole of the right arm and neck and right side of the head. This trunk
is very short and empties its supply of lymph into the right subclavian
vein.

Receptaculum chyli is the expanded portion of the thoracic duct just at
its beginning. Its function is to receive the lacteals which come from
the villi of the intestines.

Lymph glands are the enlargements of the lymph vessels. They occur
frequently in the lymphatic system, being most numerous in the axillary
space, the cervical region (in the neck) and in Scarpa's triangle.

The lymphatic system aids greatly in warding off such diseases as blood
poisoning, anthrax, etc.

_The lacteals_ are the lymphatics which carry the chyme from the villi
of the intestines and deposit it in the receptaculum chyli.


=Glands.=—The glands of the human body are divided into three classes
called tubular, alveolar and tubulo-alveolar glands.

_Tubular Glands._—In these, the secreting portion consists of a long or
short tubule, which may be relatively straight or variously twisted,
one end of which ends blindly, while the other end opens on the free
surface or into a duct.

Tubular glands may be simple, or having only a single tubule; they
may be simple branched, having more than one tubule; or they may be
compound branched, thus resembling the branching of a tree.

Some tubular glands would be the liver, kidneys, testes, lachrymal
glands, serous glands of the mucous membranes, fundus glands of the
stomach, uterine glands, the majority of the pyloric glands and the
majority of the sweat glands.

_Alveolar Glands._—In these, the secreting compartments have the form
of variously shaped vesicles or saccules, known as alveoli which open
on the free surface or into a duct.

Alveolar glands may be either simple, simple branched, or compound
branched.

Some alveolar glands would be the sebaceous glands, pancreas, mammary
gland, ovary and thyroid.

_Tubulo-alveolar Glands._—In these, there is a combination of the
tubular and the alveolar type. They may also be simple, simple branched
or compound branched.

Some of this type would be certain of the pyloric glands, certain of
the sweat glands, some mucous glands, the prostate and the lungs.

The most important glands will be discussed under the tissue or the
organ in which they are situated.


=Cartilage.=—Cartilage is a transition stage between connective tissue
and bone; when it is boiled it yields condrin. It is found in various
parts of the body, in the adults being found chiefly in the joints,
in the sides of the thorax, and in various tubes which are not kept
permanently open, such as the air passages, nostrils, ears, etc. In the
foetus, the greater part of the framework is cartilaginous and as the
foetus matures this cartilage is finally replaced by bone. Cartilage is
divided into hyaline cartilage, elastic cartilage, and fibro cartilage.

_Hyaline cartilage_ is found in the nose, larynx, trachea, and bronchi.

_Elastic cartilage_ is found in the epiglottis and the cartilages of
the larynx.

_Fibro cartilage_ is found at the point of insertion of the ligaments,
into the body of the bone, such as the cartilage which helps to hold
the femur or long bone of the thigh into the hip.


=Bones.=—Bone results from the calcification of cartilage or fibrous
tissue. It is a highly specialized form of connective tissue. There are
two varieties of bone; dense or compact bone and cancellous, loose, or
spongy bone. Compact bone is dense, like ivory, and is always found on
the exterior of bones.

Cancellous bone is found in the interior of bones, and has a
lattice-work appearance.

Bone consists of one-third animal or organic matter and two-thirds
earthy or inorganic matter. These proportions, however, vary with age.
In youth it is nearly half and half, while in the adult the earthy
is greatly in excess. It also varies with disease. With some defect
of nutrition, the bone is deprived of its normal proportion of earthy
matter, while the animal matter is of unhealthy quality, and we have
as a result, a disease called rickets, so common in the children of the
poor. The earthy or inorganic matter consists of phosphate, carbonate,
fluoride of calcium, sodium chloride, and phosphate of magnesium. The
animal matter consists of fat collagen, which when boiled with water is
resolved into gelatin.

To illustrate the two substances, take a bone and place it in dilute
hydrochloric acid. The acid will eat out all the mineral matter and we
have left only the animal matter. After this operation one can take the
bone and can bend it into any position whatever, which experiment shows
that the animal matter gives elasticity to the bone.

The second experiment would be to put the bone on a bed of hot coals
and burn it. Only the animal matter will burn and we will have the
mineral matter remaining. After this operation one will find that the
bone is very brittle and will easily break, which experiment shows that
the mineral matter gives stability and support to the bone.

   [Illustration: FIG. 5—Cross section of bone. (Sharpey)]

If a cross section is made of any long bone, such as the humerus,
and this section placed under the low power of the microscope, the
Haversian canal system can be discerned. The Haversian canal system
consists of the numerous small openings or canals through which the
blood vessels ramify in distributing the nourishment to the bone.
Around each individual canal are seen smaller spaces arranged in a
circle. These are known as the lacunae (small lakes). Going from the
lacunae are smaller canals which take on the name canaliculae, and
joining all the lacunae together, making the appearance of concentric
circles, we have the lamellae. The outside covering of the bone is
called the periosteum and the inside covering is called the endosteum.
Most of the long bones and many of the smaller bones are supplied by
a nutrient artery, which enters the bone near its center, enters the
bone marrow, and divides into two branches, one going up and the other
down in the marrow. The blood is then distributed through the Haversian
canal system. Veins emerge from the long bones in three places: 1. One
or two large veins accompany the nutrient artery. 2. Numerous veins
emerge from the articular extremities. 3. Many small veins arise in and
emerge from the compact substance.

Bones are divided, according to shape, into four classes: long, short,
flat and irregular.

_Long Bones._—These bones are usually used as a system of levers to
confer the power of locomotion. A long bone consists of a shaft and
two extremities. The shaft is a hollow cylinder within which is the
medullary canal. The extremities are somewhat expanded for the purpose
of articulation, and to afford a broad surface for the attachment of
muscles. The long bones are as a rule curved in two directions to give
greater strength to the bone. Some examples of this class of bone are
the clavicle, radius, ulna, humerus, femur, tibia, fibula, metacarpal,
metatarsal, and the phalanges.

_Short Bones._—These bones are placed in that part of the skeleton
where there is need for strength and compactness, and where the motion
of the part is slight and limited. Some examples of this class of bone
are the bones of the carpus and tarsus (in the hand and the foot).

_Flat Bones._—Flat bones are found where the principle requirement
is either extensive protection, or the need of a broad surface for
the attachment of muscles. Some of the bones of this class are the
occipital, parietal, frontal, nasal, lachrymal, vomer, scapula,
sternum, and the ribs.

_Irregular Bones._—These bones are such as from their peculiar shape
and form can not be grouped under any of the preceding heads. Some of
the bones of this class are the vertebrae, sacrum, coccyx, temporal,
sphenoid, ethmoid, etc.

If the surface of a bone is examined, certain articular and
non-articular eminences and depressions will be seen.

_Articular Eminences._—Examples of this class are found in the heads of
the humerus and the femur.

_Articular Depressions._—Examples of this class are found in the
glenoid cavity of the scapula and the acetabulum.

_Non-articular Eminences._—These are designated according to their form.

A tuberosity is a broad, rough, and uneven elevation.

A tubercle is a small, rough prominence.

A spine is a sharp, slender, pointed eminence.

A ridge, line, or crest is a narrow, rough elevation, running some way
along the surface.

_Non-articular Depressions._—These are of variable form, and are
described as notches, sulci, fossae, grooves, furrows, fissures, etc.
These non-articular eminences and depressions may serve to increase
the extent of surface for the attachment of ligaments and muscles or
may receive blood vessels, nerves, tendons, ligaments, or portions of
organs.

Canals or foramina are channels or openings in bone through which pass
the nerves and blood vessels.


=Teeth.=—In the human body we find two sets of teeth. One appearing in
childhood, and are known as milk teeth, twenty in number, the permanent
teeth replacing these about the sixth year.

There are thirty-two permanent teeth, divided into four incisors, two
canines, four bicuspids and six molars.

Teeth are made up of three different substances, which are known as
enamel, dentine and cement.

The enamel is a very hard substance, the hardest in the body, and may
be compared to quartz. The enamel covers the entire tooth down as far
as the gums.

The cement is a continuation of the enamel below the gums, and is
closely adherent to the dentine. The cement consists of bone tissue,
but the lamellae as a rule do not contain Haversian canals.

The dentine is, next to the enamel, the hardest tissue of the tooth,
and composes the main body of the tooth. The pulp cavity is found
within the center of the tooth, with the opening toward the jaw bone.
The tooth is nourished by a nutrient artery and vein and nerve which
pass into the pulp of the tooth.


=Nerves.=—Nerves are divided into two general classes, called medullary
and non-medullary nerves. The non-medullated type arise mostly from
the sympathetic system, while the medullated type arise from the brain
and cord. As a rule, the nerves of the body follow the course of the
arteries, and are generally found in the same sheath with the artery
and vein.

   [Illustration: FIG. 6—Section of a nerve fibre. (Klein and
   Noble Smith)]

They are easily distinguished from the arteries and veins by touch and
by their color, being very inelastic and fibrous, hard to the touch,
and unlike the artery or vein, since they have no central opening.


=Muscles.=—Myology is that branch of anatomy which treats of the
muscles. The muscles are formed of bundles of reddish fibres, endowed
with the property of contractility. In the body we find two kinds of
muscular tissue, called voluntary and involuntary muscle. The voluntary
type is characterized by the striped appearance which it displays when
seen under the microscope, and for this reason it is called striped
or striated muscle. It is so named “voluntary” because it is capable
of being put into action and controlled by the will. The involuntary
muscles do not present any striped appearance, and consequently are
called unstriped or non-striated, and are not under the control of the
will. An example of voluntary muscle would be any muscle of the bony
framework as for example, the biceps or triceps.

   [Illustration: FIG. 7—View of muscle fibers.]

An example of involuntary muscle would be those of the intestines and
stomach, the muscles of the bladder and uterus and the walls of the
arteries and veins, etc.

When viewed under the microscope, the muscle is seen to be composed of
many fibrils. The sheath covering each fibril is called the sarcolemma,
and contains within its boundaries the muscle plasma, or protoplasm,
and a nucleus. Many of the fibrils when grouped together constitute the
entire muscle.

The muscles get their blood supply from the nutrient artery, which
ramifies the tissues, the smallest capillaries coming in contact with
each muscle cell.


=Tendons.=—Tendons are white, glistening, fibrous cords, varying
in length and thickness, sometimes round, sometimes flattened,
of considerable strength, and devoid of elasticity. It consists
principally of a substance which yields gelatin.

Tendons do not have a direct blood supply.


=Aponeuroses.=—Aponeuroses are flattened or ribbon-like tendons, of a
pearly-white color, irridescent, glistening, and similar in structure
to the tendons.


=Ligaments.=—Ligaments consist of bands of various forms, serving to
connect the articular extremities of bones. They are strong bands of
smooth, silverwhite fibrous tissue.

A ligament is pliable and flexible, so as to allow the most perfect
freedom of movement, but at the same time it is tough and strong, so
as not to yield readily under the severe applied force, and for this
reason they serve as good connecting links for the binding of bones
together.

_Poupart's Ligament._—Poupart's ligament extends from the crest of
the ilium to the top of the pubic bone. This ligament is of utmost
importance to the embalmer, as it serves as a guide to locate the
femoral artery. By placing the thumb on the crest of the ilium and
the second finger on the top of the public bone, then letting the
first finger drop midway between the two, which would be the center of
Poupart's ligament, we have a point which marks the exit of the artery
from the body and the beginning of the femoral artery.

Poupart's ligament also forms the base of Scarpa's triangle. The
structure of this triangle will be taken up later.


=Fat.=—Fat is a deposit of an oil in the cells of the tissues, just
beneath the skin, giving roundness and plumpness to the body, and
acting as an excellent non-conductor for the retention of heat.

So tiny are these cells, that there are over sixty-five million in a
cubic inch of fat. As they are kept moist, the liquid does not ooze
out; but, on drying, it comes to the surface, and thus a piece of fat
feels oily when exposed to the air. The quantity of fat varies with
the state of nutrition. In corpulent persons, the masses of fat beneath
the skin, in the mesentery, on the surface of the heart and the great
vessels, between the muscles, and in the neighborhood of the nerves,
are considerably increased. Conversely, in the emaciated we sometimes
find beneath the skin cells which contain only one oil drop. Many
masses of fat which have an important relation to muscular actions—such
as the fat of the orbit or the cheek, do not disappear in the most
emaciated persons. Even in starvation, the fatty substance of the brain
and spinal cord are retained.

Fat collects as pads in the hollows of the bones, around the joints and
between the muscles, causing them to glide more easily upon each other.
As marrow, it nourishes the skeleton, and also distributes the shock of
any jar the limb may sustain.

Fat does not gather within the cranium, the lungs or the eyelids, where
its accumulation would clog the organs.


=Mucous Membranes.=—Mucous membranes line all the open cavities of the
body, or all those cavities which communicate with the outside.

At the edges of the openings into the body, the skin seems to stop and
give place to a tissue which is redder, more sensitive, more liable to
bleed, and is moistened by a fluid or mucous, as it is called. Really,
however, the skin does not cease, but passes into a more delicate
covering of the same general structure, and it is to this that the name
mucous membrane is applied.

The entire alimentary canal, the entire respiratory tract, and the
genito-urinary tract, are lined with a mucous membrane. Mucous membrane
secretes a mucous fluid.


=Serous Membranes.=—Serous membranes line the closed cavities of the
body. The pleurae, the pericardium and the peritoneum are examples of
serous membranes. Serous membranes secrete a serous fluid.


=Synovial Membranes.=—Synovial membranes are serous in character, and
consist of loose connective tissue, containing fat, vessels and nerves,
its inner surface being usually lined with secreting cells. The fluid
secreted is yellowish-white or slightly reddish, resembling very much
the white of an egg. It contains fats, salts, albumen, extractives from
the lymph, and a fluid known as synovia. The chief function of this
fluid is to act as an oil to lubricate the joints and surfaces in which
there is any friction.

Synovial membranes are divided into three classes, known as articular,
bursal and vaginal.

_Articular synovial membranes_ are found in every free movable joint.

_Bursal synovial membranes_ are sacs interposed between the surfaces
which move upon each other, producing friction, as in the gliding of a
tendon or of the integument over projecting bony surfaces.

_Vaginal synovial membranes_ serve to facilitate the gliding of a
tendon in the bony canal through which it passes.

   [Illustration: FIG. 8—Section of artery. (Grunstein)]


=Arteries.=—The arteries are cylindrical vessels which serve to convey
the blood from both ventricles of the heart to every part of the body.
They are called arteries from the Greek words which mean “to contain
air,” and they were supposed, by our ancients, to have this function
until the time of Galen, when he refuted this opinion and showed that
these vessels, though for the most part empty after death, actually
contained blood. The distribution of the arteries may be compared
to a tree, the common trunk of which corresponds to the aorta, and
the smallest twigs corresponding to the minute capillaries. When one
artery communicates with another it is said to anastomose, and this
communication is very free between the larger as between the smaller
branches. Anastomosis between trunks of equal size is found where great
activity of the circulation is requisite, as at the base of the brain,
where the two vertebrals unite to form the basilar artery.

In the limbs and arms the anastomoses are more numerous and of larger
size around the joints. The branches of the artery above, unite
with branches, from the vessels below. These anastomoses are called
collateral circulations. The principal ones of interest to the embalmer
are those of the deep brachial uniting with the recurrent radial and
ulnar arteries, forming the collateral circulation in the arm; the deep
femoral uniting with the recurrent posterior and anterior tibials,
forming the collateral circulation in the leg; the superficial and
deep mammary arteries, branches of the subclavian artery uniting with
the superficial and deep epigastric arteries, branches of the external
iliac, forming the collateral circulation over the abdomen and chest,
and may be considered the longest collateral circulation in the body.

A terminal artery is one which forms no anastomoses; such vessels are
found in the heart, brain, spleen, kidneys, lungs and mesentery.

_Structure._—An artery consists of an internal, a middle and an
external coat.

The inner coat consists of endothelial cells and elastic fibrous
tissue, sometimes arranged longitudinally, but usually they form a
distinct fenestrated membrane (similar to a doorscreen).

The middle coat consists mostly of elastic tissue and white fibrous
tissue.

The external coat is called the fibrous coat. It contains fibrous
connective tissue and elastic tissues.

_Vasa-Vasorum._—Running in the outer wall of the artery, we find small
capillary vessels, and their function is that of nourishing the outer
wall, for the blood which passes through the artery does not nourish
the artery from within, but depends on these small capillaries, called
vasa-vasorum, for their nutrition.

The individual sheath, or arterial sheath, the covering for the artery,
is composed of connective tissue, and at places may adhere very tightly
to the artery.

   [Illustration: FIG. 9—Valves of the veins.

   FIG. 10—Cross section through a small artery and vein. (Klein
   and Noble Smith)]


=Veins.=—The veins are the vessels which carry the blood from the
capillaries back to the right auricle of the heart, and are found in
nearly every tissue of the body. They commence as venous capillaries,
uniting together into larger and larger veins, until we have the great
ascending and descending venae cavae. In form the veins are perfectly
cylindrical, like the arteries, but with this difference, that their
walls collapse when empty and that they contain valves.

_Structure._—The vein has about the same structure as the artery, only
that the middle coat is much thinner and less elastic than the artery,
and for this reason it easily collapses.

Veins are divided into superficial, deep and sinuses. Superficial veins
are found between the layers of the superficial fascia, just underneath
the skin.

Deep veins accompany the arteries, and are usually enclosed in the same
common sheath with the artery.

Sinuses are venous channels, which in their structure and mode of
distribution differ altogether from the veins. They are found only
in the interior of the skull, and consist of channels formed by a
separation of the two layers of the dura mater.

   [Illustration: FIG. 11—Human blood.]


=Blood.=—The blood of the body is contained in a practically closed
system of tubes, the blood vessels, within which it is kept circulating
by force of the heart beat. It is usually spoken of as the nutritive
liquid of the body, but the functions may be stated explicitly,
although still in quite general terms, by saying that it carries to
the tissues food stuffs after they have been properly prepared by the
digestive organs; that it transports to the tissues oxygen, absorbed
from the air by the lungs; that it carries from the tissues various
waste products formed in the processes of dissimilation; that it is
the medium for the transmission of the internal secretion of certain
glands; that it aids in equalizing the temperature and water contents
of the body.

The total quantity of blood in the body has been determined
approximately for man as one-thirteenth of the body weight. The
specific gravity of human blood in the adult may vary from 1.041 to
1.067, the average being about 1.055.

The blood is composed of a liquid part, the plasma, in which float
a vast number of microscopical bodies, the blood corpuscles, known
respectively as the red corpuscles, the white corpuscles or leucocytes,
of which in turn there are a great many different kinds, and the blood
plates.

_Blood plasma_, when obtained free from corpuscles, is perfectly
colorless, in thin layers, for example, in microscopical preparation;
when seen in large quantities it shows a slightly yellowish tint.
The red color of the blood is not due, therefore, to coloration of
the blood plasma, but is caused by the mass of red corpuscles held
in suspension in the liquid. The proportion by bulk of plasma to
corpuscles is usually given roughly as two to one. The blood plasma
is composed of two substances, blood serum and blood fibrin. You
have noticed that blood, after it has escaped from the vessels,
usually clots or coagulates. The clot, as it forms, gradually
shrinks and squeezes out a clear liquid, to which the name blood
serum has been given. Serum resembles the plasma of normal blood in
general appearance, but differs from it in composition. Here it is
sufficient to say that blood serum is the liquid part of the blood
after coagulation has taken place. You can prepare this experiment
for yourself: If shed blood is whipped vigorously with a rod or
some similar object while it is clotting, the essential part of the
clot, namely the fibrin, forms differently from what it does when
the blood is allowed to coagulate quietly. It is deposited in shreds
on the whipper. Blood that has been treated in this way is known as
defibrinated blood. It consists of blood serum plus the red and white
corpuscles, and as far as appearances go it resembles exactly the
normal blood; it has lost, however, its power of clotting.

_Red blood corpuscles_ are bi-concave, circular disks, without nuclei;
their average diameter is 7.7 microns (1 micron equals 1-25,000 of an
inch); their number, which is usually reckoned as so many to a cu.
millimeter, varies greatly under different conditions of health and
disease. The average number is given as 5,600,000 per cubic millimeter
for males and 4,500,000 per cubic millimeter for females.

The number of red corpuscles also varies in individuals with the
constitution, nutrition and manner of life. It varies with age,
being greatest in the fetus and in the new-born child. It varies
with the time of the day, showing a distinct diminution after meals.
In the female it varies somewhat with menstruation and pregnancy,
being slightly increased in the former and diminished in the latter
condition.

The red color of the corpuscles is due to the presence in them of
a pigment, known as hemoglobin. Owing to the minute size of the
corpuscles, their color when seen singly under the microscope is a
faint yellowish red, but when seen in mass they exhibit the well-known
blood-red color, which varies from a scarlet in arterial blood to a
purplish red in venous blood, this variation in color being dependent
upon the amount of oxygen contained in the blood in combination with
the hemoglobin. The function of the red blood corpuscles is to carry
oxygen from the lungs to the tissues. This function is entirely
dependent upon the presence of hemoglobins, which have the power of
combining easily with the oxygen gas.

_White blood corpuscles or leucocytes_ contain no hemoglobin or
coloring matter. They have a nucleus or center spot. Their size varies
from 5 to 12 microns, and are less numerous than the red corpuscles,
being in this proportion: one white corpuscle to 500 red corpuscles.
The chief functions of the white corpuscles are: (1) That they
protect the body from pathogenic or disease-producing bacteria. In
explanation of this action it has been suggested that they may either
ingest the bacteria and thus destroy them directly, or they may form
certain substances, defensive proteids, that destroy the bacteria.
White corpuscles that act by ingesting the bacteria are spoken of as
phagocytes (meaning to eat the cell). (2) They aid in the absorption of
fats from the intestines. (3) They aid in the absorption of peptones
from the intestines. (4) They take part in the process of blood
coagulation. (5) They help in maintaining the normal composition of the
blood plasma in proteids.

_Blood plates_ are small circular or elliptical bodies, nearly
homogeneous in structure, variable in size, always much smaller than
the red blood corpuscles. Less is known of their origin, fate and
functions than in the case of the other blood corpuscles, but there is
some considerable evidence to show that they take part in the process
of coagulation or clotting.

_Coagulation of the Blood._—One of the most striking properties of
the blood is its power of clotting, or coagulating, shortly after it
leaves the blood-vessels, or if any foreign elements come in contact
with it. The general changes in the blood during this process are
easily followed. At first perfectly fluid, in a few minutes it becomes
viscous, and then sets into a soft jelly, which quickly becomes firmer,
so that the vessel containing it can be inverted without spilling the
blood. The clot continues to grow more impact, and gradually shrinks
in volume, pressing out a greater or smaller amount of clear, faintly
yellow liquid, to which the name blood serum is given. The essential
part of the clot is the fibrin.

Fibrin is an insoluble proteid not found in normal blood. In shed
blood, and under certain conditions while still in the blood-vessels,
this fibrin is formed. In forming, it shows an exceedingly fine network
of delicate threads that permeate the whole mass of the blood and gives
the clot its jelly-like character. The shrinking of the threads causes
the subsequent contraction of the clot. If the blood has not been
disturbed during the act of clotting, the red corpuscles are caught in
the fine fibrin mesh-work, and as the clot shrinks these corpuscles are
held more firmly, only the clear liquid of the blood being squeezed
out, so it is possible to get specimens of serum containing few or
no red blood corpuscles. The white corpuscles or leucocytes, on the
contrary, although they are also caught at first in the forming meshes
of fibrin, in latter stages of the clotting they readily pass out
into the serum, on account of their power of having movement. If the
blood has been agitated during the process of clotting, the delicate
net work will be broken in places, and the serum will be more or
less bloody—that is, it will contain numerous red blood corpuscles.
If during the time of clotting the blood is vigorously whipped with
a bundle of fine rods, all the fibrin is deposited as a stringy mass
on the whipper, and the remaining liquid part consists of serum plus
red corpuscles. Blood that has been whipped in this way is known as
defibrinated blood. It resembles normal blood in appearance, but is
different in composition; it can not clot again. The way in which
fibrin is normally deposited can be easily demonstrated by taking
a drop of blood on a slide and covering it with a cover slip, allow
it to stand several minutes until coagulation is complete, and view
under a microscope. If the drop is examined, it is possible by careful
focusing, to discover in the spaces between the masses of corpuscles
many examples of delicate fibrin net work. The physiological value of
the clotting of blood in life is that it stops hemorrhages by closing
the openings of the wounded blood vessels, but the clotting of the
blood after death, is to the embalmer one of the bugbears, and a real
method of preventing it, or of dissolving the clot after it has once
formed in the blood vessels is one of those difficult problems which
remains as yet unsolved.

Since we have no real method of preventing coagulation in the blood
vessels, let us search out the things which will hasten or retard
this coagulation. Blood coagulates normally within a few minutes
after it is liberated from the blood vessel, but this process may be
hastened by increasing the amount of foreign substance with which it
comes in contact. Thus the agitation of the liquid in quantity or the
application of a sponge or handkerchief or the application of heat
hastens the onset of clotting.

Coagulation in drawn blood may be retarded or prevented altogether by
a variety of means, of which the following are the most important:

(1) By cooling.

(2) By the action of neutral salts.

(3) By the action of oxalate solutions.

(4) By the action of sodium fluoride.

Summary.—To summarize then, the following statements may be made:

(1) The immediate factor necessary to the clotting of the blood is the
fibrin.

(2) That blood does not clot normally in the blood vessels before death.

(3) That after death blood remains for a long time without clotting,
provided some outside agent is not introduced to cause it.

Such an agent may be the blood coming in contact with the air, or
the blood drainage tube. The one point then to be emphasized is that
when a vein is cut, and the blood begins to flow, you know that the
blood is not in a coagulated condition. Then work rapidly, put the
blood drainage tube quickly into the vein and draw off as much blood
as you can before it begins to clot at the end of the tube. The great
trouble has been, that the embalmer does not work with precision. He
first raises the vein, and exposes it on the surface of the incision.
He then raises the artery. He places the drainage tube into the vein,
but shuts it off till he is ready with the artery. Now, by the time he
has placed the arterial tube in the artery, injected a few bulbs full
to see that all is in working order, and has perhaps attended to a few
other duties, he is amazed to find that the blood will not flow, that
it has clotted. What is the reason? He gave it time to clot after the
drainage tube was inserted.

A better procedure would be not to touch the vein until every other
procedure has been attended to. Then raise the vein, insert the
drainage tube and withdraw the blood quickly, and at the same time
keep injecting slowly into the arterial system to keep up the needed
pressure to keep the blood flowing.

(4) That when a clot is once formed in a blood vessel, it is not
dissolved by the addition of fluid or any other solution.

(5) That sometimes when the blood has become clotted at the end of
the drainage tube, it can be loosened up or be slightly pushed away by
attaching the pump to the drainage tube and injecting a few bulbs of
fluid, which, when it runs out, will again start the flow of blood.



CHAPTER V.

OSTEOLOGY.


=Definition.=—Osteology is the science of the structure and functions
of bones.

In regard to the treatment of this subject, it is not our aim to take
up all the minute details concerning each bone, all we desire is to
explain the form, uses and location of some of the principle bones
and sets of bones of the body in so far as they may come to be used as
landmarks for the embalmer.


=The Skeleton.=—The entire skeleton in the adult consists of 200
distinct bones.

   [Illustration: FIG. 12—The Skeleton.]

  Spine—
        Cervical          7
        Dorsal           12
        Lumbar            5
        Coccygeal         1
        Sacral            1
                         ——
                         26      26
  Cranium                         8
  Face                           14
  Hyoid                           1
  Sternum                         1
  Ribs—
        True            7 Pair
        False           3  “
        Floating        2  “
                       ———————
                       12  “     24
  Upper Extremities              64
  Lower Extremities              62
                                ———
                                200

In the above outline the bones of the ear and the sesamoid bones are
not considered. Different anatomists make different computations as to
the number of bones in the skeleton. Some authorities add the bones of
the ear, thus making 206 in all. If all the little sesamoid bones were
added, the number could be greatly augmented.


=The Vertebral or Spinal Column. (The Spine).=—The spine is a flexuous
and flexible column formed of a series of bones called vertebrae. There
are twenty-six in number and may be divided as follows:

  Cervical        7 bones
  Dorsal         12   “
  Lumbar          5   “
  Sacral          1   “
  Coccygeal       1   “

   [Illustration: FIG. 13—The Spine.]

The cervical vertebrae are smaller than those in any other region of
the spine, and may be readily distinguished as they lie in the neck and
extend from the base of the skull to the dorsal vertebrae, or the point
of attachment of the first rib to the first dorsal.

The dorsal or thoracic vertebrae are the next in rotation down the
spine and are intermediate in size between those in the cervical and
those in the lumbar region, and increase in size from above downward.

The lumbar vertebrae, the next in rotation, are the largest of the
vertebral column and can be distinguished as those lying in the lumbar
region or the small of the back.

The sacrum, meaning sacred, so called, because it was the part selected
in sacrifices. The sacrum is a large triangular bone, situated at the
lower part of the vertebral column, and at the upper and back part of
the pelvic cavity.

The coccyx, so called from having been compared to a cuckoo's beak.
It is usually formed of four small segments of bones, and gradually
diminish in size from above downward, and blend together so as to form
a single bone.

The spinal column is situated in the median line, at the posterior
part of the trunk. Its average length is about two feet, two or three
inches. The female spine is about one inch shorter than the male.

The spinal canal in which runs the spinal cord, follows the different
curves of the spine; the opening being the largest in those regions
in which the spine enjoys the greatest freedom of movement, and the
smallest where motion is more limited.


=The Skull.=—The skull is the bony framework of the head. The cranium
is the name applied when we do not consider the mandible (the lower
jaw).

The skull is oval in shape, wider behind than in front, and is
supported on the summit of the vertebral column.

The skull is composed of twenty-two bones and is divided as the
following diagram will show:

   [Illustration: FIG. 14—The Skull.]

                           { Occipital
                           { Two parietal
                           { Frontal
          { Cranium        { Two temporal
          {                { Sphenoid
          {                { Ethmoid
  Skull   {
          {                { Two inferior turbinate
          {                { Two nasal
          {                { Two superior maxillary
          { Face           { Two lachrymal
                           { Two malar
                           { Two palate
                           { Inferior maxillary
                           { Vomer


=The Bones of the Cranium.=—_Occipital Bone._—The occipital bone is
situated at the back part and base of the cranium.

_Frontal Bone._—The frontal bone is situated at the anterior part of
the cranium, and forms the forehead.

_Parietal Bones._—The parietal bones, two in number, form, by their
union, the sides and roof of the cranium. They are between the frontal
and the occipital bones.

_Temporal Bones._—The temporal bones, two in number, are situated at
the sides and base of the skull.

_Sphenoid Bone._—The sphenoid bone is situated at the anterior part of
the base of the skull articulating with all the other cranial bones.

_Ethmoid Bone._—The ethmoid is an exceedingly light, spongy bone, which
is situated at the anterior part of the base of the cranium.


=The Bones of the Face.=—_Nasal Bone._—The nasal bones, two in number,
are placed side by side at the middle and upper part of the face,
forming, by their junction, “the bridge” of the nose.

_Superior Maxillary Bones._—The superior maxillae, two in number, are
the largest bones of the face, excepting the lower jaw, and form by
their junction, the upper jaw.

_Inferior Maxillary Bone._—The inferior maxillary bone is also called
the mandible. This bone is the largest and strongest bone of the face.
In a great many cases after death this bone drops down, and it becomes
one of the first duties of the embalmer, to place this bone in the
proper position, so that it will set with the gradual death stiffening.
If the lower jaw has already set, in proper position, it is best not to
break up the rigor, because, once broken up, it will be hard to set it
in proper condition again without the use of stitches.

The upper and lower jaws are the fundamental bones for mastication.

_Lachrymal Bones._—The lachrymal bones, two in number, are the smallest
and most fragile bones of the face. They are situated at the front part
of the inner wall of the orbit of the eye.

_Malar Bones._—These are the cheek bones. There are two in number,
situated at the upper and outer part of the face.

_Palate Bones._—The palate bones, two in number are situated at the
back part of the nasal fossae. Each bone assists in the formation of
three cavities: the floor and the outer wall of the nose, the roof of
the mouth, and the floor of the orbit.

_Inferior Turbinated Bones._—The inferior turbinated bones are situated
one on each side of the outer wall of the nasal fossae.

_Vomer._—The vomer, a single bone, is situated vertically at the back
part of the nasal fossae, forming part of the septum of the nose. It is
thin and somewhat like a ploughshare in form.


=The Hyoid Bone.=—_The hyoid bone_ is named from its resemblance to the
Greek letter U. It is also called the lingual bone, because it supports
the tongue and gives attachment to its numerous muscles.

The omo-hyoid muscle, which crosses the carotid artery at its middle
third, has its insertion with the hyoid bone.


=The Bones of the Thorax.=—_The Sternum_ or _Breast Bone_.—The sternum
is a flat, narrow bone, situated in the median line of the front of
the chest. The lower end is called the ensiform process, to which the
diaphragm has its anterior attachment.

_The Ribs._—The ribs, which are curved arches of bone, form the chief
part of the thoracic walls. There are twelve in number on each side,
although this number may vary.

The ribs are divided into seven pairs of true ribs, three pairs of
false ribs, and two pairs of floating ribs, as the following outline
will show:

  Ribs

   7 true
   3 false
   2 floating
  ——
  12 pairs in all.

The true ribs are connected behind to the spine and in front to the
sternum.

The false ribs are connected behind to the spine, but are called false
because they are not attached directly to the sternum, but indirectly,
the cartilages attaching to the cartilage of the rib next above.

The floating ribs are so named because they are only attached at one
place, which is the spine and are loose or float in front.


=The Bones of the Upper Extremities.=—_The Shoulder girdle_ consists of
the _clavicle_ and _scapula_.

_The Clavicle._—The clavicle or key bone, so-called because of its
supposed resemblance to the key used by the Romans, forms the anterior
portion of the shoulder girdle. It is often commonly called the collar
bone.

_The Scapula._—The scapula comes from a Greek word meaning “a spade.”
It forms the back part of the shoulder girdle.

_The arm_ is that portion of the upper extremity which is situated
between the shoulder and the elbow.

_The Humerus._—This is the largest and strongest bone of the upper
extremity and is found in the arm between the shoulder and the elbow.
It is the only bone in the arm.

_The fore arm_ is that portion of the upper extremity which is situated
between the elbow and the wrist. The fore arm has two bones, the _ulna_
and the _radius_.

_The Ulna._—A long thin bone, but larger than the radius, and situated
on the inside of the fore arm.

_The Radius._—So-called because it is the rotary bone of the fore arm.
It is situated on the outside of the fore arm and parallel with the
ulna.

_The hand_ is subdivided into the wrist or _carpus_ bones, the
_metacarpus_ or the bones of the palm, and the _phalanges_ or the bones
of the digits. There are twenty-seven bones in each hand.


=The Bones of the Lower Extremities.=—The bones of the lower
extremities consist of _the pelvic girdle_, _the thigh_, _the leg_ and
_the foot_.

_The pelvic girdle_ consists of three portions, the _ilium_, the
_pubis_, and the _ischium_.

_The Ilium._—The ilium is the superior, broad and expanded portion and
forms the prominence of the hip. The top part is called _the crest_.

_The Ischium._—The ischium is the lowest portion of the girdle, and is
the portion which supports the body when in a sitting position.

_The Pubis._—This bone forms the front of the pelvis, and supports the
external organs of generation.

_The thigh_ is that portion of the lower extremity which is situated
between the pelvis and the knee. It consists of a single bone called
the femur.

_The Femur._—The femur is the largest, longest and strongest bone in
the skeleton. It is almost perfectly cylindrical. It extends from the
hip to the knee.

The bones of the leg are three in number and are as follows: patella,
tibia, and fibula.

_The Patella._—This bone is often called the knee cap or the knee pan.
It is a flat triangular bone, situated at the anterior part of the knee
joint.

_The Tibia._—The tibia is situated at the front and inner side of the
leg, and is next to the femur in strength and size. It is sometimes
called the shin bone.

_The Fibula._—The fibula is sometimes called the calf bone. It is
situated at the outer side of the leg, and is a quite slender bone.

The foot is divided into the _tarsus_, _metatarsus_, and the
_phalanges_. There are seven tarsus bones, five metatarsus bones, and
fourteen phalanges bones, making a total of twenty-six bones for each
foot.



CHAPTER VI.

ORGANOLOGY.


The body itself is divided into the upper and the lower extremities
and the trunk. The upper extremities consist of the head and arms. The
lower extremities consist of the legs. The trunk is that part of the
body remaining after the head, arms, and legs have been severed from
the body.


=The Cavities.=—The body has three principal cavities: namely, the
cerebro-spinal, the thoracic, and the abdominal.


=The Cerebro-Spinal Cavity.=—The cerebro-spinal cavity is formed by the
cranial bones, and the vertebral column. The cerebro-spinal cavity is
divided into the sub-cavities, called the cranial cavity and the spinal
cavity.

_In the cranial cavity_ we find the brain. The brain is the seat of the
mind, and the functions which the brain performs distinguishes man from
the other animals, as man becomes a conscious, intelligent, responsible
being through the action of the brain. The brain is egg-shaped, soft
and yielding, closely fitting the cranial cavity. The front and top of
the brain is called the cerebrum, which is the center for intelligence,
reason, and will. This part of the brain is convoluted, and the
depth of the convolutions to a great extent indicates the amount of
intelligence.

Below the cerebrum and lying in front of the occipital bone, we find
the cerebellum, which is the seat of memory and the center for the
co-ordination of muscle movements. By co-ordination of muscle movement
is meant that the muscles will do just what we want them to do, that
they will act harmoniously, the one with the other. The condition of
Saint Vitus' Dance would be an example showing a lack of co-ordination.
This part of the brain is also convoluted.

   [Illustration: FIG. 15—Brain and spinal cord.]

Between the cerebrum and the cerebellum, and connecting the two,
is found the pons Varolii. The word pons means bridge, and the word
Varolii means to cross over. It is in this part of the brain, then,
that the nerve fibers cross over to the opposite side. A person having
a paralytic stroke on the right side of the body would indicate that
the left side of the brain had become affected.

Joined to this is the medulla oblongata. This is the lowest part of the
brain and is the connecting link between the brain and the spinal cord.
The medulla controls the circulation, respiration, and deglutition
(swallowing).

Closely adhering to the brain, is a delicate membrane, sinking into
the convolutions, and following the surface of the brain valleys
throughout. This membrane is called the pia mater. In it is found
the capillaries, which supply the brain with its nutritive blood
in life and with embalming fluid after death. These capillaries do
not penetrate the substance of the brain, but the process is one of
osmosis, absorption or transfusion. Covering the outer most part of
the brain, and closely adhering to the cranial bones is a dense, tough,
glistening, membrane, called the dura mater. In the dura mater is found
the sinuses of the brain.

In between the pia mater and the dura mater is a delicate double
membrane forming a closed sack, called the arachnoid membrane. This sac
contains a serous fluid, which offers great protection to the brain.
These same three membranes also cover the spinal cord, and are called
all together the meninges of the brain and cord.

The brain is composed of white and gray matter. The gray matter is on
the outside, and the white matter is on the inside.

_The spinal cavity_ is formed by the bones of the vertebral column.
In this spinal cavity is found the spinal cord. It is cylindrical and
usually about seventeen inches in length, and extends from the medulla
oblongata, to the lower border of the first lumbar vertebra, where it
terminates in a slender filament of gray substance.

There originate from the under surface of the brain twelve pairs of
nerves, as follows:

   1. Olfactory
   2. Optic
   3. Motor Oculi
   4. Trochlear
   5. Trigeminal
   6. Abducens
   7. Facial
   8. Auditory
   9. Glosso-pharyngeal
  10. Pneumogastric
  11. Spinal accessory
  12. Hypoglossal

There originate from the cord thirty-one pairs of nerves, as follows:

  Cervical region       8 pairs.
  Thoracic region      12   “
  Lumbar region         5   “
  Sacral region         5   “
  Coccygeal region      1   “
                       ——
                       31   “

The circulation of the blood through the brain will be taken up later.



CHAPTER VII.

ORGANOLOGY.—Continued.


=The Thoracic Cavity.=—The thorax, or chest is a bony, cartilaginous
cage. It contains and protects the principle organs of respiration and
circulation.

The thorax is bounded in front by the sternum and costal cartilages,
behind by the twelve dorsal vertebrae and the posterior parts of the
ribs, on the sides by the ribs, above by the root of the neck and below
by the diaphragm.

   [Illustration: FIG. 16—Front view of the thorax. (Gray)]

In the female the thorax differs as follows from the male: Its general
capacity is less, the sternum is shorter, and the upper ribs are more
movable and so allow a greater enlargement of the upper part of the
thorax than the male.

The capacity of the cavity of the thorax does not correspond with its
apparent size externally, because, (1) the space enclosed by the lower
ribs is occupied by some of the abdominal viscera; and (2) the cavity
extends above the first rib into the neck. The size of the cavity of
the thorax is constantly varying during life, with the movements of the
ribs and diaphragm, and with the degree of distention of the abdominal
viscera.

From the collapsed state of the lungs, as seen when the thorax is
opened, in the dead body, it would appear as if the viscera only partly
filled the cavity of the thorax, but during life there is no vacant
space, that which is seen after death being filled up during life by
the expanded lungs.


=Larynx.=—The larynx is the organ of voice, placed at the upper part
of the air passage. It is situated between the trachea and the base
of the tongue, at the upper and forepart of the neck, where it forms a
considerable projection in the middle line. It is for this reason that
it is of considerable importance to embalmers, for it is just opposite
this projection, on either side of the neck, that the common carotid
divides into the internal and the external carotid.

On either side of it lie the great blood vessels of the neck, behind
it forms a part of the boundary of the pharynx, and is covered by the
mucous membrane lining that cavity.

Its vertical extent corresponds to the fourth, fifth, and sixth
cervical vertebrae. It is placed somewhat higher in the female than in
the male.

The movements of the head affect the position of the larynx. When the
head is drawn back, the larynx is lifted, and when the chin approaches
the chest the larynx is depressed. During swallowing the larynx moves
distinctly; during singing it moves slightly.

Until puberty there is no marked difference between the larynx of
the male and that of the female. In the male after puberty all the
cartilages increase in size, and the larynx becomes prominent as
the Adam's apple in the middle line of the neck. In the female after
puberty the increase of size is only slight.

The larynx is broad above, where it presents a triangular appearance,
flattened behind and at the sides. Below it is narrow and cylindrical.

It is composed of cartilages which are connected together by ligaments
and moved by numerous muscles. It is lined by a mucous membrane which
is continuous above with the lining of the pharynx and below with that
of the trachea.

The arteries that supply the larynx are the laryngeal arteries,
branches of the superior and inferior thyroid arteries.

The superior laryngeal vein runs into the superior thyroid vein and
then into the internal jugular vein, while the inferior laryngeal vein
runs into the inferior thyroid vein and then into the innominate vein.


=The Trachea.=—The trachea or windpipe is a cartilaginous elastic,
cylindrical tube, flattened posteriorly. It extends from the lower part
of the larynx, on a level with the sixth cervical vertebra to opposite
the body of the fourth dorsal, where it divides into two bronchi, one
for each lung.

   [Illustration: FIG. 17—The cartilages of the larynx; the
   trachea and bronchi. (Gray)]

The trachea is in the median line of the body. It measures about four
and one-half inches in length. The diameter is from three quarters to
one inch, being always greater in the male than in the female.

The trachea is composed of imperfect cartilage rings, not coming quite
together in the back.

The artery that supplies the trachea is the inferior thyroid artery.

The vein that withdraws the blood is the inferior thyroid vein.

_The Right Bronchus._—The right bronchus is shorter, and wider than
the left bronchus. It is about one inch in length. It enters the lung
opposite the fifth dorsal vertebra.

_The Left Bronchus._—The left bronchus is smaller and longer than
the right. It is two inches in length and enters the lung at a point
opposite the body of the sixth dorsal vertebra.

Each bronchus divides into smaller divisions called bronchial tubes.

Each bronchial tube divides into still smaller divisions called
bronchioles.

Each bronchiole ends in the air cell.


=The Pleurae.=—Each lung is invested upon its external surface by an
exceedingly delicate serous membrane, the pleura. This encloses the
organ as far as its root, and is then reflected upon the inner surface
of the thorax.

The _pulmonary pleura_ is the portion investing the surface of the
lung, and dipping into the fissures between its lobes.

The _parietal pleura_ is that which lines the inner surface of the
chest.

The space between these two layers is called the cavity of the pleurae,
(the pleural cavity); and contains nothing but a very little clear
fluid.

In the healthy condition the two layers are in contact and there is no
real cavity, but after death the lungs become collapsed and separate
from the walls of the chest. Each pleura is therefore a shut sac, one
occupying the right, and the other the left half of the thorax, and
they are perfectly separated from one another. The two pleurae do not
meet in the middle line of the chest, excepting for a short distance
between the second and third pieces of the sternum—a space being left
between them, which contains all the viscera of the thorax excepting
the lungs; this is called the mediastinum.

The mediastinum then, is the space between the right and left pleural
sacs.

The arteries of the pleura are derived from the intercostal, internal
mammary, musculo-phrenic, thymic, pericardiac, bronchial.

The veins correspond to the arteries.


=The Lungs.=—The lungs are the essential organs of respiration. They
are two in number, placed one on each side of the chest, separated from
each other by the heart and the contents of the mediastinum. A healthy
lung hangs free within the pulmonary space. The lung is suspended
by the root. The root of the lung is formed by the bronchial tubes,
pulmonary artery, pulmonary veins, bronchial arteries, bronchial veins,
etc., all of which are enclosed by the reflections of the pleurae.

The _root of the lung_ may be described as being that part where all
the great blood vessels and the bronchial tubes, enter the lungs.

In many cases the lung does not hang free, but as a result of former
pleurisy, the area of the pulmonary pleura is adherent to the parietal
pleura.

   [Illustration: FIG. 18—The root of the left lung. (Toldt)]

Each lung is conical in shape, and presents for examination, an apex,
a base, and two surfaces.

_The Apex_ forms a tapering cone which extends into the root of the
neck about an inch and a half to two inches above the level of the top
of the first rib.

_The Base_ is broad and concave and rests upon the convex surface of
the diaphragm, which separates the right lung from the upper surface of
the right lobe of the liver and the left lung from the upper surface of
the left lobe of the liver, the stomach, and spleen.

_Surfaces._—There are two in number. The external, costal or thoracic
surface is smooth, convex and corresponds to the form of the cavity of
the chest. The inner or mediastinal surface is concave, and the middle
portion, where all the vessels enter and leave the lung is called the
root.

_Lobes._—Each lung is divided up into lobes. The right lung has three
lobes, and the left lung has two lobes.

_Weight._—The weight of both lungs together is about 42 ounces, the
right lung being a little heavier than the left. The lungs are heavier
in the male than in the female. The male lungs weigh from 42 to 45
ounces, and the female lungs weigh from 32 to 35 ounces.

_Color._—The color of the lungs at birth is a pinkish white, in adult
life a dark slate color, mottled in patches and as age advances this
mottling assumes a black color.

_Substance._—The substance of the lung is of a light porous, spongy
texture. It floats in water, if it has once been filled with air. It
is elastic and for this reason we always find the lung collapsed after
death.

The structure of the lung is such that the blood brought by the
pulmonary artery comes into close relation with the air in the
air-cells which enters from the bronchioles. The blood gives off carbon
dioxide to the air-cells and the air in the cells furnishes oxygen for
the blood. The process of respiration causes the dark blood brought
from the heart by the pulmonary arteries to return to the heart as red
blood in the pulmonary veins.

_Arteries._—The bronchial arteries supply the lungs with nutrition.

The pulmonary arteries convey venous blood from the heart to the lungs
to be purified.

_Veins._—The bronchial veins carry off the impure blood from the lungs.

The pulmonary veins convey the blood which has been purified by the
lungs, back to the heart.


=The Mediastinum=.—The mediastinum is the space left in the middle
portion of the chest by the non-approximation of the two pleurae. It
extends from the sternum in front to the spine behind.

Within it are the contents of the thorax, excepting the lungs. The
mediastinum may be divided into two parts.

_The superior mediastinum_ is that portion of the interpleural space
which lies above the level of the pericardium. This space contains the
arch of the aorta, innominate, part of the left carotid artery, part of
the left subclavian artery, the upper half of the superior vena cava,
the upper half of the innominate vein, the left superior intercostal
vein, trachea, esophagus, thoracic duct, remains of the thymus gland,
etc.

The inferior mediastinum is divided into three portions:

_The anterior mediastinum_ is that portion in front of the pericardium.
It contains nothing but some loose areolar tissue.

_The posterior mediastinum_ is that portion back of the pericardium. It
contains the descending thoracic aorta, the greater and lesser azygos
veins, the esophagus, the thoracic duct, etc.

_The middle mediastinum_ is that part within the pericardium or heart
sac. It is the largest space of all the mediastinal spaces. It contains
the heart, the ascending aorta, the lower half of the superior vena
cava, the vena azygos, the bifurcation of the trachea, the pulmonary
artery, etc.

The middle mediastinum is sometimes called the cardiac cavity, because
it contains the heart.


=The Pericardium (Heart Sac).=—The pericardium is a serous sac in which
is located the heart and the commencement of the great blood vessels.

Behind we find the bronchi, esophagus and descending thoracic aorta. To
the sides we find the pleura, the phrenic nerve and the accompanying
vessels. In front we find the sternum and the remains of the thymus
gland. It is attached above to the great blood vessels and below to the
diaphragm.


=The Heart.=—The heart is a hollow, muscular organ of a conical (cone
shaped) form, placed between the lungs and enclosed in the pericardium.

The heart is placed obliquely in the chest. The base is directed
upward, backward and to the right, and corresponds to the dorsal
vertebrae from the fifth to the eighth inclusive.

The apex is directed downward, forward and to the left and corresponds
to the space between the cartilages between the fifth and sixth ribs.

The exact location of the apex of the heart would be ¾-inch to the
inner side, and an inch and one-half below the left nipple, or about
three and one-half inches from the middle line of the sternum or breast
bone.

   [Illustration: FIG. 19—A cross section of the heart showing
   valves. (Spalteholz)]

The heart is placed behind the sternum, and extends about three inches
to the left of the median line, and about one and one-half inches to
the right, or in other words, about one-third of the heart lies to the
right of the median line, and two-thirds lies to the left of the median
line.

The heart in the adult measures five inches in length, three and
one-half inches in breadth in its broadest part, and two and one-half
inches in thickness. The weight of the male heart varies from ten to
twelve ounces, and that of the female from eight to ten ounces.

The capacity of the ventricles of the heart averages about three and
one-half ounces of blood to each ventricle, and the auricle a little
less than four ounces, making the total capacity of the heart average
about fifteen ounces.

   [Illustration: FIG. 20—The right auricle and ventricle laid
   open. (Gray)]

The heart is divided by a muscular septum (separation wall) into two
lateral halves, which are named respectively the right or venous side
and the left or arterial side. The septum is called the longitudinal
septum. Each side of the heart is further sub-divided into an upper
and lower compartment, the upper on each side is called the auricle and
the lower the ventricle. The upper and lower compartments of the heart
(auricles and ventricles) are separated by the auricular-ventricular
septums (meaning a separation between the auricle and ventricle).

The superior and inferior venae cavae empty into the right auricle of
the heart, also the blood from the coronary sinus.

In fact, this compartment receives all the venous or impure blood
from all parts of the body, and sends it through what is known as the
tricuspid valve into the right ventricle or lower compartment. After
getting into the right ventricle, the blood is sent forth into the
lungs by first passing through the pulmonary semi-lunar valve into the
pulmonary artery, which enters the lungs at the root of the same.

This would then finish the circulation through the right side of the
heart, and after the purification has been accomplished by the lungs,
we find the blood being returned to the left side of the heart through
the four pulmonary veins. The pulmonary veins extend from the lungs
(two on each side) to the left auricle (upper compartment of the heart)
and deliver the purified blood to the left or arterial side. The course
of the blood from the left auricle is downward into the left ventricle
(or lower compartment) through what is known as the bicuspid or mitral
valve.

The blood is then sent out into the body to nourish all the tissues, by
being forced through the aortic semi-lunar valve into the great aorta
artery. The circulation is then completed by the blood running into
the branch arteries and from them into the smaller branches and into
the capillaries from which the course of the blood is into the smaller
veins and into the larger veins, finally terminating into the two large
trunk veins, the ascending (or inferior) and descending (or superior)
venae cavae. Of these two large trunk veins the ascending vena cava
is the only one to have a valve at its termination (eustachian). The
functions of this valve are to prevent a backward flow of blood into
the vein from the auricle.

The heart has three walls, the inner wall is called the endocardium,
the middle wall is called the myocardium, and the outer wall is called
the epicardium.

The heart is surrounded by a serous sac called the pericardium.

The heart receives its blood supply from the coronary arteries, which
are branches of the ascending aorta, just after it leaves the aortic
semi-lunar valve.

The coronary veins bring the venous blood back from the tissues of the
heart and empty into the coronary sinus, back of the right auricle of
the heart.

The veins which originate about the region of the right auricle, empty
directly into the right auricle of the heart through the valves of
Thebesii.


=The Alimentary Canal.=—The alimentary canal is a muscular membranous
tube. It is about thirty feet in length, and extends from the mouth to
the anus. It is lined throughout by a mucous membrane.

The following outline will show the parts of the alimentary canal:

              Mouth
              Pharynx
              Oesophagus
              Stomach
                    { Duodenum
  Small Intestines  { Jejunum
                    { Ileum

                    { Caecum
  Large Intestines  { Colon
                    { Rectum

The accessory organs to the alimentary canal are the following:

Teeth, Salivary glands, Liver, Spleen, Pancreas.


=The Mouth.=—The mouth is placed at the commencement of the alimentary
canal. It is a nearly oval shaped cavity.

In this cavity the mastication of the food and the insalivation of the
food takes place.


=The Teeth.=—The structure of the teeth has been considered under the
head of tissues.


=The Palate.=—The palate forms the roof of the mouth. It consists of
two portions: The hard palate is in front and the soft palate is in the
back.


=The Salivary Glands.=—By the term salivary glands is usually
understood the three chief glands on each side of the face.

The parotid gland is placed near the ear. The submaxillary gland is
placed below the jaw. The sublingual gland is placed below the tongue.

These glands secrete the salival juices which are brought into the
mouth by three small ducts, where it aids in the digestion of the food.
The digestive action of the saliva is limited to the starchy foods. Its
action is to change starches into sugars.

   [Illustration: FIG. 21—Passage into trachea and esophagus;
   Pharynx.]

It also fulfills other important functions. By moistening the food
it enables us to reduce the material to a consistency suitable for
swallowing and for manipulation by the tongue and other muscles. The
saliva also serves as a kind of lubricator that insures the smooth
passage along oesophageal canal.


=The Pharynx.=—The pharynx is that part of the alimentary canal, which
is placed behind, and communicates with the nose, mouth and larynx. It
is a muscular, membranous tube which extends from the back of the mouth
and under surface of the skull to the level of the cricoid cartilage or
to a point between the fifth and sixth cervical vertebrae.

The pharynx is about four and one-half inches in length.

Seven openings communicate with it, as follows:

Two posterior nares, two eustachian tubes, mouth, larynx, esophagus.


=The Esophagus.=—The esophagus or gullet is a muscular canal about nine
or ten inches in length, extending from the pharynx to the stomach.

It begins at a point between the fifth and sixth cervical vertebrae and
descends along in front of the spine through the posterior mediastinal
space, passes through the diaphragm, and entering the abdomen,
terminates in the stomach wall at a point opposite the tenth dorsal
vertebra.

At its commencement it is placed in the median line and gradually
inclines to the left as it passes forward to the esophageal opening to
the diaphragm.

The esophagus is from one-half to an inch in diameter.

Arteries.—The arteries which supply the esophagus are the esophageal,
which are branches from the aorta.

Veins.—The esophageal veins empty into the ascending vena cava.


=The Diaphragm.=—The diaphragm (a partition wall) is a dense, muscular,
fibrous septum, placed obliquely across the trunk. It separates the
thoracic from the abdominal cavity, forming the floor of the thoracic
and the roof of the abdominal cavity.

It is attached in front to the ensiform process of the sternum, on
the sides to the inner surface of the cartilages and bony portions of
six or seven inferior ribs, and behind it is attached to the lumbar
vertebrae.

The diaphragm has three openings, as follows: opening for the
esophagus, opening for the aorta, opening for the ascending vena cava.

The diaphragm is the principal muscle of respiration.

The arteries which supply the diaphragm are the phrenic arteries.

The phrenic veins receive the blood from the diaphragm.



CHAPTER VIII.

ORGANOLOGY.—Continued.


=The Abdomen.=—The abdomen is the largest cavity in the body. It is
oval in form, the extremities of the oval being directed upward and
downward.

To facilitate description, the abdomen is artificially divided into two
parts:

An upper and larger part, the abdomen proper.

A lower and smaller part, the pelvis.

These two cavities are not separated from each other, but the limit
between them is a line drawn around the brim of the true pelvis.

The abdomen proper differs from the other great cavities of the body,
in being bounded for the most part by muscles and fascia.

It varies in capacity and shape according to the condition of the
viscera which it contains and in addition, it varies in form and extent
with age and sex.

Boundaries.—The diaphragm forms the dome over the abdomen, the cavity
of the abdomen extending high into the bony thorax.

The lower end of the abdomen is limited by the bones of the pelvis.

In front and at the sides it is bounded by the lower ribs and abdominal
muscles.

Behind by the vertebral column and muscles.

Regions.—For convenience of description of the viscera, the abdomen is
artificially divided into nine regions. Thus if two circular lines are
drawn around the body, the one at the extremities of the ninth ribs
where they join the costal cartilages, and the other around the crest
of the ileum, the abdominal cavity is divided into three zones.

   [Illustration: FIG. 22—The regions of the abdomen and their
   contents. (Gray)]

If two parallel lines are now drawn perpendicular upward from the
center of Poupart's ligament, each of these zones is subdivided into
three parts.

The middle region of the upper zone is called the epigastric; and the
two lateral regions, the right and left hypochondriac. The central
region of the middle zone is called the umbilical; and the two lateral
regions, the right and left lumbar regions. The middle region of the
lower zone is called the hypogastric; and the two lateral regions are
called the right and the left inguinal regions.

The viscera contained in each of these are as follows:

   Right Hypochondriac  |   Epigastric Region   |  Left Hypochondriac
                        |                       |
  The greater part of   | The greater part of   | The fundus of the
  the right lobe of the | the stomach including | stomach, the spleen,
  liver, the hepatic    | both cardiac and      | the extremity of the
  flexure of the colon  | pyloric orifices, the | pancreas, the splenic
  and part of the right | left lobe and part of | flexure of the colon
  kidney.               | the right lobe of the | and part of the left
                        | liver and the gall-   | kidney and small
                        | bladder, the          | portion of the left
                        | pancreas, the         | lobe of the liver.
                        | duodenum, the         |
                        | suprarenal capsules   |
                        | and parts of the      |
                        | kidneys.              |
  ——————————————————————+———————————————————————+——————————————————————
      Right Lumbar      |   Umbilical Region    |      Left Lumbar
                        |                       |
  Ascending colon, part | The transverse colon, | Descending colon,
  of the right kidney   | part of the great     | part of the omentum,
  and some convolutions | omentum and           | part of the left
  of the small          | mesentery, transverse | kidney and some
  intestines.           | part of the duodenum  | convolutions of the
                        | and some convolutions | small intestines.
                        | of the jejunum and    |
                        | ileum and part of     |
                        | both kidneys.         |
  ——————————————————————+———————————————————————+——————————————————————
    Right Inguinal or   |  Hypogastric Region   |   Left Inguinal or
          Iliac         |                       |         Iliac
                        | Convolutions of the   |
  The caecum and        | small intestines, the | Sigmoid flexure of
  vermiform appendix    | bladder in children   | the colon and a
  and a portion of the  | and in adults if      | portion of the
  ascending colon.      | distended, and the    | descending colon.
                        | uterus during         |
                        | pregnancy.            |


=The Stomach.=—The stomach is the principal organ of digestion. It is
the most dilated part of the alimentary canal, and is situated between
the termination of the esophagus and the commencement of the small
intestines. It is placed in part immediately behind the anterior wall
of the abdomen and beneath the diaphragm.

_The lesser curvature_ of the stomach extends between the cardiac and
the pyloric orifices along the right border of the organ.

_The greater curvature_ of the stomach is directed to the left, and is
four or five times as long as the lesser curvature.

_The cardia_ is the point at which the esophagus enters the stomach
wall.

   [Illustration: FIG. 23—The coeliac axis and its branches.
   (Gray)]

_The cardiac orifice_ is the opening by which the esophagus
communicates with the stomach. It is sometimes called the esophageal
opening. It is situated on a level with the body of the tenth and
eleventh dorsal vertebrae. It is to the left of and in front of
the aorta. On the anterior surface of the body the cardiac orifice
corresponds to the articulation of the seventh left costal cartilage to
the sternum.

_The pylorus_ is the point at which the stomach passes into the
duodenum.

_The pyloric orifice_ is the opening by means of which the stomach
communicates with the duodenum.

This orifice is guarded by the _pyloric valve_. When the stomach is
empty the pylorus is situated just to the right of the median line of
the body on a level with the upper border of the first lumbar vertebra.
On the anterior surface of the body its position would be indicated by
a point one inch below the tip of the ensiform process and a little to
the right.

The size of the stomach varies considerable in different subjects.
The distance between the two orifices is from three to six inches. The
weight of the stomach is about four and one-half ounces.

The capacity of the adult male stomach is from five to eight pints. The
stomach of a new born child holds about one ounce.

The stomach is held in place by the attachment of the esophagus to
the diaphragm and the fixation of the duodenum to the front of the
vertebral column.

The wall of the stomach consists of four coats: serous, muscular,
areolar, and mucous.

The glands of the stomach are of three kinds: gastric, pyloric, and
cardiac. These glands furnish the digestive enzymes of the stomach,
namely: pepsin, renin, and hydrochloric acid.

_Arteries._—The arteries that supply the stomach are the gastric, and
branches from the splenic and the hepatic.

It must be remembered that when a body is arterially injected after
death, that the fluid only goes to the stomach walls and there ends in
the capillary system. No doubt a little of this fluid will soak through
into the inside of the stomach, and tend to preserve the contents
of the stomach, but it must be added that if the stomach contains a
considerable quantity of food and water, that there will not be enough
fluid soak through the stomach wall to preserve the contents of the
stomach and as a result gases arise which cause distention of the
abdomen and perhaps purging from the mouth and nose. As a rule then
it is safe to say that when we have purging from the mouth and nose,
with a visible distention of the abdominal cavity, indicating gases in
the stomach and the intestines that fluid has not reached the contents
of the stomach and the fecal matter of the intestines, and therefore
it will be necessary to introduce fluid to these parts, in order to
preserve the contents, and prevent further formation of gases. The
method for doing this will be given under cavity embalming.


=The Small Intestines.=—The small intestine is a convoluted tube,
extending from the pyloric end of the stomach to the ileo-caecal valve
where it terminates in the large intestines. It fills up the greater
part of the abdominal and the pelvic cavity. It is about twenty feet
in length and gradually diminishes in size from the commencement to the
termination.

The small intestines are surrounded at the top and at the sides by
the large intestines. The small intestines are held in place by the
mesentery, a part of the peritoneum, which connects or fastens to the
spine.

The small intestines are divisible into three portions: Duodenum,
Jejunum, and the Ileum.

_Arteries._—The main arterial supply to the small intestines is through
the superior mesenteric artery.

The superior mesenteric vein withdraws the main part of the blood from
the small intestines.


=Duodenum.=—The duodenum has received its name from being about equal
in length to the breadth of twelve fingers (ten inches).

It is the shortest, widest and the most fixed part of the small
intestines, being closely and firmly attached to the posterior
abdominal wall. It is not covered by the mesentery. The upper half of
the duodenum is in the epigastric region and the lower half is in the
umbilical region. It is practically in the median line of the body.

The duodenum is shaped like a horseshoe, the opening being directed
toward the left. The arteries supplying the duodenum are the pyloric
and the pancreatic duodenal branch of the superior mesenteric. The
veins correspond to the arteries.

The pancreatic duct and the bile duct empty into the duodenum at its
middle portion.


=Jejunum.=—The jejunum is the second portion of the small intestines,
it derives its name from the latin word “jejunas,” meaning empty,
because it was formerly supposed to be empty after death.

It is wider, thicker, more vascular and of a deeper color than the
ileum. The jejunum is about eight feet in length or two-fifths of the
length of the small intestines.

The arteries which supply the jejunum are the branches of the superior
mesenteric artery. The veins are of the same name.

The jejunum is fastened to the posterior wall of the abdomen by an
extensive fold of the mesentery.


=Ileum.=—The ileum is derived from a Greek word meaning to twist,
and is so named on account of its numerous coils and convolutions. It
is the third portion of the small intestines and is placed below the
jejunum. It is much narrower and thinner than the jejunum, about twelve
feet in length or three-fifths of the length of the small intestines.
It is also attached to the posterior abdominal wall by means of the
mesentery. The arteries which supply the ileum are the branches of the
superior mesenteric artery. The veins are of the same name.

_The villi_ are minute projections on the mucous membrane of the
small intestines. They are largest and most numerous in the duodenum
and jejunum, and become fewer and smaller in the ileum. It is in the
villi of the intestines that we find the termination of the mesenteric
arteries, the beginning of the mesenteric veins and the commencement of
the lacteals.

As the food passes down the intestines, having been previously prepared
in the stomach and intestines for absorption, it comes in very close
contact with the villi of the intestines and it is here that the
nutrition from the food is absorbed through the villi wall into the
lacteals, and hence carried to the receptaculum chylii.


=The Large Intestines.=—The large intestine extends from the
termination of the ileum to the anus. It is about five or more feet
in length or about one fifth of the whole extent of the intestinal
canal. It is largest at its commencement at the caecum, and gradually
diminishes in size as far as the rectum, where there is a dilatation of
considerable size just above the anus.

The large intestine differs from the small intestine in its greater
size, its more fixed position, its sacculated form.

The large intestine in its course describes an arch, which surrounds
the convolutions of the small intestines. It commences in the right
inguinal region, in a dilated part of the caecum. It ascends through
the right lumbar and the right hypochondriac regions to the under
surface of the liver, it here takes a bend to the left, the hepatic
flexure, and passes transversely across the abdomen on the confines of
the epigastric and umbilical regions, to the left hypochondriac region;
it then bends again, the splenic flexure, and descends through the left
lumbar region to the left inguinal region, where it becomes convoluted
and forms the sigmoid flexure; finally it enters the pelvic cavity and
descends along the posterior wall to the anus.

The large intestine is supplied by the branches of the inferior
mesenteric artery, and the veins are of the same name.

The large intestines are divided into the caecum, colon and rectum.


=Caecum.=—The caecum is the commencement of the large intestines, it
is a large blind pouch situated below the ileo caecal valve. _The ileo
caecal valve_ is the valve between the exit of the small intestines and
the commencement of the large intestines. The caecum is held mostly in
place by the folds of the peritoneum.

_The Vermiform Appendix._—The appendix is found only in the human, the
higher apes, and the wombat, although in certain rodents a somewhat
similar arrangement exists. The appendix is a long, narrow, worm
shaped, musculo-membranous tube, which starts from the inner side of
the posterior wall of the caecum, below and behind the termination
of the ileum. It is the seat for a very common disease called
appendicitis. It varies from one half to nine inches in length, its
average being about three inches. Its diameter is from one eighth to
one quarter of an inch.

   [Illustration: FIG. 24—The caecum and colon laid open to show
   the ileo-caecal valve. (Gray)]


=The Colon.=—The colon is divided into three parts, the ascending,
transverse and the descending colon.

_The ascending colon_ is smaller than the caecum, with which it
is continuous. It passes upward from its commencement at a point
corresponding to the ileo-caecal valve, to the under surface of the
right lobe of the liver, on the right of the gall bladder, where it is
lodged in a shallow depression on the liver; here it bends abruptly
inward to the left, forming the hepatic flexure. It is held to the
posterior wall of the abdomen by folds of the peritoneum.

_The transverse colon_ is the longest part of the small intestines,
passes transversely from the right to the left across the abdomen,
opposite the confines of the epigastric and umbilical regions, where
it curves downward beneath the lower end of the spleen, forming the
splenic flexure. In its course the transverse colon describes an arch,
the concavity of which is directed backward toward the vertebral column
and a little upward.

This is the most movable part of the colon, only covered by peritoneum
and held to the back wall by the folds of the peritoneum. The
transverse colon is in relation, by its upper surface with the liver
and gall bladder the great curvature of the stomach, and the lower end
of the spleen; by its under surface with the small intestines; by its
anterior surface with the anterior layers of the great omentum and the
abdominal wall; its posterior surface on the right is in relation with
the duodenum and on the left it is in contact with the convolutions of
the jejunum and ileum.

_The descending colon_ passes downward through the left hypochondriac
region and lumbar region along the outer border of the left kidney. At
the lower end of the left kidney it turns inward where it terminates in
the formation of the sigmoid flexure. The descending colon is held to
the back wall by folds of the peritoneum.

The sigmoid flexure, the narrowest part of the colon, is situated in
the left inguinal region and communicates with the rectum.


=The Rectum.=—The rectum is the terminal part of the large intestines,
and extends from the termination of the sigmoid flexure to the anus.
The adult rectum in male is from four to six inches in length, and in
the female is from three to five inches in length.

_The anus_ is the terminal opening of the alimentary canal.


=Liver.=—The liver is the largest gland in the body, and is situated in
the upper and right part of the abdominal cavity, occupying almost the
whole of the right hypochondriac, the greater part of the epigastric,
and extending almost to the middle of the left hypochondriac region.

In the male it weighs from fifty to sixty ounces, and in the female,
from forty to fifty.

It is relatively much larger in the foetus, being about one-eighteenth
of the body weight in the foetus, and in the adult, about
one-thirty-sixth of the body weight.

Its greatest width is from seven to eight inches, is about twelve
inches long, and in its greatest thickness about three inches.

The liver is very soft and is easily lacerated and friable; its color
is a dark reddish brown. To obtain a correct idea of its shape, you
might compare it to a wedge, the base of which is directed to the
right, and thin edge toward the left.

The liver has five surfaces, superior, inferior, anterior, posterior
and right lateral.

The liver has five lobes, right and left, caudate, quadrate, and lobus
spigelii. It has five ligaments, right and left lateral or triangular,
falciform, coronary and round. The liver has five fissures, the
umbilical, the fissure of the ductus venosus, the transverse fissure,
the fissure for the gall bladder, the fissure for the vena cava. These
fissures can be represented by the letter H.

     Fissure of |     BACK     |  Fissure
     Ductus     |              |  inferior
  L  venosus    |              |  vena      R
  E             |  Transverse  |  cava      I
  F  ———————————+——————————————+——————————  G
  T  Umbilical  |              |  Fissure   H
     fissure    |     FRONT    |  for gall  T
                |              |  bladder
                |              |

The liver is movable within certain narrow limits. It moves with
respiration. On inspiration, it moves down with the diaphragm to a
little below the right nipple line. The ligaments do not give the liver
much support because they lie relaxed, but it does get its main support
from the connective tissue which unites the liver to the diaphragm, the
hepatic veins which join the vena cava and also by the intra-abdominal
pressure resulting from the tonic contraction of the abdominal muscles.

Also when the abdominal tension is normal, the intestines are driven
up, and become a bed for the liver.

   [Illustration: FIG. 25—Excretory apparatus of the liver.
   (Poirier and Charpy)]

The most important function is the secretion of the bile; it is also
the excretor of deleterious matter and impurities. It also effects
important changes of the blood in its passage through it, for the
portal circulation.

The excretory apparatus of the liver consists (a) of the hepatic duct,
(b) the gall bladder, (c) cystic duct, (d) the common bile duct.

The hepatic duct is formed by two main trunks nearly of equal size
which issue from the liver, one from the right and one from the left
lobe. The hepatic duct passes downward and to the right from one to two
inches where it is joined at an acute angle with the cystic duct.


=The Gall Bladder.=—The bladder is a reservoir for the bile. It is a
conical or pear-shaped sack, lying on the under surface of the right
lobe of the liver. It is about four inches in length, one inch in depth
and holds from eight to ten drams.

The cystic duct is about an inch and a half in length, and passes
obliquely downward to the left from the neck of the gall bladder, and
joins the hepatic duct.

The common bile duct (ductus communis choledochous) is the common
excretory duct of the liver and the gall bladder, and is formed by
the union of the cystic and hepatic ducts. It descends to the middle
portion of the duodenum, where it unites with the pancreatic duct, the
two passing obliquely through the wall of the descending portion of the
duodenum. The tissues of the liver are nourished by the blood from the
hepatic arteries.


=The Pancreas.=—The pancreas (the sweet bread) is a gland similar in
structure to the salivary glands; is about seven inches long, of a
grayish white color; its weight varies from two to six ounces. It is
situated behind the stomach, and it secretes the pancreatic juice. It
extends to the right in a part of the epigastric space. The tail lies
above the left kidney, and is in contact with the lower end of the
spleen and in the left hypochondriac region; the body lies behind the
stomach and transverse colon and in front of the great aorta, portal
vein and inferior vena cava. The arteries nourishing it are the large
and small pancreatic, which are branches of the splenic artery.

The pancreatic duct is the principal excretory duct of the pancreas. It
extends transversely from the left to the right through the substance
of the pancreas.

After leaving the body of the pancreas, it unites with the common bile
duct of the liver where it empties into the duodenum (first section of
the small intestines after leaving the stomach).

The pancreatic duct carries pancreatic juice (a digestive fluid) from
the pancreas to the duodenum.


=The Spleen.=—The spleen belongs to that class of bodies known as
ductless glands and has no excretory duct; is oblong, flattened,
soft, very brittle, very vascular, of a very dark bluish red color; is
situated in the left hypochondriac region behind and to the left of the
stomach; is five inches long, three inches wide and two inches thick
and weighs about seven ounces. The vessels which nourish it are the
splenic artery and splenic vein. Function. It is supposed to furnish
blood corpuscles.

   [Illustration: FIG. 26—The abdominal aorta and its branches.
   (Gray)]


=The Kidneys.=—The kidneys are large glands, two in number and are
situated from five to six inches apart or about three inches on either
side of the median line in the right and left lumbar regions.

The upper extremity of the kidneys lies on the level of the twelfth
dorsal vertebra and the lower extremity on the level of the third
lumbar vertebra. Each kidney is four and one-half inches in length, two
to two and one-half inches in breadth, a little more than one inch in
thickness.

The weight of the kidney in the adult male is from four and one-half to
six ounces each. In the adult female the weight would be from four to
five and one-half ounces.

Their function is to separate from the blood certain waste products
and an excess of water, the combination of which we know as urine.
The principal products excreted by the kidneys from the blood along
with water are ammonia and urea. The blood is taken to the kidneys
by the renal arteries and the renal veins carry it back to the blood
circulation.

The urine is then taken from the kidneys by the ureters and conveyed to
the urinary bladder.


=The Ureters.=—The ureters are cylindrical tubes about sixteen inches
in length and of diameter of a goose-quill.


=The Suprarenal Capsules.=—The suprarenal capsules belong to that
class of bodies known as ductless glands and are two small flattened
bodies of yellowish color, situated at the back of the abdomen, behind
the peritoneum (the covering for all of the abdominal organs), and
immediately above and in front of the upper end of each kidney. The
name is derived from the position it occupies in relation to the
kidney, supra meaning above, and renal pertaining to the kidneys.

The functions are as yet unknown. The suprarenal arteries furnish
nourishment for the suprarenal capsules.


=The Pelvic Cavity.=—The pelvic cavity is that portion of the abdomen
situated between the ilium and pubic bones, or in other words the
extreme lowest portion of the abdominal cavity. The organs located
within this cavity are the bladder in the male and the bladder and the
uterus (womb) in the female.


=The Bladder.=—The urinary bladder is a reservoir for the urine,
situated in the pelvic cavity behind the pubic bone. In life it is
supplied with blood by the anterior branches of the internal iliac
arteries accompanied by the internal iliac veins.


=The Uterus.=—The uterus is the organ of gestation, receiving the
fecundated ovum into its cavity, retaining it, and supporting it during
the development of the foetus, and becoming the principal agent in its
expulsion at the time of parturition (delivery). It is nourished in
life by branches of the internal iliac artery, which is accompanied by
the iliac vein.

The uterus is situated in the pelvic cavity between the rectum and the
bladder, and is held in position by the lateral and round ligaments on
each side. The uterus is about 3 inches in length, 2 inches in breadth
and weighs from one to two ounces. It is composed of three coats,
external serous, middle muscular, and internal mucous.

The serous coat, derived from the peritoneum, is thin and vascular.

The muscular coat is the chief coat, it is dense, firm, of a grayish
color and cuts like cartilage.

The mucous coat is thin, smooth and closely adherent to the muscular
coat. It is highly vascular.

The blood supply to the uterus is the uterine arteries which are the
posterior branches of the internal iliac arteries, and the ovarian
arteries which are branches of the aorta. These break up in capillaries
and form a fine network plexus in the coats of the uterus.

The veins are of large size and are the uterine which empty into the
internal iliac veins and the ovarian veins. On the right side the
ovarian vein empties into the ascending vena cava, and on the left side
into the renal vein.


=Prostate.=—The prostate gland is a pale, firm glandular body, which
surrounds the neck of the bladder in the male. Its shape and size
resembles a horse chestnut. It weighs from one-half to one ounce and
measures one and one-half inches across and three quarters of an inch
deep. Its structure is inclosed by a firm thin fibrous capsule. Its
substance is of a pale reddish grey color and is composed of glandular
substance and muscular tissue.

The arteries that supply the prostate are derived from the internal
pubic, a branch of the internal iliac.

The veins form a plexus around the gland and communicate with veins
which empty into the internal iliac veins. Its function is to secrete
an opaque fluid.

   [Illustration: FIG. 27—The Peritoneum. (Gray)]


=The Peritoneum.=—During life and in the uncut corpse the peritoneal
cavity is air-tight. It is not a real cavity, as muscular tension and
atmospheric pressure permit no vacant space to form. When the surgeon
or embalmer opens the abdomen, the peritoneal cavity is at that moment
produced.

The peritoneum is the largest serous membrane in the body. In the male
it is a closed sac, a part of which is applied against the abdominal
sides, while the remainder is reflected over the contained viscera. In
the female it is not a closed sac, since the free extremities of the
fallopian tubes open directly into the peritoneal cavity.

_The parietal peritoneum_ is that portion applied against the abdominal
sides.

_The visceral peritoneum_ is that portion reflected over the viscera.

The peritoneum consists of two sacs.

_The greater sac_ lines the greater part of the abdominal cavity as
almost all of the viscera are covered by it.

_The lesser sac_ is placed behind the stomach. These two sacs
communicate with each other by a narrow orifice called the _Foramen of
Winslow_.

The peritoneum, as it covers different organs or sets of organs,
receives special names.

_The lesser omentum_ consists of two layers, these split to envelope
the stomach.

_The greater omentum_ consists of four layers. Two of these layers
extend from the stomach and together with two other layers of the same
structure which envelope the transverse colon, form an apron for the
intestines.

_The mesentery_ consists of two layers which invests the small
intestines. Between the two layers of the mesentery we find the
blood vessels, nerves, lacteals, and glands, leading to and from the
intestines. The mesentery is fan shaped, and is attached to the second
lumbar vertebra. The length of the mesentery fan is about eight inches
from commencement to termination at intestine. It extends the whole
length of the intestines, which is about twenty feet.



CHAPTER IX.

THE VASCULAR SYSTEM.


=The Vascular System.=—The vascular system is composed of the organs
immediately concerned in the circulation throughout the body of the
fluids which convey to the tissues the nutritive substances and oxygen
necessary for their metabolism and carry from them to the excretory
organs the waste products formed during metabolism.

The system is usually regarded as being composed of two portions, the
one consists of organs in which circulate the red fluid which we term
blood, and called the _blood vascular system_, while the organs of the
other contain a colorless or white fluid known as lymph or chyle, and
is known as the lymphatic circulation.

                                                           { arteries
                                           { Blood vessels { capillaries
  The vascular { The blood vascular system {               { veins
  system       {                           { Heart
               { The lymphatic circulation


=The Blood Vascular System.=—A knowledge of the general features of
the circulatory system are essential to the undertaker and the embalmer
as a means of enabling him not only to perform the ordinary operations
and duties of his profession intelligently, but to equip him with the
knowledge necessary to meet the exceptional conditions which sometimes
arise.

There is a growing appreciation of the fact, also, that thoroughness
in the practice of embalming is worth striving after. Many cases
of embalming, no doubt, require a minimum amount of attention,
particularly where the body is to be kept but a short time. Where
preservation for longer periods is required, as for transportation,
or where disease and accident have interfered seriously with the
circulation, a more exact knowledge is evidently desirable.

The blood vascular system comprises the heart, which is the central
organ of the whole system, and all the blood vessels. This system, with
its arteries and veins, permeates the whole body and becomes divided
and subdivided at its outer portion into vessels constantly decreasing
in size, until those extremely minute vessels, the capillaries, are
reached. All the tissues of the body are very rich in these, so that
all portions of the body are supplied with blood, which is essential
for the nourishment and rebuilding of the tissues. The large vessels
which convey blood from the heart are termed arteries, while the
vessels which convey the blood back to the heart are termed veins.

For one to properly embalm the human body, it is necessary to
understand the way the fluid will circulate through the body, and the
only way we can do this is to study the circulation of the blood as it
would occur in life.

To facilitate the description of the blood vascular system, it has been
divided into six subdivisions as follows:

  (1) Systemic.
  (2) Pulmonary.
  (3) Coronary.
  (4) Portal.
  (5) Foetal.
  (6) Collateral.


=The Systemic Circulation.=—The systemic circulation is called the
greater circulation of the body. The course of the blood is from the
left ventricle of the heart through the aortic semi-lunar valve to the
great aorta and its branches which end in capillaries in the tissues
of the body then through the veins the terminal trunks of which end
in the right auricle of the heart. So the systemic circulation is the
circulation of the blood from the left ventricle of the heart to the
right auricle of the heart and this circulation has the important
function of carrying oxygen to the tissues to nourish them, and of
carrying carbonic acid gas back to the heart which is a waste product
of the tissues.

The systemic circulation is divided for the sake of convenience into
the following:

  (1) The arterial system.
  (2) Capillary.
  (3) The venous system.


=The Arterial System.=—The blood leaving the heart passes from the
left ventricle through the aortic semi-lunar valve, into the ascending
aorta. Here the two coronary arteries come off which go to supply
the muscular tissues of the heart. The ascending aorta passes into
the arch of the aorta. Here are given off the innominate artery to
the right and the common carotid and the subclavian to the left. The
innominate is only about an inch or two in length, and divides into the
right common carotid and the right subclavian arteries. On each side
the subclavian passes down beneath the clavical bone and enters the
axillary space where it is known as the axillary artery. After leaving
the axillary space, the artery passes down the arm and is known as the
brachial artery. About one inch below the bend of the elbow the artery
divides into two branches, known as the radial and ulnar. The radial
goes to the thumb side of the hand, and the ulnar to the little finger
side of the hand. The ulnar artery and a branch of the radial form
the palmar arch, which gives off the branches to the fingers. Coming
off the brachial are the deep brachial arteries and the anastomotica
magna arteries which anastomose and give collateral circulation to the
forearm, by means of the recurrent radial and ulnar arteries.

   [Illustration: FIG. 28—The arch of the aorta and its branches.
   (Gray)]

The common carotid arteries pass up each side of the neck to a point
opposite the Adam's apple, where they, divide into the external
carotid, which supplies the muscular tissue of the face, and the
internal carotid artery, which goes up through the skull and helps to
form the circle of Willis.

The vertebral arteries come off the subclavian arteries on either side
and pass upward, winding through the foramen of the vertebrae, until
finally arriving inside the cranial cavity, unite to form one artery
called the basilar, which helps to form the circle of Willis.

   [Illustration: FIG. 29—The internal carotid and vertebral
   arteries. (Gray)]

The circle of Willis is situated at the base of the brain and gives off
to the front the two anterior cerebral arteries, to the sides the two
middle cerebral arteries, and to the back the two posterior cerebral
arteries. The two anterior cerebral arteries are connected by the
anterior communicating branch, and the middle cerebral artery and the
posterior cerebral arteries on each side are connected by the posterior
communicating branches. The cerebral arteries terminate in the piamater
as a dense capillary network, and from there supply the substance of
the brain with nutrition.

   [Illustration: FIG. 30—The circle of Willis. (Spalteholz)]

The external carotid artery supplies the muscular tissues of the face.
The external carotid artery arises from the common carotid artery at
about the level of the upper border of the thyroid cartilage—a level
which corresponds with the body of the fourth cervicle vertebra. Thence
it is directed upward and slightly backward towards the angle of the
jaw, where it enters the substance of the parotid gland and continues
upward in that structure to just below the root of the zygoma. Here
it gives rise to a large branch, the internal maxillary, and is
then continued upward over the root of the zygoma upon the side of
the skull, this terminal portion of it being termed the superficial
temporal artery. The branches of the external carotid artery from below
upward are (1) the ascending pharyngeal, (2) the superior thyroid, (3)
the lingual, (4) the occipital, (5) the facial or external maxillary,
(6) the posterior auricular, (7) the internal maxillary, (8) the
superficial temporal.

   [Illustration: FIG. 31—The arteries of the face and scalp.
   (Gray) FIG. 32—The external carotid and its branches. (Gray)]

The arch of the aorta now continues into the thoracic aorta, so called
while it is in the thoracic cavity, and after it has passed through
the diaphragm becomes the abdominal aorta. At a point opposite the
umbilicus or navel the abdominal aorta divides into the two common
iliac arteries. Each common iliac artery divides into an internal iliac
artery, which supplies the organs of the pelvic cavity, and an external
iliac artery, which passes beneath Poupart's ligament. As the artery
passes down the leg it is known as the femoral artery, until it passes
into the popliteal space, where it is called the popliteal artery.
About one inch below the popliteal space the artery divides into the
anterior tibial artery, which runs on a straight line down the front
and outside of the leg to a point between the big toe and the one next
to it, and the posterior tibial artery which passes down the back part
of the foreleg between the inside ankle and the heel. The peroneal,
a branch of the posterior tibial, passes down the foreleg between the
outside ankle and the heel. The anterior tibial artery, as it passes
through the instep is known as the large dorsal artery and further on
is known as the small dorsal artery. In the foot is the plantar arch,
formed by branches of the posterior and anterior tibial arteries, which
send out branches to each toe.

   [Illustration: FIG. 33—The anterior tibial artery. (Gray) FIG.
   34—The popliteal, posterior tibial, and peroneal arteries.
   (Gray)]

Coming off the femoral are the deep femoral and the anastomotica
magna arteries, which anastomose and form collateral circulation to
the foreleg by means of the recurrent anterior and posterior tibial
arteries.

Coming off the subclavian arteries are the superior and inferior
mammary arteries, which pass down over the chest wall, anastomose and
give collateral circulation to the lower extremities by means of the
superior and inferior epigastric arteries, branches of the external
iliac and femoral arteries.

The thoracic aorta gives off the intercostal arteries, which supply
the ribs, the bronchials which supply the lungs, the esophageal
which supplies the esophagus, and the pericardiac which supplies the
pericardium.

The abdominal aorta gives off in rotation the coeliac axis, which
as a hub in a wheel gives off three spokes, the gastric artery to
the stomach, the hepatic to the liver, and the splenic artery to the
spleen. The next branch is the phrenic, which supplies the diaphragm,
then the suprarenal artery, two or more in number coming off of both
the aorta and the renal arteries. The suprarenal arteries supply the
suprarenal capsules. The next branch is the superior mesenteric artery,
which supplies the small intestines; the next branch is the renal
arteries, which supply the kidneys; the next branch is the spermatic
or the ovarian arteries, which supply the testes in the male or the
ovaries in the female; the inferior mesenteric artery, which supplies
the large intestines. Also coming off the aorta at regular intervals
are the lumbar arteries, which supply the side walls.


=The Capillary Circulation.=—The capillaries are very minute blood
vessels, forming a network between the terminating arteries and the
commencing veins.

They derive their name from the word capillus (hair). They vary in size
from 1-3500 to 1-3000 of an inch, the largest capillaries being those
of the skin. These little vessels are so thickly distributed throughout
most of the tissues of the body as to make it impossible to insert a
cambric needle in the flesh without pricking scores of them.

When we embalm a body the object should be to introduce a sufficient
amount of fluid through the arterial system so that these tiny
capillaries will be filled. These little vessels are so minute and
the walls are so thin that the fluid is immediately taken up into the
tissues. If every tissue of the body can be supplied with fluid by
means of the capillaries, we would have the ideal, the body would be
perfectly embalmed. Let us then not only be arterial embalmers, but,
better still, let us be capillary and tissue embalmers.

   [Illustration: FIG. 35—Capillaries a, cells; b, nuclei.
   (Gray)]

Capillaries have one wall, which is the continuation of the inner wall
of the artery, thus making the capillary so thin that fluid finds its
way easily through it into the surrounding tissues.

Some parts of the body are more vascular than others and some
tissues of the body, such as the cornea of the eye, the epidermis,
cartilage, the substance of the brain, etc., are entirely destitute of
capillaries.

The combined area of all the capillaries of the body is many times
greater than the combined area of the trunk vessels. If this were
not so, the high pressure on the arterial system would break the thin
capillary walls and also the greater area allows the blood to circulate
more slowly which gives time for the liberation of oxygen to the
tissues and for the absorption of carbon dioxide.


=The Venous System.=—The veins, like the arteries, are tubular vessels,
their function being to receive the blood from the capillaries and
convey it to the auricles of the heart. There are two classes of veins,
=systemic= and =pulmonic=.

The systemic veins receive the impure or carbonized blood from the
capillaries and convey it to the right auricle of the heart.

The pulmonic veins receive the pure oxygenized blood from the lungs and
convey it to the left auricle of the heart. The pulmonic veins will be
taken up and discussed later under the pulmonary circulation.

_Systemic veins_ are divided into superficial and deep veins and
sinuses.

_The superficial veins_ are found between the layers of the superficial
fascia, just beneath the skin, and communicate with the deep veins by
branches which pierce the fascia.

_The deep veins_ are found deeper down, between the muscles, and are
surrounded by the deep fascia.

The smaller arteries, such as the radial, brachial, posterior and
anterior tibial, and the peroneal arteries, are each accompanied by two
veins, one on each side of the artery, which are called venae comites
(accompanying veins). The larger arteries, such as the common carotid,
the femoral and the iliac, are accompanied by only one vein.

   [Illustration: FIG. 36—Superficial veins of the head and neck.
   (Gray)]

Veins arise from the capillaries, or, rather, from the minute capillary
plexus, formed by a massing or blending of the tiny venules. These
small vessels unite to form larger trunks, and as they continue
toward the heart increase in size until they finally unite to form the
ascending and descending venae cavae.

_The Sinuses._—The cerebral veins are small vessels that arise from
the capillaries of the brain, and terminate in the sinuses of the dura
mater. There are many sinuses in the cranial cavity, and differ from
the vein, in that the walls are thinner, having only two walls while
the veins have three, and they do not have valves. The outer walls of
the sinuses of the brain are formed by a division of the dura mater,
while the inner wall is the continuation of the inner wall of the vein.

   [Illustration: FIG. 37—The internal long saphenous vein.
   (Gray)]

They are of little interest to embalmers, except for the fact that when
the brain is injected by any of the so-called needle processes, the
fluid is quickly conveyed through these vessels to the tissues of the
brain, and that organ is thoroughly preserved.

The vessels starting at the foot are the anterior and posterior tibial
veins, which unite just below the knee to form the popliteal vein, in
the popliteal space. Another vein starts from the foot and runs into
the popliteal vein called the external short saphenous. Starting also
at the foot and running into the posterior tibial vein is the peroneal
vein.

The popliteal vein after leaving the popliteal space is known as the
femoral vein as it passes up the leg, to Poupart's ligament. Another
vein, the internal long saphenous, starts at the foot, and runs into
the femoral vein about an inch below Poupart's ligament. After passing
beneath Poupart's ligament the vessel is called the external iliac.
Coming from the organs of the pelvic cavity is the internal iliac,
which joins with the external iliac vein to form the common iliac vein.
The right and left iliac veins join opposite the umbilicus to form the
ascending vena cava. The ascending vena cava passes upward to the right
of the vertebral column through the diaphragm and enters the right
auricle of the heart by means of the eustachian valve.

   [Illustration: FIG. 38—The superficial veins of the arm.
   (Gray)]

In the forearm are the radial veins on the thumb side of the hand,
the ulnar veins on the little finger side of the hand, and the median
vein just between the radial and ulnar veins. The median vein divides
into the median cephalic vein and the median basilic. The median
cephalic vein unites with the radial vein to form the cephalic vein,
which runs up the back part of the arm and finally empties into the
subclavian vein. The median basilic unites with the ulnar vein to form
the basilic, which runs up the inner part of the arm between the biceps
and triceps muscles. The deep brachial veins or the vena comites,
two in number, which follow the brachial artery, run into the basilic
vein. When the basilic vein arrives at the axillary space it takes on
the name of the axillary vein, and as the vessel passes beneath the
subclavian bone, it becomes the subclavian vein. The right and left
subclavian veins with the right and left internal jugular veins from
each side of the head form the right and left innominate veins, which
unite to form the descending vena cava, which runs into the right
auricle of the heart.

   [Illustration: FIG. 39—Vertical section of the skull, showing
   the sinuses of the dura mater. (Gray)]

Starting at the head, the superior longitudinal sinus begins at the
fore part of the brain and runs backward between the two hemispheres of
the brain and empties into the wine press or Torcular herophili. The
inferior longitudinal sinus begins at the fore part of the brain, but
rung deeper down in the pia mater between the two hemispheres of the
brain, terminates in the straight sinus which empties into the wine
press. Beginning at the base of the cerebellum are the two occipital
sinuses which run together and terminate in the wine press. After all
the blood has been gathered together in the wine press, it leaves by
means of the right and left lateral sinuses which pass down as far as
the jugular foramen. Beginning at the base of the brain in front are
the right and left cavernosus sinuses, which run into the inferior
petrosal sinuses, which pass down as far as the jugular foramen, where
they join the lateral sinuses to form the right and left internal
jugular vein. The superior petrosal sinus is between the lateral sinus
and the cavernosus sinus uniting them. Joining the right and left
cavernosus sinuses is the circular sinus and joining the right and left
inferior petrosal sinuses is the transverse sinus. The right and left
internal jugular veins pass down through the jugular foramens and down
the neck to where they with the right and left subclavian veins form
the right and left innominate veins. The right and left innominate
veins unite to form the descending vena cava which empties into the
right auricle of the heart.

   [Illustration: FIG. 40—The sinuses at the base of the skull.
   (Gray)]

Beginning in the tissues of the heart are the coronary veins, which
terminate in the coronary sinus and then into the right auricle of the
heart through the coronary valves.

   [Illustration: FIG. 41—The azygos system and venae cavae with
   branches. (Gray)]

The azygos system consists of the major azygos vein, which starts at
the right external iliac vein and empties into the descending vena
cava; the minor azygos vein which starts at the left external iliac
vein and empties into the major azygos vein back of the heart; and
the tertiary azygos vein, which starts at the left subclavian vein and
empties into the minor azygos vein. The azygos veins collect all the
blood from the side walls of the body and form a perfect collateral
circulation between the superior and inferior caval systems, and
thoroughly equalizes the blood pressure all over the body. The major
azygos vein receives the following: the right intercostal veins,
excepting the first; the azygos minor; the right bronchial vein; the
esophageal vein; the pericardiac; and the posterior mediastinal veins.
The minor azygos vein receives the following: the tertiary azygos
vein; the lower five left intercostal veins; the small left mediastinal
veins; the lower left esophageal veins. The tertiary azygos receives
the following: the fifth, sixth and sometimes the seventh intercostal
veins; the lower end of the lower left superior intercostal vein; and
the left bronchial vein. The inferior vena cava receives the following
veins: the lumbar veins; the hepatic veins; the phrenic veins; the
renal veins; the right suprarenal vein; the right spermatic or ovarian
vein. The left spermatic or ovarian vein and the left suprarenal vein
empty into the left renal vein.


=The Pulmonary Circulation.=—This is the circulation existing between
the right ventricle of the heart through the lungs back to the left
auricle of the heart.

The pulmonary artery takes its origin from the summit of the right
ventricle. It is about two inches in length, and is directed upward,
backward and slightly towards the left, and beneath the arch of the
aorta it divides into the right and left pulmonary arteries. These end
in a system of capillaries in between the air cells of the lungs, where
carbon dioxide is thrown off and oxygen taken on.

The pulmonary veins are four in number, two passing from the root of
each lung to the posterior surface of the left auricle of the heart.
Each vein is formed at the root of the lung by the union of a number
of smaller vessels which take origin ultimately from the capillary net
work formed from the branches of the pulmonary artery, and to a certain
extent from that formed by the bronchial arteries. Each pulmonary vein
is about six inches in length.


=The Coronary Circulation.=—The heart receives its blood supply through
the two coronary arteries which arise from the aorta immediately above
its origin, the return flow being by the coronary veins which open into
the right auricle of the heart by the coronary sinus. The branches of
the coronary arteries upon the surface of the heart are, as a rule,
all end arteries; that is, arteries which form no direct anastomosis
with their neighbors. Practically no blood can be carried directly,
therefore, by the left coronary artery into the territory supplied by
the right one, or vice versa.

The coronary sinus is a short venous trunk a little over an inch
in length, which occupies the right half of that portion of the
auriclo-ventricular groove which lies between the left auricle and
ventricle. At the right end it opens into the right auricle, its
orifice being guarded by the Thebesian valve.

   [Illustration: FIG. 42—A front view of the heart showing
   coronary arteries. (Spalteholz)]

   [Illustration: FIG. 43—A back view of the heart showing
   the coronary sinus, and vessels entering and leaving.
   (Spalteholz)]


=The Portal Circulation.=—This circulation is of little or no value to
the embalmer, as no part of it is directly required to supply any of
the tissues with embalming fluid.

The portal circulation is formed by the superior mesenteric vein
and the splenic vein uniting to form the portal vein. The inferior
mesenteric vein runs into the splenic vein; the gastric and cystic
veins run into the portal veins. The portal vein ends in capillaries
in the liver, where certain important changes take place, namely, the
taking out of the bile.

The portal vein and its tributaries are unlike the veins in the general
circulation, as there are no valves. Their function in life is to
gather up food or nutrition for the blood, and to the embalmer is of no
special importance, only to know how this circulation is made up. The
vessels that convey blood to the liver in life and the fluid in death
are discussed under the liver.

After death, about one-fourth of the blood of the body is to be found
in the portal system. This blood can in no way be removed, and this is
one of the reasons why the embalmer is not able to draw more blood than
he does.


=The Foetal Circulation.=—The foetal circulation is that circulation
existing between mother and unborn child.

_The placenta_ constitutes, from the third month of intra uterine
life, the nutritive and respiratory organ of the foetus. The placenta
consists of a maternal portion and a foetal portion. _The maternal
portion_ is that portion of the placenta next to the uterine wall
of the mother. In this are intervillus blood spaces, which may be
regarded as derivations from the eroded maternal blood vessels. In
the non-pregnant state the uterus is supplied with branches from the
internal iliac artery, which end in capillaries in the wall of the
uterus. In the pregnant state the numerous branches of the arteries
supplying the uterus do not end as capillaries, but pierce the basal
plate of the placenta, where the arterial vessels lose their muscular
coat and open directly into the intervillus or intraplacental blood
spaces. Maternal capillaries are wanting within the placenta, since
they become early replaced by the intervillus spaces. The maternal
blood is carried away from these spaces by wide venous channels,
forming networks from which proceed the larger venous trunks.

   [Illustration: FIG. 44—Plan of the foetal circulation. (Gray)]

_The foetal portion_ of the placenta is that portion next to the child.
Here end the terminal loops of the foetal blood vessels, the blood
being conveyed to and from the placenta along the umbilical cord, by
the umbilical arteries and vein. Although coming into close relation,
the blood streams of the mother and of the child never actually
mingle, because of the delicate septum which intervenes. The delicate
septum, however, allows the free interchange of gases necessary for
the respiratory function as well as the passage of nutritive substances
into the foetal circulation.

_The umbilical cord_ connects the body of the foetus with the placenta,
and conveys the foetal blood to and from the placenta to the child.
This blood is carried by means of two umbilical arteries and one
umbilical vein.

The umbilical vein originates by means of capillaries in the placenta,
traverses the cord and enters the body of the child at the umbilicus.
The umbilical vein now enters the substance of the liver and passes
from that organ to the ascending vena cava by means of the ductus
venosus. The blood now enters the right auricle of the heart and the
eustachian valve is so placed that this blood is thrown directly into
the left auricle of the heart, from there into the left ventricle, and
out into the aorta to find itself in the general circulation of the
child. The blood coming from the upper extremities of the child finds
its way into the right auricle of the heart by means of the descending
vena cava, thence into the right ventricle, and out into the pulmonary
artery. This artery after birth will lead the blood to the lungs, but
before birth, in as much as the lungs are not functioning, the lungs
can not accommodate this amount of blood, so it passes directly into
the arch of the aorta by means of the ductus arteriosus, and thence
into the general circulation. The umbilical or hypogastric arteries
leave the internal iliacs, pass one on each side of the bladder to
the umbilicus, and thence down the cord to the placenta, end there in
capillaries, where the blood is now purified, and nourished for its
return flow.


=The Collateral Circulation.=—By collateral circulation is meant the
anastomoses of arteries, or veins through a side branch. There are
three great arterial collateral circulations in the body. One is in
the arm, the deep brachial artery, and the anastomotica magna, coming
off of the brachial artery and anastomosing with the recurrent radial
and ulnar artery. One is in the leg, the deep femoral artery, and the
anastomotica magna coming off of the femoral artery and anastomosing
with the recurrent anterior and posterior tibial arteries. One over
the front part of the body, the superior and inferior mammary arteries
branches of the subclavian artery and anastomosing with the superior
and inferior epigastric arteries, branches of the external iliac and
femoral arteries.

   [Illustration: FIG. 45—Collateral anastomosis of veins
   (Poirier and Charpy)]


=The Lymphatic Circulation.=—The lymphatic system is a system of
vessels which occurs abundantly in almost all portions of the body and
converge and anastomose to form two or more main trunks, which open
into the subclavian veins just before they are joined by the internal
jugular. The vessels contain a fluid termed lymph, usually colorless
and containing numerous white blood corpuscles known as lymphocytes.

In those vessels which have their origin in the wall of the small
intestines, the contained fluid has, especially during digestion, a
more or less milky appearance, owing to the lymphocytes being loaded
with particles of fat which they have taken up from the intestinal
contents. On this account, these vessels are usually spoken of as
lacteals, although it must be recognized that they are merely portions
of the general lymphatic system.

In certain respects the vessels of the system strongly resemble
the veins. They arise from a capillary network, their walls have a
structure closely resembling that of the veins, they are abundantly
supplied with valves, and it may be said that the fluid which they
contain flows from the tissues towards the subclavian veins. With
these similarities there are combined marked differences. One of the
most important of these consists in the fact that the capillaries of
the lymphatics are closed and do not communicate with any other set of
vessels as the venous capillaries do with the arterial; and another
important difference is to be found in the frequent occurrence upon
the lymphatic vessels of characteristic enlargements, the so-called
lymphatic nodes or glands, quite different from anything occurring in
connection with the veins.

Throughout the body spaces of varying size are found, containing a
clear, more or less watery fluid, which are called lymph spaces. These
spaces do not communicate with the capillaries of the lymphatics, but
are in such close relationship with them that the fluid easily finds
its way into the lymph capillaries by osmosis, absorption, lymphocytes
going out into these spaces and returning filled with the lymph fluid.

The lymphatic capillaries, which are arranged in the form of networks
of very different degrees of fineness and complexity, closely resemble
in structure the blood capillaries, their walls consisting of a
single layer of endothelial cells. They differ from those of the blood
vascular system not only in their ultimate branches being closed, but
also in their general appearance. They are of greater caliber.

The lymph vessels, which issue from the capillary networks and convey
the lymph ultimately to the subclavian veins, have the arrangement
closely resembling that of the veins; the larger ones are usually
situated alongside and accompany the course of the blood vessels.
Just as the veins unite to form larger trunks as they pass from the
capillaries toward their termination, so, too, the lymphatics, but the
lymphatics present two peculiarities which distinguish them from the
veins. They do not anastomose as abundantly as veins and there is not
the same proportional increase in the size of the lymphatic vessel. The
left trunk or thoracic duct is much larger than the right, beginning
in the abdominal region and traversing the entire length of the thorax
to reach its destination. It receives all the lymph returned from the
lower limbs, the pelvic walls and viscera, the abdominal walls and
viscera, the lower part of the right half and the whole of the left
half of the thoracic viscera, the left side of the neck and head,
and the left arm. The other trunk, the right lymphatic duct, is very
short and sometimes wanting. It receives the lymph from the upper part
of the right side of the thoracic wall, from the right half of the
thoracic viscera and the upper surface of the liver, the right side
of the neck and head, and from the right arm. The structure of the
larger lymphatic vessels is similar to the veins, but, as a rule, their
walls are thinner than those of the veins of corresponding caliber and
their valves are more numerous. The walls of the most robust trunks,
particularly those of the thoracic duct, consist of three coats. From
within outward these are: (a) the intima, composed of the endothelial
lining and the fibro-subendothelial layer; (b) the media, made up of
involuntary muscle interspersed with fibro-elastic tissue; and (c) the
adventitia, consisting of fibro-elastic tissue and longitudinal bundles
of involuntary muscle.

Lymphatic nodes are scattered along the course of the lymphatic
vessels, found in various regions of the body as elliptical flattened
nodules of varying size. The embalmer will meet with these in the
axillary and inguinal regions, or when he is raising the axillary or
femoral arteries.



PART III.

EMBALMING



Embalming


The central thought of the modern funeral director in the care of the
dead and in all the arrangements of the funeral is to remove so far
as may be all that is necessarily painful to those who must place out
of sight the body through which the soul of the dear one has expressed
itself, in all the ways that are prompted by affection. This does not
seem to have been the case in the former days when the methods were in
striking contrast to those of today and were such as would intensify
the suffering of the living. Beginning with the arrangement of the
body in the room made cold by nature in winter or by the ice box in
the summer and ending by lowering the body into an unlined grave, each
detail seems to have been made with little thought of lessening the
pain caused by those things which necessarily have to be done. Perhaps
the central thought in the old days was the same as that which was
the comfort offered upon funeral occasions by a former local pastor
which was “death is a horrible thing.” If this was not the controlling
thought, it is certain that many details of former funeral customs
would be considered horrible today. Today the aim is to lighten the
burden and to cheer the hearts of those who mourn.

The introduction of embalming in the seventies has been of untold
benefit in improving the environment of the dead prior to interment.
Recollections of the use of the old ice box, the crude and cumbersome
cooler, the ice water to be cared for and the thought of the chilled
body are not pleasant now, and were far from pleasant then to those
into whose homes death had entered in hot weather. In winter natural
cold was depended upon, the body being placed in the coldest place
possible. With the best of care the results were uncertain and far from
satisfactory. Modern embalming has changed all this. Its results are
with rare exceptions certain and satisfactory and the embalmed body may
be dressed and placed in a warm and comfortable room.



CHAPTER X.

MODES, SIGNS AND TESTS OF DEATH.


Just as surely as we are born, just so surely must we die, and just as
it is the physician's duty to care for the living body, if possible to
keep it in a strong and healthful condition, so it is the embalmer's
duty to care for the body after death, not so much for the body itself,
but from a sanitary standpoint, namely, to see that the body is well
disinfected and embalmed so that there will be absolutely no chance for
the spread of disease.

Any one who is familiar with hospital work must know that all do not
die in the same way. For some it is the long lingering disease, chronic
in form, which after a long and tedious course the thread of life is
finally broken, and we hardly know the instant at which the change was
completed. For others, it is the short, acute attack, which snaps the
life away in a very instant, only after a very short duration. For some
it is to die from accidental causes, while for others it is only the
passing out from the period of old age. For some the mind may be active
and the intellectual faculties useful up to the last moment, while for
others the contrary is all but too true.

Although there may be many different kinds of disease infecting the
human race, yet we find that death ultimately results from the stoppage
of any one, or maybe, all three of the vital organs, namely the heart,
brain or lungs. Anything whatsoever which plays upon the body, to such
an extent, as to affect the functions absolutely, of either the heart,
brain or lungs, will result in the death of that body. And since these
organs are of such vital importance to us, and since the stoppage of
any one of them will result in death, they have been termed the vital
organs.


=Modes of Death.=—There are, then, only three modes of death: syncope,
or the stoppage of the heart; coma, or the failure of the brain to
perform its functions; apnea, or the stoppage of the lungs.

_Syncope._—For the heart to properly perform its function, namely
that of propelling the blood to all parts of the body, it must first
be properly nourished itself. If for any reason the heart does not
get this proper nourishment, say the coronary arteries should become
clogged, or a fatty infiltration, or a lack of red blood corpuscles, we
would have a condition in the body known as anemia.

The heart must also have a proper nerve supply from the brain, and if
because of any disease, the vaso-motor or the vaso-constrictor fibers
should become affected, the heart would cease to contract and expand,
and hence the complete stoppage of the heart. A condition of this kind
is known as asthenia.

But whether it is death by anemia or asthenia, the state of suspended
animation, common to both these forms is expressed by the single
term—syncope.

_Coma._—In cases of apoplexy, where we have the blood escaping from the
ruptured vessels, compressing the brain, we find death ensuing. Also in
accidental cases such as fracture of the skull, the injury will often
cause death. These are examples of coma, and can be explained in this
way, viz.; the power of the brain becomes inactive either through the
result of an injury or a disease, and when this inactivity occurs the
respiratory apparatus subsides and the heart deprived of its normal
stimulus through the vaso-motor and constrictor fibers, soon ceases to
beat, and death is the result.

_Apnea_, _Asphyxia_.—If for any reason the supply of oxygen is cut off
from the lungs, we will have the body dying the result of asphyxia or
apnea. The most common forms found of this mode of death are those of
hanging, drowning or coal gas poisoning.


=Signs of Impending Death.=—The signs of impending death are those
conditions which exist on the body or the peculiar features of the
body which aid the physician in ascertaining the exact condition
of the body. These signs assume many different forms and in no two
instances may they be found alike. They of course, are not positive in
themselves, but are sufficient to guide us in forming an opinion as to
the approach of death.

One of the first signs to be noticed is the coldness of the
extremities. In this case the coldness begins at the extreme tips of
the fingers and toes and gradually extends toward the trunk. This,
of course, is due to the gradual diminishing activity of the heart to
propel the blood to the extremities.

The brain also fails to receive its proper blood supply and becomes
weakened and we find the mind wandering. This wandering results in the
patient going through movements representing the playing with flowers,
or picking at the bed clothing. A further result of this weakness is
that the patient may have visions of angels and heaven.

Speech begins to grow thick, and a large lump of phlegm gathers in the
throat.

The hands now feel cold and clammy, and if they are raised they
instantly fall. One cannot detect the act of respiration, as the
movements of the thoracic walls are so slight as to be scarcely
perceptible.

The heart loses its power to propel the blood and the stoppage of every
organ in the body ensues.

The eyes become fixed with a staring look as though they were not
focused on anything directly. The eyes lose their lustre on account of
the lachrymal glands refusing to secrete.

The vital organs, the heart, brain and lungs come to a halt, and we
find the body passing from life to the great beyond.


=Tests of Actual Death.=—From the large number of statistics that
have been gathered together for our purpose, we find that the time
of greatest mortality is in the early morning hours between three and
six A. M., for it is between these hours that the body is in a perfect
state of relaxation, and at the lowest ebb of vitality.

The time of least mortality is between the hours of eleven and two P.
M., as the body is in a relatively high state of vitality during these
hours.

The tests of actual death can be placed in two classes, the common
tests and the expert tests.

The common tests are those that have long been used by the
inexperienced to ascertain the fact of death. They are not necessarily
conclusive in themselves, but when all are taken together there can not
be much doubt.

(a) _The Feather Test._—In this test a feather is held to the nostrils
to observe whether it moves. The feather being so light, the slightest
respiration of the lung would be apt to move it.

(b) _The Mirror Test._—In this test a mirror is held to the mouth
and nostrils. If moisture collects on the mirror it is evident that
respiratory movements are going on. If there is an absence of moisture
we are quite safe in saying that the patient is dead.

(c) _The Bandage Test._—In this test a bandage is placed around the arm
and then twisted very tightly. If there is the slightest circulation
existing in the body the blood will accumulate back of the bandage in
the venous system and thus demonstrate the fact. There will also be no
swelling or discoloration beyond the ligature.

(d) By placing the ear to the chest over the heart, no sounds will be
heard.

(e) If the ear is applied over the lungs, no sounds will be heard.

(f) If a cup of water is placed on the chest there will be no movement
of rays or ripples on the surface.

(g) If the skin is cut, no blood will flow, nor will the wound close.

(h) If heat, say for instance a burning match be applied to the skin
it will not blister, or if ammonia is hypodermically injected under
the skin there will be no redness, but rather the skin will turn to a
yellowish color.

(i) The living hand when held to the light shows pink through the inner
edges of the fingers, but with the dead hand it shows opaqueness.

(j) When a strong light is brought before the eye the pupil of the eye
will not dilate or contract.

(2) The expert tests are those which a doctor or coroner might use to
ascertain the fact of death. These tests are made with the stethoscope
and the ophthalmoscope.

(a) By the use of the stethoscope the physician can hear the sounds of
the heart and if there is the slightest sound he can detect it. In the
absence of any sound the body is pronounced dead.

(b) By the use of the ophthalmoscope the physician is enabled to look
into the pupil of the eye and if there is life he can see the blood
circulating through the tiny capillaries of the retina. If he does not
see this capillary circulation he is quite safe in saying the body is
dead.

(c) Another method consists in the hypodermic or intravenous injection
of certain substances, and ascertaining whether these substances have
been dispersed throughout the body. If they have, then a circulation
exists and life continues, although the pulsation of the heart may
not be detected by auscultation. Among the substances recommended for
injection are fluorescin, sodium iodide, lithium iodide and potassium
ferro-cyanide. The injection of the small quantities as used will not
cause death should the patient still be living.

Fluorescin is usually injected, one gramme dissolved with an equal
weight of sodium carbonate in eight cubic centimeters of water, and
the whole quantity injected hypodermically. If the circulation is
persisting, the skin and the mucous membranes after a very few minutes
assume a greenish color; about twenty minutes after the injection,
the portion of the eye within the iris assumes a green color from
penetration of the fluorescin into the vitreous and aqueous humors, and
in the blood the fluorescin may be detected by the following method:
One or two threads of cotton are passed under the skin in the form of
a seton, and when saturated with blood are transferred to a test tube,
and boiled with a little water. As the liquid clears the green color
of the fluorescin becomes evident, if that substance has been absorbed
into the blood.

(d) Another method for the distinction of real from apparent death
consists in picking up a fold of the skin and compressing it with a
pair of artery forceps. If the skin does not completely settle down,
and if the fine furrows produced by the teeth of the forceps continue
indefinitely, then death has occurred. Whereas, if the circulation
is continuous, the fold and the marks of the forceps would disappear.
Moreover, if death has occurred the portion of the skin compressed by
the forceps assumes a parchment-like appearance.

(e) The electrical current affords a means of determining death. It
is now known that the muscles, after cadaveric rigidity has set in, do
not respond to electric stimuli. The faradic current will cause, when
death has occurred, muscular contractions until a short time before
post-mortem rigidity occurs. The faradic stimulus is lost first and
the galvanic stimulus soon after. We may be enabled to approximate the
time at which death occurred, for, if we find any response to either
the faradic or the galvanic current, we know at once that post-mortem
rigidity has not yet occurred.

No person should be buried as long as the muscles contract when
stimulated by either the faradic or the galvanic current. If the
electrical test were always applied before a death certificate was
signed, there would be absolutely no possibility of a person being
buried alive and the public would soon lose the morbid fear of such an
occurrence.


=Later and More Positive Signs.=—(a) After a few hours the blood
gradually sinks to the dependent parts of the body giving a
reddish-blue discoloration, known as post-mortem discoloration, or
cadaveric lividity.

(b) The eyes become sunken in the sockets, the eye balls become
flattened, the cornea opaque and the pupil irregular in shape.

(c) The eyelid loses its elasticity, and the white transparent color of
the conjunctiva is lost, often becoming black or gray.

(d) Rigor mortis may or may not be present.

(e) The body gradually cools to the temperature of the surrounding
atmosphere.

(f) On opening an artery it is generally found to be empty after death.

(g) The latest and most positive sign of all is putrefaction, and when
this is found to be present all other signs may be ignored.

(h) Skin slip present on the body is only another manifestation of
putrefaction, and also signifies that the body is dead.



CHAPTER XI.

PREMATURE BURIAL.


=Premature Burial.=—In this enlightened age, with our knowledge of
respiration and the circulation of the blood, with our complete mastery
of the phenomena of death with scientific tests, it is absolutely
impossible to have such a thing as a premature burial.

Nevertheless from the earliest times the fear of premature burial has
been felt by many, and curious and strange methods have been adopted to
prevent the possibility of individuals being consigned to their graves
before life was extinct.

Tradition records many cases where, in spite of their precautions,
such unfortunate actions have happened. It may be that tradition is
an uncertain and erring guide. And yet underlying all tradition, as
Dieulafoy said, is a solid substratum of truth which the thoughtful
investigator must take into consideration. The tale of the Cologne
goldsmith's wife, that survives in the legend of the neighing
horses, may be weird, bizarre, and from a scientific point of view,
demonstratively ludicrous, but its germ is to be found in the recorded
fact that in times of epidemics, when the dying were huddled away
with the dead, mistakes did occur, and one or two were rectified by
the resurrection of the “dead.” In cases where burial took place in
commodious family vaults, the changes in the position of the coffin,
produced by atmospheric and other physical factors and were startlingly
disclosed when the vaults were opened to receive new bodies, doubtless
gave an impetus to the belief in the comparative frequency of such
mistakes. The medical man remembers that on occasions he has found
it difficult, without applying some of the common and finer tests,
to certify death in a patient dying of a lingering disease, but his
knowledge forbids him believing that such difficulties as he may
have experienced in his own practice can ever have caused his fellow
practitioner to make so grievous a mistake in a similar case. The
public has no such knowledge; it relies on the exceptional cases and
glibly credits the statement—true enough in a limited sense that there
is no certain proof of death. While it is certainly true that no single
sign can be absolutely relied upon to prove that life is extinct,
all practitioners will agree that several signs taken in combination
and methodically applied are sufficiently accurate to obviate the
possibility of mistake. Much has been made of the cataleptic condition
and the probability of mistaking it for death, which has formed the
basis of one of Poe's narratives. As a matter of fact, catalepsy, of
such a nature as to be confounded with _tota exitus_, is extremely
rare—so rare that we doubt if any practitioner with a large experience
of nervous conditions has met with more than one or two instances.
Further, even in such extremely rare conditions, the usual tests are
applicable and to the trained medical man at least clearly prove the
nature of the case. The stethoscope and the mirror held in front of
the patient's mouth are usually sufficient to demonstrate that the
patient is alive and we should want more conclusive evidence than such
as has been brought forward up to the present, to feel that cataleptic
patients have been consigned to their coffins before life was totally
extinct.

Newspaper writers delight in the fictitious and marvelous, and without
any regard whatever to the scientific phase of the subject, frequent
mention of cases of premature burial is to be found almost daily in the
press of the country. But upon investigating these newspaper stories,
it will be found that they have been either originated in the fertile
brain of some reporter or were merely published to consume space.



CHAPTER XII.

THE CHANGES IN THE BODY AFTER DEATH.


=Cooling of the Body.=—The internal temperature of the healthy living
being is about 37 degrees centigrade. But it may be increased several
degrees in consequence of disease. After death the chemical changes
upon which the maintenance of this temperature depends rapidly
diminishes, and the body gradually cools to the temperature of the
surrounding atmosphere. This usually occurs in from about fifteen
to twenty hours, but the time required depends upon a variety of
conditions. Immediately after death there is, in nearly all cases, a
slight elevation of internal temperature, owing to the fact that the
metabolic changes in the tissues still continue for a time, while the
blood ceases to be cooled by passing through the lungs and peripheral
capillaries. After death from certain diseases yellow fever, cholera,
rheumatic fever, and tetanus, a considerable elevation of internal
temperature has been repeatedly observed.

The time occupied by the cooling of the body may be prolonged after
sudden death from accidents, acute diseases, apoplexy, and asphyxia.
A number of cases is reported in which the body retained its heat for
several days without known cause.

After death from wasting chronic diseases, and in some cases after
severe hemorrhage, the cooling of the body is very rapid, the internal
temperature being reduced to that of the surrounding air within four or
five hours.

Fat bodies cool less quickly than lean ones, the bodies of well
nourished adults less quickly than those of children or old persons.
The temperature of the surrounding atmosphere, the degree of protection
of the body from currents of air, of course, modify the progress of
cooling; and the internal organs naturally retain their heat longer
than the surface of the body. The rate at which cooling occurs is
most rapid as a rule, during the hours immediately following death,
notwithstanding the postmortem rise which may ensue.


=Cadaveric Lividity.=—This means the black and blue discoloration from
the effects of the congestion or contusion of the blood.

After life becomes extinct, and before the blood coagulates, it
changes its position chiefly in two ways: First, it is driven by their
contraction out of the arteries and into the veins; second, it settles
in the veins and the capillaries of the more dependent parts of the
body, inducing, usually within a few hours after death, a mottling of
the surface with irregular livid patches. These patches may coalesce,
forming a uniform dusky red color over the back of the trunk, head
and extremities, and sometimes over the ears, face and neck. The same
effect is noticed on the anterior aspect of the body if it has lain
on the face. At points of pressure, from the folds in the clothing,
and from the weight of the body on the bed or the cooling board, the
red color is absent or less marked. This to the undertaker and the
embalmer is known as postmortem discoloration. These changes occur
before putrefaction sets in. This cadaveric lividity should not be
mistaken for the antemortem ecchymoses from which it may usually be
distinguished by its position and extent by the fact that the surface
of the skin is not elevated, and by the fact that on incision no blood
is found free in the interstices of the tissues. Not infrequently
the subcutaneous tissue in the neighborhood of these postmortem
discolorations become infiltrated with a reddish serum. Very soon after
death, particularly in warm weather, the tissues immediately around the
subcutaneous veins of the neck and the thorax and in other situations,
may become stained a bluish red color from the decomposition and escape
from the vessels of the coloring matter of the blood. This to the
undertaker and the embalmer is known as postmortem discoloration.


=Putrefactive Changes.=—As soon as the body dies, it becomes as any
other inanimate object, subject to putrefaction and decay.

The tissues of the body undergo various changes as to consistency of
the solids, semi-solids, fluids, and as to color.

Putrefactive changes are caused by the presence of putrefactive germs
normally present in the tissues or gaining access to them, which in
their effort to satisfy their own nutrition, break down those complex
molecules of which the tissues are composed into simpler compounds.

Putrefaction then is organic decomposition or decay the result
of putrefactive bacteria. Putrefaction may also be defined as the
separating of the constituent elements of the body due to the presence
and growth of bacteria.

Although septic changes may take place before the death of a body, yet
the term putrefaction is not applied until after the death of a body,
and denotes those changes in color, consistence, and smell so clearly
perceptible.

Usually in from one to three days, depending upon circumstances, a
greenish discoloration of the skin occurs at first upon the middle
of the abdomen, over which it gradually spreads, assuming a deeper
hue, and often changing to greenish purple or brown. Greenish patches
may now appear on the different parts of the body, earliest upon
those overlying the internal cavities; this discoloration is probably
produced by the action on the haemoglobin of gases developed by
decomposition.

The eyeballs now become placid and if the eyelids are not closed the
conjunctiva and cornea become brown and dry. The pressure of gases
developed by decomposition in the internal cavities not infrequently
forces a greater or less quantity of frothy, reddish fluid or mucous
from the mouth and nostrils, distends the abdomen, and, if excessive,
may lead to changes in the position of the blood in the vessels and
even a moderate amount of displacement of the internal organs.

After five or six days, under ordinary circumstances, the entire
surface is discolored to a green or a brown. After this the epidermis
becomes loosened through the formation of gases and separating of
fluids beneath, and the tissues become flaccid.

The abdomen and the thorax may be greatly distended, and the features
distorted and scarcely recognizable from swelling, and the hair and
nails loosened.

On the interior of the body, those soft and less compact tissues,
or those tissues in which there is a great amount of fluid, are the
first to decompose. This may be noticed by examining the walls of the
trachea, esophagus and the intestines and noting the change in color.

Decomposition of the soft and liquid portions of the body take place
almost immediately after the death of the body, and then follow in
rapid succession the decomposition of the semi-solids and finally the
solids. Beyond this stage of putrefaction, the consecutive changes can
scarcely be followed with accuracy.

The putrefactive changes can not be said to begin at the same place in
all bodies, as the conditions under which death occurred will regulate
that. The rapidity with which these changes follow one another depends
upon a variety of conditions such as temperature, moisture, access of
air and the diseases which have preceded or caused death.

Various temperature relations will effect greatly the more or less
rapid decomposition of the body. Bodies dying in mid-summer are
decomposed much more quickly than those dying in mid-winter.

Moisture added to the temperature relation will hasten the rapidity
of the decomposition as can be noticed in those localities with a high
temperature but moist climate that the decomposition takes place very
quickly. In those climates with high temperature, but dry or absence
of moisture, the tendency is to dry up the tissues, and instead of
putrefaction we have mummification as the result. This last statement
then serves to explain the reason for the high state of preservation in
the forms of mummification as exists in those countries like Egypt with
their extremely hot and dry climates.

Exposure added to the temperature and the moisture relations adds
greatly to the rapidity of the decomposition. A moist climate with a
hot temperature and free exposure favors rapid decomposition. We notice
that putrefaction progresses much more rapidly in the air than in the
water and in the earth its progress is slower than in the water. The
more exposed a body is then, to the elements, especially the air, the
more rapid will be the decomposition.

An elevated temperature and the presence of air and moisture hasten the
advent and progress of putrefactive changes.

Bodies dying in high fever and edematous subjects are much more quickly
decomposed than those dying with the ordinary wasting away disease.

The bodies of infants usually decompose more rapidly than those of
adults, fat bodies more rapidly than lean ones.

The infectious diseases, intemperance, and the puerperal condition
promote rapid decomposition as also does death from suffocation.

Poisoning from arsenic, alcohol, antimony, sulphuric acid, strychnine
and chloroform may retard the progress of decay.

It is impossible, then, to say how long a body will keep without the
use of preservatives, as it depends partly upon temperature, partly
upon moisture, partly upon the amount of exposure and partly upon the
conditions existing in the body before death.

We can easily understand the reason for all this if we understand the
bacteriology relating to the subject.

In the first place, bacteria require for their best and most rapid
growth the proper temperature, moisture and media relations. By this
we mean that the temperature should be moderately warm, ranging from
about forty to one hundred degrees Fahrenheit, the optimum being
about the body temperature 98.6 degrees Fahrenheit or 37 degrees on
the centigrade scale. With this optimum temperature, the element of
moisture should always be present, as we find that nothing in nature
will germinate without the necessary moisture. Then the bacteria must
have the proper media, meaning that they must have the right substance
on which to grow. Inasmuch as the cause of putrefaction is the host
of putrefactive bacteria which abound trying to satisfy their own
nutrition, and since these bacteria require a moderately warm and
moist media on which to grow, it is only natural that putrefaction and
decomposition should occur much more rapidly in warm moist climates
than in dry cold climates.

In regard to exposure we learn that certain putrefactive bacteria are
aerobic in character, i. e., that they need a great quantity of oxygen
for their growth, and for this reason a body in water or buried in
the earth does not decompose as rapidly as one exposed to the air.
But although they do not decompose as rapidly yet we find that they do
decompose in time. This is due to the fact that there is another class
of bacteria, called anaerobic, i. e., which do not need oxygen for
their growth. In the case of the body in water these anaerobic bacteria
exist and develope slowly in the alimentary tract, and eliminate gases
sufficient to bring the body to the surface, where the aerobic bacteria
enter, and putrefaction progresses much more rapidly.

The starting point of decomposition is usually at the seat of the
disease the subject had before death, but it soon spreads to all the
various tissues of the body.

Putrefaction is always accompanied by a great amount of odor, which
is caused by the generation of gases the result of bacterial action.
The obnoxious gases, offensive to the smell are sulphureted hydrogen,
nitrogen, carbonic acid and ammonia.

The material actually present when the body is actually decomposed has
been determined as being water, nitrogen, methane, carbon dioxide, etc.

_Treatment by the Embalmer._—Putrefaction always means that there
is present a great amount of putrefactive bacteria and if you are to
arrest this condition you must resort to the most thorough embalming.
By placing some preservative fluid in the arteries and having a
thorough circulation all the tissues of the body can be reached
and hence the complete destruction of those bacteria causing the
putrefaction.

If all the tissues are properly bathed with embalming fluid there need
be no further danger of putrefaction; but what seems sometimes at first
a thorough circulation, proves afterward to be only a partial one. If
after several days the body still shows signs of decomposition it is
best to reinject or if the decomposition only occurs in spots a simple
hypodermic injection will prove adequate.


=Skin Slip.=—To properly understand the causes of skin slip a thorough
knowledge of the structure of the skin is necessary. It would be best
then to turn to the chapter on the tissues of the body and study the
minute structure of the skin.

Skin slip is caused by a putrefactive softening of the epidermis.
There is a watery infiltration from the minute capillaries and the
surrounding tissues between the dermis and the epidermis, causing the
latter to loosen and if touched to slip and tear away from the dermis
or true skin.

Many embalmers have been led to believe that the slipping of the skin
is due to the use of certain fluids used in injecting the arterial
system. This error should be corrected, as it is most generally the
absence of the fluid from the part which results in the slipping of the
skin.

Diseases of the heart, liver, kidney and dropsical conditions
predispose to the early skin slip. The immense amount of water
occurring in the minute capillaries of the skin prohibits the embalming
fluid from reaching the tissues.

Skin slip then is due to putrefactive changes occurring in the skin,
and if it should occur after embalming, it is positive proof that the
part or parts have not received a sufficient quantity of a preservative
fluid.

_Treatment by the Embalmer._—In the average case you will never see
skin slip, because you will be called comparatively soon after death
has occurred and the body will be embalmed and buried before this later
form of putrefaction will manifest itself. But in some few cases you
will have to keep the body for a greater length of time, say to await
the arrival of some friend living abroad, or it may be a coroner's
case. In cases like this the body being kept for a period of weeks,
will if it is not perfectly embalmed show signs of skin slip. As has
been stated above, cases that die from diseases causing dropsical
infiltration in the subcutaneous tissues should also be handled
carefully. If you are aware before hand that you are to keep the body
for a great length of time or that you have a dropsical subject, a
little formaldehyde should be added to the fluid that is injected,
about two or three ounces to each quart of fluid. Zinc compounds might
be added, but formaldehyde is better because of its great affinity for
water.

If skin slip occurs after the body is embalmed it is best to place a
layer of cotton over the part where the skin slip occurs and saturate
the cotton with equal parts of alcohol, formaldehyde and glycerine.

In drowned cases where all the skin is slipping it is best to envelope
the whole body with a layer of cotton saturated with formaldehyde.


=Rigor Mortis.=—Rigor mortis is the stiffening condition which occurs
on the body after death.

When the muscle substance dies it becomes rigid, or goes into a
condition of rigor; it passes from a fluid to a solid state. The rigor
that appears in the muscles after somatic death is designated usually
as rigor mortis, since its occurrence explains the death stiffening
in the cadaver. It is characterized by several features: the muscles
become rigid, they shorten, they develope an acid reaction, and they
lose their irritability to stimuli.

After the death of an individual the muscles enter into rigor mortis
at different times. Usually there is a certain sequence, the order
given being the jaws, neck, trunk, upper limbs, lower limbs, the rigor,
therefore, taking a downward course. The actual time of the appearance
of the rigidity varies greatly, however; it may come on within a few
minutes or a number of hours may elapse before it can be detected.

Death after great muscular exertion, as in the case of hunted animals,
or soldiers killed in battle, is usually followed quickly by muscle
rigor. Death after wasting diseases is also followed by an early rigor,
which in this case is of a more feeble character and shorter duration.

Certain drugs such as veratrum, hydrocyanic acid, caffeine and
chloroform, will hasten the development of rigor.

People who die in full habit, meaning that there has been no muscular
exertion or wasting processes before death, usually have the rigor
developing more slowly and of a longer duration.

After a certain interval, which also varies greatly, from one to six
days, the rigidity passes off, the muscles become soft and flexible;
this phenomenon is known as the release of the rigor.

The usual explanation that is given of rigor is that it is due to a
coagulation of the fluid substance, the muscle plasma, of which the
fibers are constituted. During life the fluids exist in a liquid or
viscous condition; after death they coagulate into a solid form.

Rigor mortis is not a sign of death, as there is rigidity of the
muscles following apparent death, as in cases of asphyxia and trance.
If the body is rigid, in a case in which there is a doubt that death
is present the rigidity may be broken up. If it is a case of trance or
that of the contraction of the muscles following drowning, it is likely
to return, especially in case of trance; but if death is actually
present it will not return.

The chemical changes occurring, the result of rigor mortis can be
briefly stated:

(a) There is a coagulation of the proteid material of the muscle plasma.

(b) There is an increased acidity, which is doubtless due to the
production of lactic acid.

(c) There is a production of carbon dioxide.

(d) There is a consumption of glycogen.

_Treatment by the Embalmer._—Many times when called to embalm a subject
you will find the body in a state of rigor. In cases of this kind the
rigor mortis should be broken up. This can be done by taking each of
the joints and gradually bend them a little at a time until they become
perfectly lax. Once a joint is bent the stiffening disappears and the
embalmer can proceed.


=Fermentation and the Production of Gas.=—A molecule is the smallest
portion of a compound which can exist by itself.

An atom is one of the ultimate particles composing a molecule. A
complex molecule is one in which two or more elements have been
combined. Example: water molecules are formed by two atoms of hydrogen
and one atom of oxygen.

A ferment is a substance causing fermentation in other matter with
which it comes in contact. There are two kinds of ferment expressed by
the names organized and unorganized.

Unorganized ferments are chemical substances having the power to
produce or assist in the production of fermentation.

Organized ferments are bacteria having the power to produce
fermentation.

Fermentation means the process through which complex molecules are
decomposed and their ingredients disassociated by the action of
ferments. As an example of fermentation, we can take proteid food
substances, the molecules of which are always of complex form, and
by subjecting them to the action of organized ferments (bacteria),
decompose them, and separate each gas ingredient, obtaining therefrom a
variety of gases from what was formerly a substance of perfect chemical
union. Fermentation is present in most of the natural processes
whereby chemical changes are produced in animal and vegetable matter.
Fermentation is taking place all the time in all the climes excepting
possibly the frigid zones. The organized ferments (bacteria) are
subject to the same temperature limits that govern the reproduction and
the growth of all bacteria.

Fermentation is divided into spirituous fermentation, digestive
fermentation, metabolic fermentation, and putrefactive fermentation.


=Spirituous Fermentation.=—Spirituous fermentation is that process
of fermentation by which forms of yeast cells, by their growth and
reproduction in such complex substances as grapes, fruit, apple
juice, grains, etc., extract alcohol from these substances and by this
process produce wine, cider, spirits, etc. Many times in the dead body,
spirituous fermentation occurs. Spirituous fermentation is caused by a
vegetable parasite called yeast.


=Digestive Fermentation.=—Digestive fermentation is that process by
which digestion and nutrition in the living body is assisted through
the action of ferments called enzymes, acting on the food substance.
This process is mainly one where each food particle is split up by a
particular ferment or enzyme. After death this process may continue for
a certain length of time and result in the formation of gas. Digestive
fermentation is mostly chemical.

Enzymes are unorganized ferments and are cast off the living body
within the living body.


=Metabolic Fermentation.=—Metabolic fermentation is that process by
which enzymes in the tissues of the living body destroy the dead cells,
and reduce them to the following gases: nitrogen (N), carbon-dioxide
(CO₂), ammonia (NH₃), uric acid, and other materials. In the living
body these gases and other products are eliminated from the tissues,
by the sudoriferous glands and ducts through perspiration, by the
lungs with the expired air, by the intestines with the feces and by
the kidneys with the urine. In the dead body the enzymes become active
agents in tissue gas production, unless they are kept in restraint by
being brought in contact with germicidal embalming fluids.


=Putrefactive Fermentation.=—Putrefactive fermentation is the process
by which undigested food substances (principally proteids), under the
influence of ferment bacteria, yield gases. This change rarely takes
place in the small intestines of the living body as the germs are held
in restraint by lactic acid and acetic acid bacteria in those parts.
There is little restraint to their activity in the large intestines,
however, and the intestinal gases along with putrefactive changes in
fecal material are a natural consequence.

Intestinal fermentation is hastened in the dead body by the presence of
much undigested food and the absence of any restraining organisms. The
gases produced in the intestines of either the living or dead body by
the action of putrefactive ferment bacteria are: carbon-dioxide (CO₂),
hydrogen (H), nitrogen (N) hydrogen sulphide (H₂S), methane (CH₄).
The continued fermentation in the stomach and the intestines causes a
coffee colored material of a frothy character to purge from the mouth.

When the hollow needle or trocar is used to reach the scene of ferment
activity, the gases mentioned are released from the effected organs.
As these gases are extremely odorous, they should be passed through
a pledget of cotton saturated with formaldehyde, before being allowed
to pass into the open air. Germicidal fluids when directed against the
bacteria in an intelligent manner should destroy them and prevent their
becoming active again.

Putrefactive fermentation is divided as follows: abdominal
fermentation, gastric fermentation, and intestinal fermentation.


=Abdominal Fermentation.=—Abdominal fermentation is putrefactive
fermentation as it effects the tissues and necrotic substances of the
abdominal cavity itself (excepting the digestive organs), caused by
the action of zymogenic bacteria. Perforations of the intestines or
appendix, inflammation of the mesentery or peritoneum, may allow putrid
material to escape into the cavity proper, where bacterial action will
produce noxious gases. You will recognize a condition of this kind
by the following illustration: As soon as the point of the trocar
has penetrated the peritoneum and the rod has been withdrawn, there
will be an escape of gas. This escape is due to the internal pressure
being greater than the atmosphere pressure. This explains the swollen
condition of the abdominal wall and its subsequent relaxation as the
gas is allowed to escape.

Certain diseases predispose to abdominal fermentation as inflammatory
diseases which effect the peritoneal covering of the organs, and cause
a swollen abdominal wall after death.

_Treatment._—In the treatment of these cases it is always advisable
that the operator be familiar with the location of the disease, so
that direct trocar application can be made to the affected part. The
location of the affected part is not always the same, as it varies
with the location of the particular tissue or organ affected. In
appendicitis, where death has occurred without surgical attempts to
remove the appendix, the operator should spray the right inguinal space
with enough fluid to neutralize the cause of the gas. Where the cause
of death has been typhoid, the umbilical, hypogastric and epigastric
spaces should be sprayed. Where the cause of death is puerperal fever,
the right and left inguinal and hypogastric spaces should be sprayed.
The gas itself, will be eliminated from the cavity of the body by
simply inserting the trocar and allowing the gas to escape until the
internal pressure approximates that of the atmospheric pressure. This
though does not prevent the reformation of gas, as the origin of the
gas is the living and growing fermentative and putrefactive bacteria.
To prevent a recurrence the bacteria must be killed, and this is done
by spraying a germicidal fluid around the affected part. Abdominal
fermentation and gas is much easier to treat than gastric or intestinal
fermentation.


=Gastric Fermentation.=—This is recognized by a frothy coffee colored
purge from the mouth or nose caused by pressure in the stomach, due
to putrefactive bacteria, and their action on proteid food substances
which are present in the stomach. Where the cause of death has been
principally from inflammatory processes, or where the deceased has died
shortly after eating a full meal, this condition must be looked forward
to. The swollen condition directly over the stomach is another visible
sign of value in diagnosing the condition.

_Treatment._—When the body is placed in your care, the embalmer should
make a careful and thoughtful survey of the condition of the body and
the cause of death. Any inflammatory disease of the abdominal tissues
or a full meal eaten shortly before death will almost always predispose
to the formation of gas. The treatment would be to take proper care of
the stomach contents.

(a) Insert the trocar at a point two inches to the left of the median
line, half the distance from the ensiform cartilage and the umbilicus.
Direct the trocar downward and diagonally to the left to a depth of
three to four inches. Remove the trocar rod and allow the gas to escape
into a fluid bottle, containing a small amount of fluid, so that the
gas may be deodorized. Before removing the trocar, inject not less
than one pint of normal fluid into the stomach, so that the fermentable
materials and the bacteria may be destroyed.

(b) Make an incision in the median line of the body, three inches long,
from the tip of the ensiform cartilage downward toward the umbilicus,
and proceed as directed for the direct incision described on page 257.

The treatment for gastric fermentation demands the specific treatment
as directed above. No short treatments can be depended upon for certain
results. Cotton placed in the mouth only delays the time for the
purging to begin from the mouth. Gastric fermentation can be prevented
in all cases by the use of the specific treatments as described in (a)
and (b).

If in your practice, you receive a body from a shipping undertaker,
which unfortunately was not treated in the correct manner, and which is
purging from the mouth, arrange to puncture the stomach in the manner
described in treatment (a). This can be done without disturbing the
position of the body in the casket, by opening the clothes above the
stomach. After puncturing the stomach and allowing the gas to escape,
inject not less than one pint of fluid therein, cleanse the mouth with
absorbent cotton by the use of the lock forceps and a recurrence of the
purge will not be possible.

If in your practice you have overlooked the possibility of gastric
fermentation, and find, either by advice from the family or from your
own observation, that purging is going on, use either the treatment (a)
or (b), neutralize the fermentable material, cleanse the mouth and no
recurrence will be possible.


=Intestinal Fermentation.=—Here we have the fermenting gases in the
intestines and the colons. The pressure of the gases will bear upon the
stomach and there may or may not be purging from the mouth depending
upon the fact of presence or non presence of material in the stomach.
The abdomen though will be greatly distended, and when palpated will
give a drummy note.

_Treatment._—(a) Insert the trocar through the umbilicus, and direct
the point downward into the right inguinal region so as to relieve the
gases from the caecum, then inject a small quantity of fluid; then
direct the point of the trocar upward into the left inguinal region
so as to relieve gases from the sigmoid flexure, and inject a small
quantity of fluid; then direct the point of the trocar upward into
the right hypogastric region so as to relieve gases from the hepatic
flexure, and inject a small quantity of fluid; then direct the point
of the trocar upward into the left hypogastric region so as to remove
gases from the splenic flexure, and inject a small quantity of fluid;
and if at this time it is thought that the stomach contains gas,
relieve it, and inject therein a small quantity of fluid; now place
some fluid directly into the abdomen around the small intestine and
with this treatment you are assured that your intestinal fermentation
is taken care of.

(b) Intestinal fermentation may also be treated by the direct incision,
as described on page 257.



CHAPTER XIII.

DISCOLORATIONS.


=Discolorations.=—Discolorations should be treated as a separate
and independent subject because they are causes of great annoyance
and embarrassment to the operator, and their treatment is of utmost
importance. Just think of the possibility of having a body properly
injected, and the preservation complete, and something along the line
of a discoloration coming to the front and ruin the results of the
work. If there is any condition possible in the dead body that can
cause more trouble to the embalmer than discolorations in general,
it has not as yet been discovered. You have only to realize what the
appearance of a body would be in the casket, if any discolorations were
present on an exposed surface, to know that too much can not be said on
the subject.

Discolorations may not occur in conjunction with tissue changes, so
when they do occur we should look for the cause of the same before
deciding just what the name of the discoloration is, or what treatment
should be given to eradicate it.

For convenience in study, and for the proper classification of
the various conditions, the subject has been divided into those
discolorations occurring before death, and those discolorations which
may occur in the body after death.


=Discolorations Occurring before Death.=—Those discolorations occurring
before death and which would remain on the body after death would be:

  (a) Yellow jaundice,
  (b) Pigmentary atrophy,
  (c) Cancerous spots,
  (d) Gangrene,
  (e) Ecchymosis or ante-mortem staining,
  (f) Wounds, fractures, scars and tattoo marks.


(a) =Yellow Jaundice.=—In the study of the liver you have heard that
the liver secretes a digestive juice called the bile.

Bile acts as the natural antiseptic of the intestines in life, and aids
with the digestion of fatty food substances along with other actions.
The principal coloring matter of the bile is a yellow substance called
bili-rubin. Biliverdin, green, is precipitated by alkalies.

The course of this bile in life is from the liver to the gall bladder,
which acts as the reservoir, into the cystic duct and then into the
common bile duct and into the cavity of the duodenum (first section
of the small intestines). It sometimes happens that there may be an
obstruction of the bile ducts with the result that the bile is backed
up into the gall bladder, and from there into the liver again, throwing
it into the blood vessels of the liver and out into the tissues of
the body along with the blood. As the blood traverses the entire area
of the body, and as the yellow coloring matter of the bile acts as a
stain, it is only a matter of course that the tissues will be stained
the characteristic color of the bile.

This stain will be found all over the body from the outer layer of
the skin to the membrane covering the bone (the periosteum) and will
adhere very closely to the tissues, rendering the removal practically
impossible.

Ordinary arterial injection of a body of this character will have
absolutely no effect, no matter what preservative fluid may be used and
regardless of whatever any one may say, as it stands to reason that
when the discoloration is not located in the blood vessels, that the
removal of same can not be accomplished by flushing the blood vessels
alone.

Of course, the washing of the blood vessels with a solution will
aid the removal of the discoloration, but it is necessary to employ
a strong bleaching solution on the outer surface of the exposed
parts in order to better the conditions so that the body may be made
presentable.

In addition to this treatment, it would be advisable to color the
lights in the room in which the body is to be shown, so as to make
every thing in the room about the same color of the body, including the
persons viewing the remains. This will have the effect of lessening the
apparent bad color of the body, and will add to your reputation as an
embalmer.


(b) =Pigmentary Atrophy.=—Here is another instance of the work of bile
pigments or coloring matters, in which not only the yellow, but the
green colors are deposited in the tissue cells. In addition to this,
the cells all over the body atrophy (contract or reduce in size). The
contraction of the cells may be due to imperfect nutrition or perhaps
anemia or some other action causing great emaciation of the body.

You will see very readily that the main point of difference between
yellow jaundice and pigmentary atrophy is in the color, and also in the
fact that the cells in yellow jaundice are in their normal state and in
pigmentary atrophy are in a contracted condition. The treatment given
for yellow jaundice as follows: injecting and washing the blood vessels
with a mild solution and the application to the affected parts of a
strong bleaching solution, should be given for pigmentary atrophy.

The suggestions as regarding the lights to show the body under, should
also be noted and used in these cases.


(c) =Cancerous Spots.=—What is intended for this particular
discoloration, is not the ordinary cancer that has eaten through the
skin, but that form sometimes noted in aged persons where the cancer is
just about to come through the skin. In other words, a yellowish brown
color showing in any of the exposed parts of the skin before death.

As cancer is in fact a rottening or mortification of the tissues, the
injection with a hypodermic outfit of a strong hardening and bleaching
solution will harden and bleach out the color of the cancer to a great
extent, and thus improve the appearance greatly, the ordinary cosmetic
powders will finish the preparation.

For the hypodermic injection we would suggest the following:

  R   Alum, 10 gr.
      Corrosive sublimate, 5 gr.
      Zinc chloride, 5 gr.
      Grain alcohol, 4 fluid oz.
      Formaldehyde, 2 fluid oz.

The cancerous spot should not be confounded with the color of
dessication which will resemble it somewhat. The main point of
difference would be that the cancer would be present before death,
and the dessication could not possibly occur until after the body
is embalmed. This caution is advised on account of the tendency the
solution to be injected hypodermically would have to make a dried spot
worse in color than better.


(d) =Gangrene.=—Gangrene can best be described as the death of certain
areas of tissue of the living body. The death of the tissue may be
brought about by very many causes; by vascular obstruction and arrest
of the blood supply to a part, or of the outflow from a part; by
enfeebled circulation; temporary stoppage of the circulation of a part
or organ; acute infection; and by burns.

Gangrene with its peculiar color, a dark green, is not often found on
the exposed surfaces of the body, but will more often be found on the
lower extremities and then only on the bodies of aged persons. For this
reason it will be unnecessary to treat it for the removal of color.


(e) =Ecchymosis, or Antemortem Staining.=—Ecchymosis is an
extravasation of blood into the areolar tissues, forming a bruised
place caused principally by a blow from a heavy instrument or missile.

This form of discoloration is mostly seen in accident cases, where
death was due to mechanical causes.

In ecchymosis the blood capillaries being ruptured, the blood permeates
the bruised tissues surrounding the ruptured vessels and thus gives the
characteristic color of venous blood. There seems to be no positive
treatment, but in some cases it can be remedied to some degree by a
hypodermic injection of a good bleacher, and then massaging the part
with a strong bleaching solution. Spots of this kind can sometimes be
covered with flesh tints.

It is often important to determine whether violence has been inflicted
on a body before death. In regard to this point, we must remember,
first, that blows and falls of sufficient violence to fracture bones
and rupture the viscera may leave no marks on the skin, even though
the person has survived for several days; and, second, that there are
postmortem appearances which simulate antemortem bruises. A severe
contusion during life may present, at first, no mark or only a general
redness. After a short time the injured part becomes swollen and of
a red color, this color may be succeeded by a dark blue, and this in
turn fade into a greenish yellow or yellow; these later appearances
are due to an escape of blood from the vessels and to a subsequent
decomposition of the hemoglobin. If, therefore, we cut into such an
ecchymosis after death, we find extravasated blood or the coloring
matter of the blood, in the form of pigment granules, free in the
tissues. Postmortem discolorations, on the other hand, although their
external appearance may resemble that of antemortem ecchymosis, are not
formed by an extravasation of blood, but by a circumscribed congestion
of the vessels or by an escape of blood stained serum. If you cut
into such discolorations, therefore, we find no blood outside the
vessels. Care should be taken not to mistake the lesions of hemorrhagic
infection for traumatic ecchymosis.

Blows on the skin of a body which has been dead for not more than two
hours may produce true ecchymosis with extravasation of blood, such
as can be distinguished with great difficulty or not at all from those
formed during life. If putrefactive changes be present, the difficulty
of distinguishing between antemortem and postmortem bruises is greatly
enhanced.

Hanging and strangulation are attended with the formation of marks
on the neck which are described in works on forensic medicine. These
marks must not be confounded with the natural creases of the skin of
the neck. Many adults during life have creases of the skin of the neck,
one or more in number, running downward from the ear under the chin or
encircling the neck. After death these creases may be much more evident
than during life, and may be rendered more decided by the position of
the head, or if the body be frozen. They usually persist until the skin
putrefies.


(f) =Wounds.=—The embalmer should notice the situation, extent and the
direction of a wound, the condition of the edges, and the surrounding
tissues. If it be a deep, penetrating wound, its course and extent
should be ascertained by careful dissection rather than by the use of
a probe.

If the edges of a wound be inflamed and suppurating, or beginning to
heal, it must have been inflicted some time before death. In a wound
inflicted a short time before death the edges are usually everted;
there may be more or less extravasation of blood into the surrounding
tissues, and the vessels contain coagulated blood; but sometimes
none of these changes occur. The chief characteristics of a wound
inflicted after death are absence of a considerable amount of bleeding,
non-retraction of edges, and the absence of extravasation of blood into
the tissues. But a wound inflicted within two hours after death may
resemble very closely one received during life. In general, unless a
wound is old enough for the edges to present inflammatory changes, the
embalmer must be very careful in asserting its antemortem or postmortem
character.


(g) =Fractures.=—It may be important to determine whether a bone was
fractured before or after death. This point can not always be decided.
Fractures inflicted during life are, as a rule, attended with more
extravasation of blood and evidences of reaction in the surrounding
tissues; but fractures produced within a few hours after death may
resemble these very closely. Usually a greater degree of force is
necessary to fracture bones in the dead than in the living body.


(h) =Scars and Tattoo Marks.=—The presence and character of these
should be noted. Scars produced by any considerable loss of substance
may become very much smaller and less conspicuous, but never entirely
disappear. Slight and superficial wounds, however, leave marks which
may not be permanent.

The discoloration produced by tattooing may, although it rarely does,
disappear during life. The embalmer should not try to remove it.



CHAPTER XIV.

DISCOLORATIONS.—Continued.


=Discolorations Occurring After death.=—Those discolorations occurring
after death would be as follows:

  (a) Desiccation.
  (b) Greenish tinge of putrefaction.
  (c) Chemical action.
  (d) Postmortem discoloration.
  (e) Postmortem staining.
  (f) Capillary or venous congestion.


=Desiccation.=—This is a brownish color caused by the drying of the
skin. Various conditions might cause this color of which a few are
considered here:

Natural evaporation, the drying action of formaldehyde, freezing the
skin, feverish conditions of the body before death, absence of a normal
amount of moisture in the skin of the dead body.

_Natural Evaporation._—The passage of moisture from the skin into a dry
atmosphere reduces the normal amount of moisture in the skin, thereby
producing an altered color. The extent of the moisture reduction
governs the color produced. When evaporation begins, the skin loses its
softness and becomes slightly yellow in color. As evaporation continues
the skin becomes more hard and the color changes from yellow to brown.
At this time nothing can be done to restore the original color as in
the absence of the blood circulation, the pigment of the skin will not
take up moisture, nor will moisture penetrate the skin itself.

_Treatment._—The only treatment for a condition of this kind is
necessarily a preventive one. While embalming a body, the operator
should apply either water or one of the commercial face solutions to
the skin of all the exposed portions of the body. If the condition
within the skin is one in which there is a predisposition toward
dryness, the face solution or the water by being present on the skin
will reduce evaporation from the skin itself; in this way maintaining
the natural degree of moisture. Should a hard, dry spot appear in the
absence of any preventive treatment, the operator can only coat the
spot with grease paint and thereby hide it.

_The Drying Action of Formaldehyde._—Formaldehyde is derived from
methyl spirits, which in itself has an active affinity for water. The
amount of water ordinarily mixed in formalin in the compounding of a
formaldehyde fluid is not sufficient to satisfy the appetite of the
formaldehyde for more water. When a formaldehyde fluid comes in contact
with moisture laden skin, there will be a movement of moisture from
the skin toward the formaldehyde fluid, thereby reducing the degree
of moisture in the skin and in that way causing it to become dry.
When the skin becomes dry, it changes in color the same as in natural
evaporation.

_Treatment._—There are three conditions in the skin met by the
operator. The first is where there is a predisposition toward dryness
and this is where the skin does not contain a normal amount of moisture
to begin with. In old age cases, tubercular, and anemic bodies, the
ordinary embalming fluid should be diluted at least one half for the
first part of the injection, thus reducing the appetite for moisture on
the part of the fluid. In addition to this, water or a face solution
should be used externally to prevent outward evaporation from further
reducing the moisture in the skin. The fluid exhibits a tendency to
draw water into the pores, thus maintaining to a large degree, the
normal moisture percentage.

The second condition met with is one in which the skin contains a
normal amount of moisture. In this case it would not be necessary
to reduce the strength of the standard fluid at any time during the
injection, but it is necessary to apply water or a face solution
externally to limit outward evaporation and to provide a source
whereby moisture could be drawn into the pores by the appetite of the
formaldehyde, thus again maintaining the normal percentage of moisture
in the skin.

The third condition is one in which the skin along with the balance
of the body, will contain more than a normal percentage of moisture.
This condition may be looked for in edematous or dropsical cases. The
injection in these cases should be normal in strength unless the dropsy
is very pronounced, when an overnormal injection can be given without
reducing the moisture percentage in the skin below the normal point.

Should the above precautions not be used and the skin be dried through
the appetite of formaldehyde for water, no treatment can be given which
will restore the moisture to the skin. When moisture is drawn from the
skin and the percentage is below normal, the skin will shrink and will
draw tight against the bones and subcutaneous tissue. This frequently
gives rise to the sharp nose and to the drawn appearance so common in
those cases. Prevention is the only remedy.

_Freezing the Skin._—When the body is subjected to a temperature of 32
degrees Fahrenheit, the moisture in the skin freezes, thereby removing
it from its usual consideration, as the element that is responsible for
the usual softness and flexibility of the skin.

In the cold months, bodies are sometimes left in cold rooms with
the windows open. The embalmer did this in the past, thinking that
subjecting the body to the influence of a cold atmosphere would
simplify preservation.

From the standpoint of preservation alone, this theory is correct,
but in accomplishing the above result the moisture of the skin may be
frozen. The resulting color is light yellow. The texture of the skin is
changed from soft to a slightly hardened condition.

_Treatment._—Never allow the room temperature to approach the freezing
point. Should the above treatment be disregarded, and the yellow
color become present, have the room warmed, and the color will slowly
disappear.

_Feverish Conditions in the Body Before Death._—Fever is the name
usually given to the rise of temperature that goes with inflammation.
In severe inflammatory diseases, the tissues lose much of their
moisture through the arrest of the saturating power of the blood stream
and the disturbance of circulation. The skin contains a sub-normal
amount of moisture when the embalmer reaches these cases, which may be
further reduced by outward evaporation and the dehydrating power of the
embalming fluid. Small brown spots resembling the fever blister in the
living body may be present around the mouth.

_Treatment._—Use half strength fluid for the first part of the
injection, followed by normal fluid for the second, third and fourth
parts. Apply water or a commercial skin or face solution while the
injection is going on.

_Absence of a Normal Amount of Moisture in the Skin of the Body._—The
normal amount of moisture in the skin has been determined to be an
amount equal to seventy-five per cent. of the weight of the skin. Any
percentage less than seventy-five per cent. is considered subnormal.
This condition can be expected in all fever cases, in anemics, and in
old age.

_Treatment._—When the skin appears rather dry, the injection of fluid
should be half strength for the first and second parts, normal for
the third and fourth. The skin of the exposed parts of the body should
be dampened with an application of water or a commercial face or skin
solution, while the injection is being made.


=Greenish Tinge of Putrefaction.=—Putrefaction discolorations are those
which are produced when putrefactive bacteria become active in the skin
or subcutaneous tissue.

This discoloration appears generally about the second day, unless
preservative fluids have been applied to prevent it. It first begins in
the ileocaecal region or lower part of the abdomen. The skin covering
these parts assumes a brownish color which shades to yellow, yellowish
green, and finally a green color. This green discoloration will in a
few days spread all over the surface of the body.

Among the putrefactive bacteria is the bacillus fluorescens, a
chromogenic germ, which produces a greenish color when it becomes
active in the tissues. One of the first external evidences of
putrefaction is the production of a greenish color in the abdominal
wall. This, of course, could not occur when embalming had been done
with any degree of completeness. Should an insufficient circulation
be encountered when embalming a body, the part which does not receive
the fluid, being unprotected, may be affected by the color producing
germ mentioned above. The most likely to be affected by an insufficient
circulation will be located somewhere in the extremities of the
circulation, that is to say, in the skin. We can place the affected
part more definitely in the skin of the face, particularly the nose,
which has a rather poor circulation. This condition will not make
its presence known until three or four days after embalming has been
done, making it almost entirely absent in bodies embalmed in ordinary
practice. Should several days elapse between the time the body died
and embalming, allowing the discoloration to appear, the following
treatment would be advisable:

_Treatment._—Inject a very small portion of the following solution just
under the skin, using a hypodermic needle.

  Alum                          10 gr.
  Corrosive Subl.               10 gr.
  Zinc Chloride                  5 gr.
  Grain Alcohol                  4 fl. oz.
  Formaldehyde                   2 fl. oz.

Just a small portion of the above solution is all that will be
necessary, working it under the skin with the finger tip, so as to
avoid destroying the features by swelling the tissues.

This treatment being a chemical one, it is necessarily slow in its
action of bleaching the green color. Should haste be necessary, inject
a very small quantity of embalming fluid to arrest the putrefactive
process and then cover the spot with theatrical grease of the proper
color to match the surrounding skin.


=Chemical Action.=—Chemical action is any discoloration of the skin
or tissues of the body which may be caused by the action of opposing
chemicals. There is only one known discoloration occurring in the
body after death as a result of the presence of a chemical in the
body, which, when coming in contact with formaldehyde, produces a
discoloration. This particular discoloration, greenish in color, is
the result of the work of the drug methylene blue in contact with
formaldehyde.

Often, in cases of chronic malaria, or diseases of the liver, or again
as a general antiseptic, methylene blue will be administered by the
attending physician, and you should learn this fact beforehand, for
if methylene blue has been administered it is advisable not to use
a formaldehyde fluid. There is a chemical action set up between the
formaldehyde and the methylene blue, which gives the tissues a greenish
color, which is quite objectionable.

In this case you would use some fluid which does not contain
formaldehyde, benzoate of soda, or borax, or peroxide solution should
be used.

Another good formula to use is the following:

  Rx

  Carbolic acid                    5 oz.
  Borax                           12 oz.
  Glycerine                        1 oz.
  Water, sufficient to make        1 gall

                      or

  Rx

  Carbolic acid                    5 oz.
  Oxalic acid                     12 oz.
  Boracic acid                     2 oz.
  Water, sufficient to make        1 gall


=Postmortem Discoloration.=—This is a general expression, and refers to
any discoloration which might occur on the body after death.

What is usually meant, though, when this term is used is _the settling
of the blood to the dependent parts of the body after death_. If the
body is lying on the back, the blood will naturally gravitate toward
the back, into the azygos system and cause a bluish discoloration, or
the same condition will result, if the body is found lying on the face
and stomach, in which case the discoloration will be in the face and
the anterior chest and abdominal walls.


=Postmortem Staining.=—This condition is caused by changes in the
blood while in the veins. The blood becomes more fluid in character
and the red blood corpuscles become granular and give off their oxygen
which escapes through the walls of the veins and carrying with it the
haemoglobin or coloring matter of the blood, stains the tissues over
the superficial veins a purplish red color. This discoloration only
appears on the ventral surface of the body and along the course of the
large superficial veins. An excellent example of this discoloration
is seen in the drowned subject where almost always all the superficial
veins can be easily traced by this discoloration.


=Capillary or Venous Congestion.=—This term includes those
discolorations either caused by gas distension or by the unskillful
injection of fluid into the vascular system. Gas forming in the
abdominal or thoracic cavities will so press upon the heart as to empty
it of its blood, which will be forced upwards into the large venous
trunks of the head, neck and axilla. All embalmers are familiar with
the flushed face which often appears when the arterial system has been
injected in a too hasty manner. It causes the veins and capillaries of
the face and neck to become congested the same as that caused by the
formation of gases in the cavities.



CHAPTER XV.

ARTERIAL EMBALMING.


=Making the First Call.=—There are some pertinent points to consider
regarding the procedure at the time the call is received. Many
embalmers have some particular rules that govern their inquiries at
this time. It is the consensus of opinion among professional men of
all kinds that a rule is a good thing to have to cover any regular
procedure. It matters not so much as to what the rule is, just so
the necessary information can be acquired in a uniform manner, thus
systematizing that part of the work and enabling the embalmer to
properly prepare for the case at hand before leaving the establishment.

The habit of inquiring about the sex, and age of the person, as well as
the cause of death, should be cultivated. The importance of knowing the
sex of the person lies in the fact that in some communities different
styles of door badges or decorations are more appropriate for one sex
than for the other. When the ruling decoration is some form of fresh
flowers, this should be ordered before the embalmer leaves for the
house of mourning if possible, unless the call should be received at
night or in the early hours of the morning, when this item is usually
left until the earliest business hour. The age of the person also
determines to a great extent the style of decoration which is to be
used.

The cause of death is vitally necessary. In some cases, the ordinary
contents of the embalmer's grip or hand bag are sufficient for the
usual needs. In other cases, extra material of various kinds are
necessary, for instance, the rubber floor covering for the carpet in
dropsical cases; the sanitary clothes in eruptive contagious diseases;
the fumigating outfit in the same diseases, (providing this duty is not
performed by the health authorities); and other articles needed only in
the treatment of special cases.

After obtaining the above information, examine your grip or hand bag
to see that you have all the equipment needed to care for the case in
the proper manner. This saves many cases for those who follow these
rules, as they are enabled to have just what is needed, and prevents
the slighting of a case for which there may be some excuse if the
proper materials are not in the outfit. From a professional standpoint,
it should be necessary for the embalmer to carry anything he may need,
otherwise carelessness may dictate his procedure and disaster may
result.

An ordinary case can be attended with the following material[1]:—

   [1] NOTE—Many embalmers get along, some way, with much less in
   their outfit than enumerated here. The authors believe that the
   embalmer should have all the material needed to properly carry
   out his work, and anything of necessity left from the outfit only
   reduces the efficiency of the embalmer, and leaves him, at times,
   without the proper assortment of material.

  The couch embalming board.
  The slumber robe, and face cover.
  A rubber or oil cloth cover for the board.
  A suit case grip, or hand bag.
  Concentrated fluid (at least 4 bottles).
  One or two empty 64-oz. bottles (for mixing fluid).
  One bottle for blood drainage.
  One injecting outfit (pump, tubes, etc.)
  One blood drainage outfit.
  One instrument wallet, containing:—
     2 scalpels, 1 bone separator, 2 aneurism needles,
     1 spool linen thread, 1 grooved director, 3 arterial
     tubes (assorted diameters), 1 bistoury, 1 lock forceps,
     1 spring forceps, 1 artery forceps, 1 case
     needles, 1 6-inch child's trocar, 1 12 or 14-inch trocar,
     1 chin rest, 1 hypodermic outfit, 1 roll absorbent
     cotton, 1 sponge, 1 box face powder, 1 nail
     file, 1 hair brush, 1 bottle bichloride of mercury
     tablets, 1 shaving outfit.

For special cases it would be well to have on hand the following
articles:—

  1 small can plaster of paris.
  1 tube lip cement.
  2 rubber bandages.
  1 can hardening compound.
  1 bottle Platt's chlorides or any other good deodorant.
  1 outfit of formalin and permanganate of potash, or
    any other standard gaseous germicide preparation for
    fumigating.
  1 small bottle of tincture of iodine as a preventive to
    infection should you cut yourself.

After the outfit has been found correct for the case at hand, place
everything in the conveyance, and leave for the house. Upon arriving
at the house, enter alone and meet the member or members of the family
who have been delegated to talk to you. At this time it will be well
to ascertain the position of the body, the wishes of the family in
reference to where the body is to be placed after embalming and to
where the body is to rest in the casket until the time of the funeral.

If you meet with any objection as to embalming, it will be well for
you to consider the sanitary aspect of the case in speaking to those
interested. In this case the sanitary aspect should always take
precedence over the preservative aspect, since you can count on the
assistance of the physicians in supporting embalming on that account.
Should your wishes be overruled after you have presented the facts in
the matter, it would be well for you to place the entire responsibility
for the condition of the body upon the family, since without embalming
you are unable to know the final condition of the body, and should not
be held responsible for it regardless of what the condition may be in
that case.

After this short talk with the family, return to your conveyance and
carry your outfit to the room of death. Everything that you carry
should be properly covered, as there is nothing quite as indecorous
as the display of an embalming board without a cover. When you have
placed the outfit in the room, call for everything that you will need
from the family, which will include such things as a pail, warm water,
soap, towels, etc. Do all of this before touching the body; and after
securing all the necessary items, close the door, and do not open it
again until the work has been completed.

Should unforeseen circumstances cause you to re-open the door,
present yourself with a coat on, and never, under any circumstances,
appear before any one in your shirt sleeves, as that is another
indecorous procedure. After the preservation has been completed,
dust a little face powder on the face and hands, to remove the moist,
clammy appearance which may have been left on those parts. Place the
undergarments on the body and then any other garments which may have
been given to you by the family. Cover the body with the slumber robe,
and then call in as many members of the family as may wish to view the
body, asking them to criticize your work. Before calling in the family
it would be well to put everything out of sight and not have any grips
open.

If favorable comment is heard from the family, your work is done for
the time being. If unfavorable comment is heard, ascertain the cause
of the comment and do not leave the house until the proper appearance
has been secured. If your work has been pleasing to the family, you can
rest assured that the case is a success and that you have done your
work well. When you are satisfied in your own mind that all is well
with the body, make arrangements for the selection of the casket, and
then retire from the house. If the door decoration has not been placed
in position before you leave, you will place it in position yourself.

Some funeral directors set the time for the funeral during the first
call, and some wait until later. The same for the other arrangements,
such as newspaper notices, minister, singers, church or chapel
services, number of conveyances, etc. Whatever method you choose to
use in your community should be carried out systematically so that
at no time, will anything be left undone to cause confusion at some
inopportune time.


=The Position of the Body on the Embalming Board.=—The position of
the body on the embalming board is regulated by the adjustment of the
movable head end of the board.

After much experience with various classes of bodies, we find that
the adjustment mentioned is a very valuable aid in securing the best
results both as to completeness of the circulation and amount of blood
drained.

In anemic, tubercular, cancer of the stomach and exhaustion cases,
together with other conditions resulting in emaciation, the head end
of the board should be raised to the height that seems suitable for the
position of the upper part of the body when placed in the casket during
the injection of the first bottle of fluid. When the first bottle of
fluid has been injected, lower the head end of the board until the
entire board is level, and leave it in that position until you have
completed the injection, when you will again raise the end of the board
until the position of the body is just as it will be in the casket.

When pneumonia and other non-emaciated bodies are to be injected, with
drainage, use the same procedure as is stated above for the emaciated
bodies.

In dropsical cases, raise the head end of the board only for the first
bottle of the injection; then for the second bottle, lower the head end
to about half of its first height, and set the foot end of the board
on some object that will raise it five and six inches. In this way you
will have a slight elevation at both ends of the body, and drainage
can better be obtained from the center of the circulation. When the
operation is complete, lower the foot end again and raise the head end
so that the body occupies the proper position for the casket.

These adjustments are practical methods of overcoming gravity handicaps
in the distribution of the fluid, and of accelerating the amount of
drainage obtainable by keeping the level of the drainage tube below the
blood level in the body, thus accomplishing a universal distribution
of fluid, and securing a greater quantity of undiluted blood from the
vein.

It is very important to remember when you are through injecting the
body that you are to place the body in the exact position on the
cooling board which you want it to have in the casket. After a little
time the body will become more or less rigid due to the action of the
preservative fluid used, and will set in the position you have placed
it which condition will be hard to change later.


=Selection of an Artery.=—Great care should be taken in the selection
of an artery. Never make a practice of using the same artery on
all cases. Acquaint yourself with the location of them all, and on
different occasions, as different conditions arise, use the artery most
likely to give the best results for the condition in hand.

Convenience usually governs the operator as to the artery he is to
use. If blood is to be removed it is best to raise one of the larger
blood vessels, such as the carotid artery and the internal jugular
vein, or the femoral artery and femoral vein, or the axillary artery
and axillary vein. If it is desired to draw the maximum amount of
blood, the femoral artery and vein should be selected, as they are more
dependent, and control more of the blood, when the body is placed on
an incline. A drainage tube sufficiently long to reach above Poupart's
ligament as far as the common iliac is all that is necessary as there
are no valves intervening between the bifurcation of the common iliac
and the right auricle. However if you can, extend the tube up through
the ascending vena cava and eustachian valve into the right auricle.
This will give you a chance to draw blood from the right auricle and is
a much better procedure than tapping the right auricle with the trocar.

If the body is already dressed and the hands or feet need to be
re-injected, the radial or posterior tibial likely will be most
convenient as their use will not necessitate the removal or cutting of
the clothing.

Oftimes there is but a single window to admit light and the operator
should be so skilled as to be able to raise the arteries either on the
right or left side without having to turn the cooling board.

In emaciated subjects the linear and anatomical guides are always
plain but in fleshy subjects this is not always the case. Look over
the subject and see which artery will be the most convenient to raise.
Usually in fleshy subjects the femoral is hard to raise as there is
a great amount of fat in Scarpa's triangle making the artery lie very
deep, but in these subjects the guide for the brachial is quite plain,
a distinct groove being seen between the biceps and triceps muscles.

In a short necked subject it is never advisable or convenient to raise
the carotid as there is not much room to work and the incision is very
liable to show. Another artery will be found much more advantageous in
these subjects.

In accident cases the seat of injury will determine the artery to be
raised, using the one through which you can give the body the greatest
supply of fluid to all parts. Often it will be necessary to raise
several arteries to complete the injection.

There is no necessity for undue exposure in either sex, however it is
hardly ever advisable to inject the femoral in the female, as some
mischief-maker might without any real cause influence others in the
community against your methods.

When selecting the brachial and femoral arteries always raise them at
a place below the point where collateral circulation is given off or in
other words raise them in the middle third. By so doing the fluid will
reach, by means of collateral circulation, the tissues of the arm and
leg below the point of injection.

As far as the injection of fluid is concerned, one artery is just as
good as another. All arteries are parts of the same channel branches of
the aorta. No valves exist in any part of their course.


=How to Raise an Artery.=—With the scalpel make an incision an inch
long in the average size arm, cutting through the skin and then through
the fat. Reverse the blade and at each end of the wound cut forward
and upward to make it clean. Take the grooved director and with the
small end puncture the deep fascia, then reverse ends of the director
and force the blunt end up the wound, underneath this deep fascia,
one-fourth to one-half an inch longer than the wound. Now take the
scalpel with the edge of the blade upward and split the fascia as far
up as the needle extends and cut the tissue (fascia and fat) up to the
skin, being careful not to cut the skin. Reverse the needle and cut the
lower end of the wound the same way. This will give you an incision one
inch long on top and one and one-half or two inches at the bottom of
the wound, and none of the vessels will be injured.

With the handle of the aneurism needle separate the tissues between the
muscles, artery, vein and nerve, then use the hook end of the aneurism
needle, pass it under the artery and raise it to the surface, passing
the bone separator or the forceps with the closed end underneath.
Remove the individual sheath surrounding the artery. Likewise raise the
vein to the surface.

If the artery and vein lie side by side and it is desired only to raise
the artery, hook down between the two, away from the vein, sliding
the hook forward and backward underneath the artery, then raise to the
surface.

If the artery and vein lie side by side and it is desired to raise
both, pass the hook around the vein first, as by hooking around the
artery toward the vein the point of the hook will often rupture the
vein.


=How to tell an Artery from a Vein or a Nerve.=—Raise the suspected
vessels to the surface, placing a bone separator underneath to form a
bridge, which will cause the blood to recede on every side. If you are
in doubt which is the artery, remove the individual sheath from each
one.

The nerve will appear as a glistening white cord, very solid to the
touch and showing bands of nerve fibres which can be separated by the
aneurism hook. It will not have any central opening.

The vein will appear as a dark blue color and collapsible because of
the fact that they have thinner walls than the arteries, lacking the
middle circular layer of fibres. Veins have a central opening. As a
rule the vein contains blood after death, which gives it the dark blue
color but should it not contain blood, it resembles the artery very
closely as to color.

The vein contains valves which can be seen distinctly, if the blood be
pushed the opposite way from which it runs in life.

The artery is of a creamish white color and non-collapsible because of
the fact that it has heavy walls and a middle circular layer of fibres.
The arteries feel firm to the touch while the veins are soft and
velvety. Arteries have a central opening and as a rule do not contain
blood after death. They likewise do not have valves. The artery is
usually more constant than the vein.

Should all these not convince you, raise the one you think is the
artery with the hook, pass the forceps underneath, spread these and
pass the bone separator under for a bridge and with the scalpel incise
the artery about one-fourth the way. Attach the arterial tube and if
there is blood present, allow it to drain by lowering the arm. When
it has ceased to flow, inject very gently and slowly. If you get a
half-pint of fluid in the body, you may be assured of its being the
artery.

Another way to tell the artery from the vein is to roll them lightly
between the fingers. If it feels like a thin rubber tube, and does not
roll together in a little bundle, the supposition is that the vessel
is an artery. This however is not certain, as phlebitis, or some other
diseased condition of the veins may result in the thickening of the
walls of those vessels, to such an extent as to make it impossible to
distinguish in this way between the artery and the vein.

The anatomical and the linear guides for the arteries and veins, and
their relation to the accompanying nerve, will help also to tell them,
one from the other.


=How to Cut an Artery for Injection.=—After the artery has been located
it should be freed from the surrounding tissues and then raised to the
surface. After it has been raised to the surface the bone separator
which is to act as a support while cutting the artery, should be placed
underneath the artery.

The artery may be cut in several ways as follows—a T shaped incision
may be made. This is a very old method, one of the first to be used
for this purpose. To make this kind of an incision in the artery, the
scalpel is placed point down about one-fourth the distance from the
edge of the artery, and then by forcibly bearing down on the scalpel
cut the artery crosswise. Rotating the artery the cut will now be on
the upper surface. Now from the middle of the crosswise cut, extend a
longitudinal cut lengthwise of the artery, for almost one half inch.
We have no comment to make on this kind of an incision, excepting to
say that the method is old and obsolete, and no longer used, and that
a much better method is now used.

Another method suggested by some authors is the longitudinal incision.
With the belly of the scalpel cut the artery lengthwise for a distance
of a little less than one half inch. The disadvantage of this kind of
a cut is that the operator does not know when he has cut to the center
of the artery and no more than the center. If the cut has been made to
a distance beyond the center, then the inside wall on the opposite side
will be cut and if the wall is in the least diseased, the arterial tube
when it is inserted may get between the walls which will mean that no
fluid can be injected.

Another method is to cut the artery crosswise, placing the point of the
knife on the artery about one fourth the distance from the edge of the
artery, bearing down so that the point will come through to the bone
separator which is beneath, then forcibly bearing down cut outward with
the belly of the knife. Now rotate the artery and the cut will be on
the front of the artery.

Another better method is the same as the above, but instead of cutting
outward perpendicular to the artery, cut outward diagonally, then when
the artery is rotated there will be a V—shaped cut. The point of the V
should be made opposite the way the operator is to inject the fluid.
With the aneurism hook, pick up the point of the V, which will mean
that the hook will have to be inside of the artery, and using the hook
as a guide insert the arterial tube. The only disadvantage of this
method is that the tensil strength of the artery is to a certain extent
weakened, but if the artery is not cut too deep, this is not a serious
disadvantage. The advantage is that the operator is always certain that
he is in the center of the artery, that if his knife is sharp, that he
will always cut all three walls of the artery at once, and thus prevent
a ruffling up of the inner wall of the artery should it be diseased.


=The Injection of Fluid.=—One very important point to be taken into
consideration when embalming, is the slowness with which the fluid
should be injected.

Upon this one thing will depend very largely the success you will have
with the perfect circulation of the fluid and cosmetic effects.

Some authorities on the art and science of embalming have made the
claim that it makes no difference how rapidly a body is injected as the
fluid is so widely distributed through so many branches of the artery
that no harm can come from this source. This is very erroneous for when
the fluid is forced rapidly through the arteries, it also flows rapidly
through the capillaries into the veins, thereby enlarging the quantity
of fluid in those vessels and often forcing the blood into the exposed
parts of the body, causing serious discolorations.

The capillaries are sometimes ruptured by the rapid injection of fluid,
causing spots to appear on the face that would never have been there
had the body been injected more slowly.

A further reason for slow injection is that the disinfecting fluid is
given an opportunity to be absorbed by the tissues as it passes into
the capillaries and not be forced through those little vessels into
the veins, as it is by the absorption of the fluid that the body is
disinfected. This is especially true when the drainage tube is being
used as the fluid, seeking the course of least resistance, passes
through the artery, into the capillaries, through those vessels to the
veins and out through the drainage tube.

As it takes but little blood to color a large quantity of embalming
fluid, many embalmers are led to believe that they are removing large
quantities of blood, while in reality perhaps one-half of the colored
liquid which flows from their drainage tube is the fluid which is being
injected. Many failures have resulted from this error.

Fluid should always be injected into the body very slowly, and the more
slowly it is injected the more perfect will be the cosmetic effect.

If necessary make a second injection. An embalmer who makes the
proper charge for his services as a professional can afford to make
two injections if necessary. He can let it be known that he will
not be content with anything but perfect work, and patrons will not
only cheerfully pay for it, but will have a better opinion of his
professional standing. Thorough drainage and slow injection are the
best safeguards against discoloration.

Dr. Erdman before the Minnesota association suggests that the amount of
fluid that fills the arteries is not enough to percolate through the
capillaries and into the tissues, and saturate all the parts of the
body. He favors the gravity injection by merely allowing the fluid to
flow naturally into the arteries from an elevated vessel, and would use
no force or pressure in injection. Ideal embalming would be a series
of gravity injections at intervals of several hours. While the gravity
injection such as the doctor describes will undoubtedly be a sure
method of getting a perfect circulation, and while it is the process
generally pursued in morgue work where the apparatus is convenient, it
is in the majority of cases in the home impractical.

All bodies to be shipped must be thoroughly arterially embalmed, that
is, to have introduced into the arterial system sufficient amount of
disinfecting fluid to thoroughly sterilize every particle of matter in
the dead body. This can only be done by introducing into the arteries
an approved disinfecting fluid.[2]

   [2] The quantity to be injected of course varies, but a fair
   estimate would be that the quantity should be three-fourths of
   the capacity of the blood vessels of the body. This would require
   approximately one and one-eighth gallons of fluid to every 150
   pounds of tissue. The latest transportation rules demand the
   injection of an amount of fluid equal to 10% of the body weight
   into the arteries.


=Approved Disinfectants.=—This is construed by most states to mean a
fluid which is sufficient in strength to kill all the germs on the
surface of the body or on the interior. An approved disinfectant
for the external surface of a dead body is a solution of 1 : 1000
bichloride of mercury. An embalming fluid which has the official
approval should contain 5% formaldehyde.


=Embalming Fluids.=—At the present time only a few states have placed
restrictions on fluids. These restrictions are that they contain
neither mercury, arsenic, antimony or any of their compounds. These
poisons when used to inject a body make it almost impossible to detect
from a chemical analysis whether death was caused by a poison or
the poison was from the embalming fluid. Iowa recommends a fluid the
formula consisting of formaldehyde, glycerine, borax, boracic acid,
salt petre and water.


=Wrapping a Body in Cotton.=—In certain diseases, when a body is to be
shipped, the law compels the embalmer to wrap the body in cotton. This
may be the ordinary cotton purchased from a dry goods store. The cotton
should be cut in strips at least one to one and one-half feet longer
than the body. Two layers are laid side by side upon a sheet, the body
then placed thereon and the whole wrapped about the body will envelope
the body in a satisfactory manner. This means that the entire body is
to be enveloped, so that the face head or feet will not be exposed, and
the wrapping should never be removed. Absorbent cotton may be used for
this work, but it is more expensive and not as good as dry cotton for
this purpose.

=[3]The Charge of Embalming.=—This subject is one that has
long been forcing itself upon the thought and attention of
progressive undertakers, principally because of the many abuses and
misunderstandings that have grown out of the manner in which members of
the profession regard the value of their services and the careless and
indifferent systems used in conducting the business side of our work.

   [3] Extracts from a paper written by F. W. Alexander, Conrad,
   Iowa.

In order to succeed in a chosen calling one must first have a liking
and a natural adaptation for the work; second, he must prepare himself
by obtaining a thorough working knowledge of the profession or business
he expects to follow. He must educate himself for the work. This is
fundamental and has been proven many times with the successes in every
profession. It is fair to presume then that the great majority of men
entering this profession have considered the probabilities of success
and have met the requirements needed to qualify them to follow this
calling and to receive the support of any who through necessity need
their services.

Without going into the non-essentials showing the rights of individuals
holding a license as an embalmer to practice, we may naturally come to
the next question in this connection, the value of his services and
how they should be charged for. Charge what your work is worth,
and do not conceal the amount in the price made on the casket or any
other part of the funeral expenses. Make it a specific charge in every
instance for there is a good and sufficient reason why you should.

An explanation of these reasons may be summed up as follows: the
conscientious effort in qualifying yourself to meet the needs of your
calling and the requirements of the state, the cost of your training
and education in time and money, the years spent in the hard school of
practical experience and self development.

Next your business equipment and investment, the care of the case on
which you are called, its peculiar requirements and how it taxes your
skill in doing the work, the risk from infection, the distance you must
travel and the expense of the trip. All of these considerations enter
into the cost and should be the basis on which to formulate a charge
for the work.

Just as the well equipped surgeon of wide experience and training
skillfully performs operations relieving suffering, saving and
prolonging life, naturally allows the difficulties of the case and
the distinctive personal service rendered to govern him in the amount
of the fee, so in a very similar sense the services of the embalmer
should hold a certain ratio of value to the conditions under which he
works and the ability he employs in its performance. Therefore let me
again urge that you make it a specific charge showing it a distinctive
personal service.

In the matter of the value of personal services the question is
often raised: “Which is the more important part of the work in our
profession, directing and managing the funeral or the embalming and
care of the body.” In answer to this let me say that the care and
the embalming of the body is first importance because the law says
so, because the education of the embalmer is paramount to other
considerations and so regarded by the national association, because
sanitary science demands it, because without a body properly embalmed
and prepared for burial the funeral is a failure from whatever
standpoint you wish to judge it.

A director may bungle the arrangements and at the most it is but a
matter of annoyance to the family. However, let him fail to properly
fit and prepare the body so that the relatives can see restored to
them the face of their beloved one, beautified in the last long sleep
of death, and they will never forgive him. They secured his services
first as an embalmer and incidentally as a director of the funeral,
naturally, therefore, the greater importance of his work centers around
his services to the family in that capacity. Now in all candor, why
should he not make a specific charge for his work? He is rendering the
greater service in caring for the body, it should be the first item
charged for on the funeral bill.



CHAPTER XVI.

THE ANATOMICAL AND LINEAR GUIDES FOR SPECIAL ARTERIES.


=How to Locate and Inject the Carotid Artery.=—The carotid artery,
is not used much, by the average embalmer for several reasons. It is
usually a hard artery to raise, partly because the average embalmer
does not know the anatomy of the neck. In subjects having short and
very fleshy necks it is not advisable to use the carotid, however in
subjects where the neck is long and not fat it is with some a favorite.
It is always essential to know how to raise and inject the carotid for
in accident cases, where the arteries of the lower part of the neck
and thorax are ruptured it becomes necessary to raise and inject the
carotids to get the fluid into the tissues of the face and brain. In
cases of suicide where the arteries of the neck have been cut it is
necessary to know where the arteries and veins lie so that they may be
tied off. Often the body is so badly mutilated that it is impossible to
raise any other artery excepting the carotid. Every practitioner should
know how to raise and inject this artery, even though some other artery
is the one generally used.

   [Illustration: FIG. 46—The arteries of the neck. (Gray)]

_Linear Guide._—By a linear guide is meant that an imaginary line is
drawn from a point to a point the same direction the artery runs so
that by mentally imagining this line one can be safe to cut on the line
and be sure that the desired artery will be reached.

The linear guide for the carotid is represented by a line drawn from
the sterno-clavicular junction to a point between the angle of the jaw
and the lobe of the ear. (Mastoid process).

As the body lies on the cooling-board place one finger on the
sterno-clavicular junction and the other at a point between the angle
of the jaw and the lobe of the ear, and by cutting on this imaginary
line, the artery will be reached, providing the artery is normal and
if the embalmer is thoroughly acquainted with the anatomy about the
artery, as is summed up in the anatomical guide.

_Anatomical Guide._—By the anatomical guide is meant the relation which
the artery bears to the surrounding tissues.

The anatomical guide for the carotid artery is that the artery lies
between the sterno-mastoid muscle to the outside, and the muscles
surrounding the trachea (wind pipe) and the esophagus, to the inside.
In the middle third or sometimes between the middle and upper third the
omohyoid muscle crosses over the artery.

_Perpendicular Incision._—The artery is divided for the sake of
description into thirds. By making an incision on the linear guide in
any one of the thirds the tissues that must be passed through are the
following:—skin, platysma muscle, superficial fascia, deep fascia,
common sheath, and the individual sheath.

The platysma muscle is a broad tissue paper like muscle, placed
immediately beneath the skin and a part of the superficial fascia,
in the cervicle or neck region. It arises by thin fibrous bands from
the fascia covering the pectoral and deltoid muscles on the thoracic
wall, and passes upward over the clavicle and inserts the lower jaw.
This muscle is so delicate and the fibers so finely divided that it is
hardly perceptible. When the skin is cut, the platysma muscle will as
a rule be cut too, and because of its thinness it will rarely be seen
or does it form any hindrance to the raising of the artery. It is only
mentioned here because it forms part of one of the questions so often
asked by the State Board in their examination: “What tissues would you
pass through in raising the carotid artery?”

Having cut through the skin and platysma muscle, the superficial fascia
is next seen. In this part of the body it consists of but a single
layer and very thin.

The deep fascia lies next and constitutes a complete investment of the
neck. When this is torn or cut through the sternomastoid muscle comes
into view.

The sternomastoid, is a large, thick muscle, which passes obliquely
across the side of the neck, being inclosed between two layers of deep
fascia. It has its origin at the sternum and clavicle and attaches to
the mastoid process of the temporal bone. By making the perpendicular
incision in the lower third, in as much as the muscle slightly covers
the artery, it can either be cut or pushed to the outside of the
incision. It is best to push the muscle to the outside with the thumb,
and with the handle of the scalpel, work down deep through the areolar
tissue. The operator will now arrive at the common sheath, or that part
of the deep fascia surrounding the artery, vein and nerve. The common
sheath will be very tough and a slit must first be cut, then it can be
torn the length of the incision.

The artery will now be seen lying next to the wind pipe and the
internal jugular vein to the outside. In the lower third the artery
will be about one-half inch deep, while in the upper third it will
be about one to two inches deep, owing to the amount of fat in this
region. In the upper third, the omohyoid muscle crosses over the
artery, which must be either pushed aside or cut in two.

It is always advisable, to raise this artery in the lower third, as it
is less apt to show in that third.

Loosen the artery well from the surrounding tissues with the aneurism
hook, raise to the surface and place a bone separator beneath the
artery.

Now remove the individual sheath, incise the artery and insert the
arterial tube.

If it is desired to raise the internal jugular vein for the withdrawal
of blood, it is best not to open up the common sheath, but to raise the
artery and the vein both at the same time. Having raised them to the
surface they can then be separated by the removal of the common sheath
and dropping it back into the incision.

If it is desired only to raise the carotid, the hook should always
be inserted between the artery and the vein, and directed toward the
trachea. If it is directed around the artery in the other direction
there is danger of rupturing the vein, and thus getting a bloody
incision.

_The Circular Incision._—In the circular incision as much of the skin
as can be, is pushed above the clavical bone from off the chest wall.
The cut is then made from one sterno-clavicular junction to the other
following the supra-sternal notch. This method was devised for the use
of the “Y” shaped tube, where both sides of the face could be injected
at the same time. One precaution however should be noted, which is,
that care should be taken that not more than the skin, be incised with
the first cut. Just below the incision will be noticed a little branch
vein which runs into the arch connecting the two external jugular
veins. If the first cut is too deep this branch will be cut, and a flow
of blood will result. However by cutting carefully this little branch
can be noticed, tied off in two places and cut in between, and thus
cause no further trouble. Remembering the linear guide, the artery can
be reached by going down at either end of the incision. The tissues to
go through will be the same as for the perpendicular incision, and the
method of raising the artery will be the same, only, in the circular
incision usually both carotids are raised, so as to inject both sides
of the face at the same time.

The only advantages derived from the circular incision is that one can
by the use of the “Y” shaped tube inject both sides of the face at the
same time and get an equal distribution of fluid, and that after the
injection is over, and the incision sewed up, the skin can be pulled
back in place, making the incision appear much below the clavical, and
where it is less liable to show than in the perpendicular incision.

For embalming female subjects, if the carotid is chosen as the artery
to use, it will be best to use the circular incision. However for
ordinary embalming it will perhaps be best to choose some other artery,
which will be less apt to show, and not so deep.

We should be so skilled as to never make a mistake, but the best
sometimes do make mistakes. If in raising another artery, a mistake
should occur, the operator can raise either above or below the original
cut, but with the carotid, the only advisable incision to make is in
the lower third, and if a mistake is made the last chance is lost. For
this reason then a great amount of care should be taken.

In injecting the body from the carotid, the arterial tube should be
inserted first toward the heart, and after the body has received a
sufficient amount of fluid, if it is noticed that the side of the face
from which you are injecting has not received a supply of fluid, then
reverse the tube and inject a few bulbs of fluid upward.

_Relation of Artery, Vein and Nerve._—The common carotid artery lies in
relation to the internal jugular vein and the pneumogastric nerve. The
artery lies to the inside next to the muscles surrounding the trachea
(windpipe). The internal jugular artery lies to the outside of the
artery. Just back of the common carotid artery and the internal jugular
vein and between the two lies the pneumogastric (vagus) nerve. These
all as a rule lie in the same common sheath of deep fascia.


=How to Locate and Inject the Axillary Artery.=—The axillary in recent
years has come to be a much used artery. It not quite as large as
the common carotid, but as a rule large enough to admit the large
size arterial tube. It has become a favorite with many because it is
quite easy to locate and to raise, and because of its proximity to
the axillary vein, a vein which is large enough to admit a drainage
tube for the withdrawal of blood. Again the axillary artery is in a
secluded place, being as it is in the axillary space (arm pit). The
artery does not lie very deep, and is not covered by any muscles as you
operate, there being practically nothing to hinder the progress of the
operation.

   [Illustration: FIG. 47—The axillary and its branches. (Gray)]

Then after the operation is completed and the arm placed back in normal
position, the casual observer is not liable to see the incision, even
though the body be only partially dressed.

_Linear Guide._—A line drawn through the center of the axillary space
(arm pit), at the anterior border of the hair line.

_The Axillary Space._—When the arm is maintained in a horizontal plane,
the axilla has the shape of a three-sided pyramid, the apex of which
lies above, below the clavicle, and the base of which corresponds to
the lower wall, covered only by skin and fascia.

The axilla is filled with blood vessels, lymph vessels, lymph glands,
nerves, and masses of fat.

_To Raise the Artery._—Make an incision on the linear guide. After
the skin is passed through there is a large quantity of fascia, lymph
glands, and lymph vessels, which must be carefully dissected through,
and at the same time the axillary vein will be discovered. This vein,
for the present, should not be loosened from the surrounding tissues.
Dissect down to the upper side of the vein, and the common sheath of
fascia surrounding the artery and nerves will be seen. By carefully
tearing this the length of the incision, the brachial plexus of nerves
now is exposed. Now by gently pushing the nerves apart with the handle
of the scalpel, the artery will be seen. With a hook loosen the artery
from the surrounding tissues and raise to the surface.

If it is desired to draw blood, now proceed to raise the vein to the
surface. Open the vein and insert a drainage tube, which should be
long enough to reach through the entire length of the axillary and
subclavian veins, because they have valves along their entire course
nearly to the bifurcation of the innominate.

Inject a few ounces of fluid toward the hand as the axillary is above
the point of collateral circulation. Then reverse the tube and inject
toward the heart, until a sufficient amount of fluid has been injected.

_Relation of Artery, Vein and Nerve._—The vein is quite superficial,
just below it and to the upper part of the incision is the brachial
plexus of nerves, which surrounds the artery.


=How to Locate, Raise, and Inject the Brachial Artery.=—The brachial
artery is located in the upper arm and extends from the inferior margin
of the muscle pectoralis major, or from the shoulder to the elbow. It
is one of the most popular arteries known to the embalmer, and is now
used, perhaps, more than all others combined.

The anatomy of this vessel is simple, yet, when we take into
consideration all the numerous anomalies or irregularities that
surround its use to us as embalmers, we feel the necessity of making
the description very thorough and complete, in order to raise it under
all the various difficulties that attend its use.

The brachial artery has its several branches, the most prominent of
which are the artery profunda brachii (superior profunda artery) and
the artery collateralis ulnaris superior (inferior profunda artery) and
the artery collateralis inferior (anastomotica magna artery).

For the sake of a more correct description we divide the artery into
thirds, viz: the upper, middle and lower thirds. The upper third begins
at the extreme upper part of the arm and extends one third of the way
to the elbow, the middle and lower thirds occupy the remainder of the
artery. In the upper third we have the superior and inferior profunda
arteries coming off; their position is not always the same, and in
the extreme lower third the anastomotica magna artery. These arteries
continue down the outer and inner arm and anastomose with the recurrent
radial and ulnar arteries, thus furnishing collateral circulation. Thus
if the fluid is injected in the middle third, toward the heart, these
branches that come off the brachial in the upper third will convey the
fluid down the arm, filling the branches below the point of injection,
which supply the forearm and the hand.

   [Illustration: FIG. 48—The brachial artery. (Gray)]

The brachial artery is one continuous vessel, the entire length of
the upper arm, and varies in size according to the size of the person
and the development of the arm. It is accompanied by the venae comites
or deep brachial veins, the one to the inner side of the artery about
one-third to one-half the size of the artery, the other about one-half
its size lies directly underneath. All are encased in the same common
sheath of deep fascia that surrounds and holds them together. Great
care, then, should be taken to separate the artery from these veins
before cutting the artery for injection.

The artery lies along the inner and under border of the large muscle
on top of the arm known as the biceps. The biceps is the muscle used
when lifting a weight. To those whose occupation is to exercise the
muscular tissue of the body liberally, this muscle becomes quite large,
and generally the artery is proportionally large.

_Linear Guide._—The course of the brachial artery may be marked out by
drawing a line from the middle of the axillary space (arm pit) to the
center of the elbow, provided the palm of the hand be turned upward.
This line will be immediately over the artery, which will be found
by cutting through the skin at any point on the line, and dissecting
through the subcutaneous tissue toward the center of the arm.

_The Anatomical Guide._—In the upper third the artery lies between the
biceps and coracobrachialis muscles which lie above the artery, and
the triceps muscle which lies below the artery. In the upper third the
nerve lies close to the muscle, the artery below and to the inner side
toward the body, and the vein a little farther to the inside.

In the middle third the artery lies between the biceps which lies above
the artery, and the triceps muscle which lies below the artery. In the
middle third the artery will lie beneath the nerve.

In the lower third the artery lies between the biceps which lies above
the artery, and the triceps which lies below the artery. In the lower
third the artery lies next to the muscle and the nerve to the inner
side next to the body, and the vein still farther to the inner side.

_How to Raise the Artery._—First trace the inner border of the biceps
muscle, feel for the median nerve, which will always be present. The
artery in the middle and lower thirds will follow the border of the
muscle. The palm of the hand should always be turned upward, and the
linear guide, as stated above, will indicate the exact position of
the artery. Make an incision through the skin, on the linear guide,
pushing the fatty subcutaneous tissue to one side, if there be any, and
with the handle of the scalpel, work through the superficial fascia.
Reverse the blade, and at each end of the incision, cut forward and
upward to make it clean. Now with the scalpel cautiously cut through
the deep fascia, and remove this from the vessels below. This will
expose to view the median nerve, and with the handle of the scalpel,
separate the tissue between the artery and the muscle, and between the
artery and the nerve. Having thus freed the artery, use the hook end
of the aneurism needle and pass it under the artery toward the muscle,
and raise the artery to the surface. Pass the bone separator or the
forceps with the closed end, underneath, remove the sheath surrounding
the artery and the deep brachial veins. The natural position will be,
the artery on top, the larger deep brachial vein to the inner side and
the smaller one underneath. It is very necessary to remove these deep
brachial veins, for the reason that if they are not, in cutting the
artery for injection, they will be cut also, resulting in a flow of
venous blood into the incision.


=How to Locate, Raise and Inject the Radial Artery.=—The radial artery
is one of the branches of the brachial artery, and extends from about
one half inch below the bend of the elbow, along the valley of the
forearm, to the thumb part of the hand. It is divided into thirds, viz:
the upper, middle and lower thirds. It is accompanied in close relation
by the radial veins, but in no way do they interfere with the operation
of raising the vessel. The value of this artery is in the embalming
of ladies, where the body has been dressed and the sleeve cannot be
removed to use the brachial artery without material inconvenience and
annoyance. It is especially desirable to those who are just beginning
to use the arteries. The radial artery is somewhat smaller than the
ulnar, but, on account of the depth of the latter and inconvenience
of raising, the radial artery is the one artery in the forearm which
is generally used. It is an excellent vessel to employ in cases where
the friends are opposed to embalming because of the mutilation of the
body, as they choose to call it. Some object to the use of this artery
on account of the fact that the mutilation is not easily hidden. The
wound can be easily covered by simply pulling the sleeve down to its
normal place. The incision necessary to be made is so small and it can
be closed so neatly, that no objection on the part of the relatives
need be apprehended.

Before the advent of formaldehyde fluids the radial artery offered more
advantages to the embalmer than any other artery used for injecting.
But at the present time almost all embalming fluids contain large
quantities of formaldehyde, and when injected into this artery, which
is very small, it is liable to constrict the vessel to such an extent
as to sometimes make it difficult to inject the fluid.

Moreover, since both the radial and the ulnar arteries have many
branches, a large quantity of fluid is liable to accumulate in the
forearm, hardening it more than is necessary and giving the hand an
undesirable color.

The radial artery is very superficially located, and can be secured
without the possibility of error and with very little mutilation. The
expert will, of course, choose that vessel which he believes will at
the time and under the circumstances best serve his purpose.

_The Linear Guide._—Is a line drawn from the center of the bend of the
elbow to the center of the ball of the thumb.

   [Illustration: FIG. 49—The radial and ulnar arteries. (Gray)]

_The anatomical guide_ for the radial artery (in the wrist, where it
should be raised) is the brachio-radialis muscle on the outside of
the artery and the flexor carpi radialis muscle on the inside of the
artery.

When about to raise this vessel, the embalmer should hold the arm at
right angles with the body, with the palm up, and holding the hand of
the body, with the hand, draw the arm tight. In most bodies this will
show plainly the tendons of the muscles between which the vessel lies,
thus affording an excellent guide for the incision. The arm should
never be grasped and the tissues drawn out of their normal position,
as that is very misleading. The vessel should be raised at a point
about three inches above the wrist joint (the space where you would
feel the pulse beat in life). The operator making an incision through
the skin, superficial fascia, and fat, about one-half inch in length,
will plainly see the artery lying in its sheath between the two tendons
of the muscles. The cut should now be opened carefully, by placing the
fingers on either side of it, and the fascia dissected from the artery,
when it can easily be raised with the aneurism hook. There is no other
vessel at this point that can be mistaken for the radial artery. Its
two venae comites, or accompanying veins, are usually attached to the
artery and need not be removed, as they are very small and can give the
embalmer no trouble.

=How to Locate, Raise and Inject the Ulnar Artery.=—The ulnar is the
larger branch of the brachial artery. It crosses obliquely the inner
side of the forearm, to the beginning of its lower half, it then runs
along the ulnar border to the wrist, crosses the annular ligament on
the radial side of the pisiform bone (wrist bone), and immediately
beyond this bone into two branches, the superficial and deep palmar
arch. In its upper half it is deeply seated, being covered by all the
surface muscles. It is crossed by the median nerve, which lies to
the inner side for about an inch. In the lower half of the forearm
the artery runs more superficially, and is covered only by the skin
and superficial and deep fascia, but at that, the ulnar lies a little
deeper in the wrist than the radial. The ulnar nerve lies to the inner
side in the lower half and the ulnar artery is accompanied by two ulnar
veins, one on either side, called the venae comites.

_The Linear Guide._—Is a line drawn from the center of the bend of the
elbow, to the inside of the pisiform bone in the wrist.

_The Anatomical Guide._—The artery lies in a groove in the wrist,
made by the flexor carpi ulnaris muscle on the outside, and the flexor
digitorum sublimis on the inside.

To raise the ulnar artery, locate the valley in the lower third about
one to two inches above the pisiform bone. Make an incision about an
inch in length, cutting first the skin, superficial fascia, layer of
fat, which will vary in thickness. The deep fascia is now reached,
which should be split by means of the fascia needle and bistoury. Then
separate with the handle of the knife or bone separator, the artery
from its connective tissue on either side. Then with the hook raise it
to the surface, and place the bone separator beneath, remove the hook,
and tear off the individual sheath.

The two ulnar veins will be separated from the artery by taking away
the individual sheath, which should be allowed to drop back into the
incision. Proceed now to open and inject the artery the same as you
would the radial or the brachial. While this artery may seem just a
little more difficult to raise, still at times it has its place in
arterial embalming.


=How to Locate, Raise and Inject the Femoral Artery.=—The femoral
artery is usually objected to, because, situated as it is, it requires
an undue exposure of the limb, especially in ladies. For this reason,
then, the femoral artery should never be raised in the female,
excepting in accidental case when it is impossible to raise any other
artery. In the male, however, the femoral with many is a favorite. The
artery should be raised either in the upper or the middle thirds, but
preferably in the former, as by raising at this point the artery is
not very deep in the tissues as it will be further down, and at the
same time one is able to get collateral circulation to the lower leg
and foot by means of the deep femoral and the recurrent anterior and
posterior tibials.

It is believed quite commonly, that by the injection of the femoral
artery, there is a great danger of flushing the face. This belief
is erroneous. Flushing of the face will result from the injection of
any artery if it is full of blood and if it is found that the femoral
artery contains blood, and likewise any other artery, this blood should
be removed before injection takes place, and what little then remains,
will not discolor the face, since it will be greatly diluted.

The internal long saphenous vein is mistaken frequently for the femoral
artery. It is a superficial vein and is usually found empty after
death. It lies a short distance to the inner side of the femoral artery
in Scarpa's triangle. This vein is taken up frequently, not only by the
younger members of the profession, but by the older as well, when the
guides are not followed closely, and when this mistake does occur, and
fluid is injected through it, flushing of the face results.

Next to the common carotid artery the femoral artery is the largest
branch artery used in embalming. The femoral artery commences
immediately behind Poupart's ligament and is a continuation of the
external iliac artery.

   [Illustration: FIG. 50—The femoral artery. (Gray)]

It passes down the forepart and inner side of the thigh, terminates at
the opening in the adductor magnus, at the junction of the middle with
the lower third of the thigh, where it becomes the popliteal artery.
In the upper third the artery is contained in a triangular space
called _Scarpa's triangle_ and in the middle third of the thigh it is
contained in an aponeurotic canal called _Hunter's canal_.

At a point about one and one-half to two inches below Poupart's
ligament, the femoral artery gives off a branch to the outer and under
side, known as the deep femoral artery, or the profunda femoris, which
courses the thigh downward, and connects with branches coming off the
popliteal and the anterior tibial arteries, thus forming the collateral
circulation to the lower leg and foot.

As the femoral artery leaves the body, it is accompanied by the femoral
vein, which for two inches down, lies along side the femoral artery to
the inner and under side. At about this juncture, however, it passes
underneath the artery and continues its course in that position until
it passes below where we have occasion to use the artery.

The femoral artery can be used all the way from where it leaves
the body at Poupart's ligament until it reaches Hunter's canal. At
Poupart's ligament the artery is very superficial, being covered only
by the skin, superficial fascia and superficial lymphatic glands, but
it gets deeper further down, being covered not only by the above named
tissues, but also by muscles, making it very difficult to raise in the
middle and lower thirds of the thigh. About five to seven inches below
Poupart's ligament the artery passes under the adductor magnus muscle,
and enters what is known as Hunter's canal. Because this artery does
get deeper as it courses down the thigh, it is generally raised in the
upper third.

A knowledge of the anatomy of the vessels of the thigh and leg will be
of value in treating accidents when this member is injured.

_Scarpa's triangle_ is a triangular space, the apex of which is
directed downward, and the sides formed externally by the sartorius
muscle, internally by the inner border of the adductor longus muscle,
and above by Poupart's ligament. The floor of the space is formed from
without inward by the ilio-psoas pectineus and the adductor longus
muscles. The space is divided into two nearly equal divisions by the
femoral vessels, which extend from the middle of its base to its apex,
the artery giving off in this situation the superficial and profunda
branches, and the vein receiving the deep femoral and the internal
saphenous veins. Besides the vessels and nerves this space contains
some fat and lymphatics.

_Hunter's canal_ is the aponeurotic space in the middle third of the
thigh, extending from the apex of Scarpa's triangle to the femoral
opening in the adductor magnus muscle. Hunter's canal contains the
femoral artery and vein inclosed in their own sheath of areolar tissue,
the vein being behind and on the outer side of the artery, and the long
saphenous nerve lying at first on the outer side and then in front of
the vessels.

_Linear Guide._—The guide for the femoral artery is represented by a
line drawn from the center of Poupart's ligament to the inner side of
the knee joint.

Poupart's ligament extends from the crest of the ileum bone to the
top of the pubic bone. To determine the center of Poupart's ligament
for the right leg, get on the right side of the body and with the
left hand, place the second finger on the top of the pubic bone and
the thumb on the crest of the ileum bone, then let the index finger
drop down between the two which will represent the commencement of the
femoral artery.

_Anatomical Guide._—The artery runs through the center of Scarpa's
triangle from the center of its base to its apex. In the middle third
of the thigh the artery passes beneath the vastus medialis muscle and
enters Hunter's canal.

_Relation of the Artery, Vein and Nerve._—The femoral vein at Poupart's
ligament lies close to the inner side of the artery, separated from it
by a thin fibrous partition; but two inches down the vein runs behind
the artery and then to its outer side.

There is no nerve in relation to the artery in the upper third, the
anterior crural nerve lies about half an inch to the outer side of
the femoral artery, being separated from the artery by the ilio-psoas
muscle. In the middle third of the thigh the internal saphenous nerve
is situated on the outer side of the artery, but not usually in the
same sheath with the artery.

_To raise the femoral artery_ in its proper place, is to measure down
from Poupart's ligament from one and one-half to two inches in the
linear guide, and there begin the incision, making it two inches or
less in length. This will bring the incision below the point where the
collateral branches are given off. Cut through the skin, then the fat,
which will vary in thickness with the subject. Underneath the fat are
several layers of deep fascia, which must be split the length of the
incision.

The femoral artery will then be seen, and underneath it will be the
femoral vein. Both will be in the same common sheath of fascia, which
may be removed with a hook by gently tearing the sheath loose over the
artery. When the artery has been loosened the length of the incision,
raise it to the surface, placing a bone separator underneath for a
bridge.

If it is desired to remove the blood, the femoral vein should then be
raised.



CHAPTER XVII.

CAVITY EMBALMING.


=Cavity Embalming.=—In shipping a body, cavity embalming must always be
resorted to and consists of introducing a trocar into the abdominal and
thoracic cavities and injecting sufficient fluid over the contents of
these cavities to thoroughly preserve them.

The scientific work in the embalming of to-day is being done on the
arteries, but cavity embalming should still hold an important place
with those embalmers who desire to get the best results. Although
the arteries have been injected, yet we find that sometimes the fluid
does not reach the cavities. Any cavity may contain gas or material
for decomposition, such as blood, pus, lymph, or as in perforation
of the intestines, feces in the abdominal cavity. Besides these we
always have the bacteria of decomposition, called saprophytes, which
have thoroughly invaded the organs and tissues of the body as soon as
sixteen hours after death. Then, if for any reason the fluid has not
reached a certain part, fermentation, and putrefaction will immediately
set in.


=The Cerebral Cavity.=—Gases may be generated in the cerebral cavity
soon after death, especially in drowned cases, where the gas forming
bacteria, the aerogenes capsulati, are distributed all over the body.
These bacteria work much more rapidly in fresh or shallow water, or in
the summer when the water is warm, than in the winter when the water
is cold, or the body is in salt water. The gases may penetrate every
tissue in the body, particularly the tissues about the eyes, which
gives the eyes their bulged appearance. The gases that are formed in
the brain and forced out into the tissues surrounding the eye do not
enter the eye ball. In these cases the eye ball may or may not be
pushed out of its socket, depending, of course, upon the amount of
gases that have been produced.

These gases may be removed by inserting a trocar inside the head at the
inner angle of the eye or in the nose through the turbinated process of
the ethmoid bone.

After the gases have been removed from the inside of the skull, about
one-half pint of strong formaldehyde fluid should be injected.

Another method of inserting the trocar into the brain would be to pass
it through the foramen magnum. This can be done by inserting the trocar
in the neck a little below and behind the lobe of the ear, directing
the needle upward and inward toward the opposite eyebrow, when the
needle will enter the subarachnoid space (Barnes Method).

In cases of hydrocephalus (water on the brain) where there may be from
one to two quarts of water inside the cranium, the water may be removed
by any of the above processes.

For ordinary cases we do not feel that it is necessary to make a cavity
injection in the head for the reason that the circulation there is
complete, only in rare instances do we find an obstruction.


=Purging.=—By purging, as the embalmer uses the term, is meant, the
fluid which emerges from the mouth and nose of the cadaver. If this
fluid is a brownish coffee-like substance, it signifies it is coming
from the stomach, but if it is a bloody frothy mixture it signifies it
is coming from the lungs.

The real cause of purging is the living and growing saprophytic
bacteria, which were normally in the body, or having gained access
later, produce as a result of their development, gas formations. These
gases confined as they are, press out from the stomach and lungs the
contained fluids of the color mentioned above.

Purging from the stomach may either be due to the presence of gases in
the stomach itself, or in the intestines or in both. If the gases have
formed in the intestines, they would dilate the canal sufficiently to
fill the entire abdominal cavity, thus pressing the stomach against the
diaphragm with enough force to cause the contents to escape through the
upper end of the alimentary canal.

Purging from the lungs is due to the presence of bacteria of
putrefaction, which begin to develope in the diseased portions. These
cause liquefaction of the lung substance and the formation of gas.
The gas will force the liquefied matter, of a bloody, frothy color out
through the respiratory tract.

Before embalming of the chest and the abdominal cavity is begun
the trachea and the esophagus should be treated in order to prevent
purging. There are two ways of doing this:

The first method consists of placing a ligature about the trachea and
the esophagus, this is done by making an incision through the skin and
tissues over the left edge of the trachea, one-half inch above the top
of the sternum. Insert the right forefinger, passing it to the right
side behind the trachea and the esophagus to separate the tissues from
them. In doing this great care should be taken so as not to injure the
carotid on the left and the innominate artery on the right side. Pass
the aneurism hook threaded with narrow tape (this must be very strong
tape) along the inner side of the finger, below the trachea and the
esophagus, to the point of entrance on the left side. You will have no
difficulty now in tying securely both the above tubes, and there will
be no possibility of purging from either the lungs or the stomach.

The second method of preventing purging from the lungs and stomach
consists in plugging the pharynx through the mouth, there-by plugging
the trachea and the esophagus. The only disadvantage of this method is
that it can not be done successfully after the body has been embalmed
arterially. And for this reason, after arterial embalming, the lower
jaw will be firmly set and to use this method, it would mean that the
lower jaw must be pried back in order to gain access through the mouth.
Then it will be found very difficult and in some cases impossible to
set the lower jaw again in its proper position. If this method is to
be used at all, it is advised that you do the plugging of the pharynx
before the arterial embalming has been done.

To do this, take your position at the head of subject on the right
side, and open the mouth wide enough to admit two fingers. Roll several
pieces of dry cotton, the size of an English walnut, and holding the
corner of the mouth back with the left hand, insert a ball of cotton
with the right hand and shove it hard down behind the tongue (this
can best be done with a pair of clamp forceps). Continue to do this
until the pharynx is well and firmly filled, but avoid bulging out the
side of the cheek. If properly done this plug will prevent an ordinary
amount of purging and dry cotton seems much better to use for this
purpose than absorbent. It must be borne in mind that simply filling
the mouth is of no use; nothing is plugged by this procedure, as it
leaves the opening into the nose open.

If you had not anticipated purging in the beginning, and the body has
been embalmed arterially it will be necessary to stop the purging by
the first method.

A third method of preventing purging from the lungs and stomach is in
the use of plaster of paris. In this method the plaster of paris is
mixed thinly, then by means of a paper funnel, pour the liquid into the
nose and mouth, then plug tightly with absorbent cotton as in method
two. It requires only a short time for the plaster of paris to set and
it has been found quite successful. Probably the only disadvantage
of this method is that it is mussy and because of the rapid drying
qualities of the plaster of paris the operator must work very quickly.


=The Thoracic or Chest Cavity.=—Cavity embalming must be resorted to
frequently in the chest or thoracic cavity for the reason that in
certain diseases, especially tuberculosis, fluids cannot enter the
diseased cavities, as the capillaries and small vessels are destroyed
by the disease and the ends of the arteries securely plugged. If
this were not so, the patient would have died of hemorrhage of those
arteries, a thing which seldom takes place.

Again in certain other diseases, especially pneumonia, the fluid cannot
reach the diseased lung, either through the nutrient arteries or by
the respiratory tract, because of the resistance offered. The nutrient
arteries will be filled with coagulated blood and the bronchi, to a
certain extent, with a bloody mucous.

This being the case, the bacteria of putrefaction will begin to develop
within the diseased portions of the lungs, and will be the cause of the
purging so much dreaded by the embalmer.

The thoracic cavity may be treated by one of several methods.

A first method consists in passing a curved trocar into the trachea
just above the sternum and injecting a strong embalming fluid into
the bronchi. In cases of gangrene of the lung, the sputum has a very
offensive odor, which may be disinfected by this method. But it must
be remembered that the ends of the bronchioles which enter the diseased
parts of lungs will be closed (from the nature of the disease), so that
any fluid injected into the bronchi from the trachea will not reach the
diseased part of the lungs. You will thus see that it is absolutely
necessary to use a method in treating the thoracic cavity, whereby
any mass of rotten tissue, which may be present, may become thoroughly
saturated with the disinfectant.

A second method written about the Robbins, is accomplished by inserting
the trocar on both the right and left sides at the tops of the lungs,
and at the bases. At the top of the lungs the trocar is introduced two
inches outside the sternum just below the clavicle. The trocar may then
be pushed in any direction, except toward the sternum, without injury
to any of the larger vessels.

The arch of the aorta passes a little to the right of the sternum and
as high as the lower border of the first rib, then makes a turn to
the left and goes directly back to the left side of the fifth dorsal
vertebra. The superior vena cava lies a little to the right of the
arch of the aorta. The advantage of inserting at this point rather
than above the clavicle is that there are no vessels in the location
in danger of perforation. If the trocar is inserted above the clavicle
on either the right or the left side there is danger of perforating
the subclavian artery or vein, while if the insertion is made next
to the sternum, the aorta may be perforated, in either case breaking
the circulation. Disease fluids are seldom found at the top or apexes
of the lungs, but in consumption, breaking down of the lung substance
usually begins at this point, especially in young cases. To insure a
perfect embalming of the lungs, you should inject at the apexes, about
a half-pint of strong formaldehyde on each side. It should, however, be
remembered that the injection at the tops of the lungs, as suggested,
gives no fluid to the lower parts of the lungs where it is often most
necessary.

It is not an unusual condition to find a whole lobe rotten and broken
down at the base of the lung, and when such a diseased condition exists
the lungs become firmly attached to the chest walls, and unless fluid
is placed below these adhesions it does not reach the diseased parts.
The intelligent embalmer, will never trust to the fluid passing from
the tops of the lungs to the base, as in almost all cases the adhesions
between the lungs and the walls absolutely prevent this taking place.

It is necessary first to draw off by aspiration, at the bases of the
lungs, the fluids which have accumulated and which may be either water,
pus or blood. This is done by inserting a curved trocar of small size,
between the fifth and sixth ribs on the axillary line. The thoracic
cavity extends in the back as low as the last rib and the twelfth
dorsal vertebra and it may be necessary to pass the trocar down into
this part of the cavity in order to remove the fluids.

As soon as the fluids are removed, inject from a pint to a quart of
strong formaldehyde on either side. By so doing the gangrenous and
decomposed part of the lung will be put to soak in the embalming fluid,
which will insure perfect disinfection and an absence of bad odors.


=Abdominal Cavity.=—Often it will be found necessary to do cavity work
in the abdominal cavity. Gases may arise causing a distention of the
abdominal wall, resulting in purging from the mouth and nose. This gas
is the result of putrefaction and fermentation in the alimentary canal.
When one of the principle arteries is injected, the fluid finds its
way to the minute capillaries of the organs of the abdominal cavity,
including the stomach and the intestines. It must be remembered that
often there is a great amount of undigested food and fecal matter in
the stomach and intestines. The only way the fluid which is in the
minute capillary circulation of the stomach and intestines, is able
to reach the inside of those organs and come in contact with the
undigested food and the fecal matter is by soaking through the mucous
wall. No doubt a certain quantity of the fluid does soak through, and
when it does, if there is not much undigested food or fecal matter
in these parts, disinfection will be accomplished and it is in these
cases that we do not have any trouble with distentions of the abdomen.
When however, there is a great amount of undigested food and fecal
matter inside the stomach and the intestinal tract, it is only obvious
that enough fluid can not possibly soak through to disinfect, and
consequently a host of putrefactive, and fermentative germs will begin
their work, with the formation of gases and the distended abdomen, and
perhaps purging from the mouth and nose.

To prevent the formation of gas now which has arisen, a second
injection will do no good. More drastic measures will have to be used.
One method that has long been in vogue is the use of the trocar.

_The Trocar Method._—In this method a trocar varying in length from
six to fourteen inches is used. It may either pierce the abdominal
wall through the umbilicus, or two inches above and two inches to the
left of the umbilicus. Then after the trocar has entered the abdomen
the secret of removing gases successfully depends very largely upon
the operator having a very correct idea of the location of all the
abdominal organs. It is difficult to know when the trocar has pierced
the interior of the stomach, or in fact even to make it pierce the
stomach at all for the peritoneum which is a covering for all the
organs of the abdominal cavity contains a serous fluid which makes
the organs slippery, and even the sharp pointed trocar often does not
take hold as it should. Again it must be remembered that the stomach
is a hollow organ, and for example let us try to pierce a soft rubber
ball, containing air and a small opening, a condition resembling the
stomach, with a trocar, we know that the one wall, will have to be
pushed up against the other wall, and then placed against something
firm, before the trocar will pass through. Just this condition happens
with the stomach when the trocar tries to pierce the arterial wall of
the stomach there is nothing solid to bear against and consequently the
front wall will be pushed up against the back wall and then if enough
pressure is now used to push the trocar through, it is very liable to
pass all the way through both walls.

Again it must be remembered that the descending aorta passes very close
behind the stomach and should the trocar go all the way through the
aorta might be pierced and the circulation in a measure ruined. The one
main disadvantage of this trocar method is that the operator is always
working blindly, it is always impossible to tell just how much damage
may be done to the internal organs and the circulation, and again
should the operator desire to place fluid in a certain part—say the
inside of the intestines or the inside of the stomach or the colons,
will the operator have assured knowledge that he has actually placed
the fluid in the part desired. From the number of experiments that
have been carried out in our anatomical rooms, the proof seems to be in
every case that the fluid has not reached the part it was supposed to
reach.

The advantage of this method is the fact that by introducing the
trocar into the abdominal cavity two inches above and two inches to
the left of the navel that after the abdomen has been treated that the
trocar then can be directed upward into the thoracic cavity and fluid
there distributed to the several parts, but this is seldom necessary.
After the trocar has been removed or better, just before the trocar is
entirely pulled out the operator should sew a circular stitch about the
wound and then as soon as the trocar is pulled out, pull the stitch
closely together as if it were a draw string, and tie. This will
prevent any further leakage from the part.


=The Direct Incision.=—Sometimes before the body is embalmed or a day
or two after the body has been embalmed, there is a distention of the
abdominal wall indicating gases and there may or may not be purging
from the mouth and nose. From the great number of cases that have been
posted in our anatomical laboratories, it has been found that the gas
that has accumulated is as a rule located in either the stomach, the
transverse colon, or the colons in general, but rarely in the small
intestines to the extent that it would do much damage. By the use
of the direct incision, make a cut with a sharp scalpel, about three
inches long in the median line of the body over the abdomen. Start the
cut about one inch below the ensiform process of the sternum and cut
toward the navel. After a cut has been made three inches in length on
the skin, direct the scalpel downward so that it enters the abdomen.
Place the index and second finger in the incision thus made pressing
the organs from the abdominal wall, and carefully cut upward between
the two fingers. This will prevent the operator cutting any of the
underlying intestines.

The incision having been made, it is evident now that the part
containing the gas will come up into the incision. If the stomach
contains the gas it will come up, if the transverse colon contains
the gas it will come up, but that makes no difference, for it is the
part with the gas that the operator is after. Usually the transverse
colon will be the first to come up into the incision, now take hold
of the part with your artery forceps and with a pair of scissors make
a clip through the wall, this will let the gas escape. Do not let
the gas escape into the room not deodorized, so place over the hand
quickly after you have made the clip, a towel, or absorbent cotton
that has been saturated with formaldehyde, this will both deodorize and
disinfect the gas. Keep hold of the part until all the gas has escaped,
and then pick up the arterial tube and inject a small quantity of fluid
in the colon, and then sew up with the circular stitch. Then locate the
stomach, which can easily be found if it contains gas and treat it in
the same way, relieving the gases and then placing a small amount of
fluid inside. Treat the other several parts of the intestines in the
same way if gas be present and it is remarkable how quickly the abdomen
sinks to its normal level. After this has been done place hardening
compound or common salt in the cavity, and placing a layer of absorbent
cotton in the abdomen under the incision, sew up neatly.

The one great advantage of this method is that you can actually see
what you are doing, you can see the part that contains the gas and
treat that part particularly, the operator is not working blindly, but
is able to place the fluid in the part that he desires and is assured
of the fact that it is in the part for his eyes do not deceive him as
the sense of feel and touch sometimes do. By this method the operator
is able to surround the parts of the abdominal cavity with a hardening
compound, and thus feel sure that his case if it is to be shipped,
will be received in proper condition, at least it will be as far as the
abdomen is concerned, if it is treated under this method. This method
is one sure cure for purging, for the gases once properly relieved from
the stomach and the contents disinfected, there is no chance for them
to recur. If the stomach is found to be full of liquid as well as of
gas, as is the condition during purging, the liquid can be taken from
the stomach with a drainage tube or a stomach pump, and lastly every
part is deodorized and disinfected properly.

A seeming disadvantage might be that a critic might suggest that you
are mutilating the body with your abdominal incision. Let a fair
question be asked. If it were your sister that was to be embalmed
and gases had to be removed, which would you rather see some operator
running a trocar here and there through the abdomen, relieving gases
and injecting fluid here and there, or, the use of the neat surgical
incision, made as a surgeon would make it.


=Embalming of the Subcutaneous Tissue.=—It is not always possible to
fill the tissues of the body through the arterial system, the arteries
may be full of blood in a coagulated condition so that it can not
be removed, the walls of the arteries may be diseased, or they may
be severed at many places the result of accidental death, such as
railroad accident, etc. If any of the above conditions be present or
other similar conditions, it will be impossible to inject the arterial
system, or it may be that arterial injection is only partly possible.
In order, in arterial embalming, to have the tissues embalmed the
fluid must reach the capillaries, and to fill the capillaries it is
first necessary to fill the larger arteries. So if for any reason it
is impossible to reach all or certain tissues by arterial embalming, it
becomes necessary to resort to some other means.

With these difficulties then in view, the best operation for filling
the tissues, that is the subcutaneous tissue covering the bony
framework of the body, is the direct injection of fluid into the
part by means of (1) the hollow needle trocar, and (2) the hypodermic
needle.

The hollow needle trocar is to be used for the rough work, so called.
Inserting the trocar into the center of the popliteal space it can be
pushed through the tissues of the foreleg, and fluid injected; then
reversing, push the trocar through the tissues of the leg proper,
and inject fluid. Inserting the trocar into the center of the bend of
the elbow it can be pushed into the tissues of the forearm, and fluid
injected; then reversing, push the trocar through the tissues of the
arm proper and inject fluid. Turn the body over so as to trocar the
back. Insert the trocar above the sacrum bone in the middle line of
the back, and push the trocar through the fleshy parts of the gluteal
regions, and inject fluid. Again insert the trocar in the middle line
of the back between the two scapulae bones, and inject fluid into the
region of the shoulders and the small of the back.

After each puncture, before the trocar is removed a circular stitch
should be thrown around the trocar and when the trocar is removed draw
the puncture shut, the circular stitch acting as a draw string.

A large amount of fluid may be injected in this manner, it being
possible to inject several gallons into a body of average size. The
fluid transudes through the tissues very readily filling them up
completely, but of course, not as certainly as if the fluid were
injected arterially. It is an easy matter to inject from two to three
gallons of fluid into the soft tissues on the outside of the skeleton
of a body weighing from 130 to 140 pounds.

This procedure is only to be used if it is impossible to inject
the body by the ordinary arterial embalming. The cavity work in the
cerebro-spinal, the thoracic, and the abdominal cavity, should be done
first, and then follow with this subcutaneous tissue outside the bony
framework.

This procedure may be used in dropsical cases and in certain cases,
where for some reason the fluid does not reach a certain part, or where
a certain part is not completely supplied with fluid, by the arterial
injection.

The hypodermic needle is to be used for the more delicate work, such
as the hands and the face. Insert the needle at the wrist and direct it
into the palm of the hand, inject a very small quantity of fluid; then
into the back of the hand and inject a small quantity of fluid.

To reach the tissues of the face insert the needle into the muscles and
tissues of the face from the inside of the mouth. The region about the
temple can be reached by inserting the needle into the tissues in the
hair line, which will hide the puncture.

With the use of the hypodermic needle fluid can be placed in contact
with all the tissues of the hands and face, and the cosmetic effect
will be almost perfect if the operator is careful as to the amount he
injects, and is careful to see that, the fluid is equally distributed
throughout the part.


=Plugging Orifices of the Body.=—The proper manner in which to plug the
orifices of the body is to use a pledget of absorbent cotton dipped in
your embalming fluid and forced into all the orifices, following this
up with a pledget of dry absorbent cotton. In this the fluid disinfects
the surface with which it comes in contact and the dry cotton prevents
the outgoing of the germs from the body or the passage inward of
bacteria. It must be understood that absorbent cotton filters out germs
from the air, even though air passes through it, they become entangled
in the meshes of the cotton and there remain.


=Removal of Urine.=—As a rule, in the last throes of death, the bladder
is emptied, but in some instances this is not done and then it becomes
necessary for the embalmer to remove the urine. This may be done in
two ways. Use the steel catheter, insert it in the bladder through
the urethra, and draw off the urine, or use the trocar and insert it
through the abdominal wall in the median line just above the pubic
bone, directing the end of the trocar into the bladder which lies just
below the pubic bone and draw off the urine. It is seldom necessary to
inject the bladder with fluid, as after the urine has been removed, we
find from general experience that it is well supplied with fluid from
the arterial injection.

In the male it is wise to tie a string about the penis just back of the
head, or glans, while in the female it is best to plug the meatus of
the urethra and the vagina with cotton.



CHAPTER XVIII.

THE REMOVAL OF BLOOD.


=The Removal of Blood.=—In November 1882, Prof. J. H. Clarke and Dr.
C. M. Lukens, while instructing a class in Philadelphia, in taking up
the carotid artery, the internal jugular vein was injured and a flow of
blood followed much to their dismay. This however turned out to be one
of the greatest events that ever happened for the embalming profession,
as it marked the beginning of the practice of the removal of blood from
the body.

There are some very important reasons why blood should be removed from
the body.

(1) There may be discolorations on the body, especially the face.
This discoloration may be due to the presence of blood in the minute
capillary system and other vessels which are near the surface skin.
This discoloration may be due to the presence of the bile pigments
in the blood, which would tend to give the body a yellowish hue. This
discoloration may be due to the breaking up or disintegration of the
blood corpuscles after death, which would tend to give the tissues of
the body a light, pale, yellow color. Or this discoloration may be due
to the presence of chromogenic bacteria, or color producing bacteria,
in the blood, which might give to the tissues a characteristic green
color.

(2) There may be blood in the arterial system after death, which
certainly will have to be removed or else it may be pushed into the
tissues of the face during the injection of the fluid and cause a
discoloration. Besides if the arteries are congested with blood, this
will have to be removed to make room for the embalming fluid, so that
it will reach the capillaries and the tissues of the body.

(3) There may be the formation of tissue gas, and there is no doubt but
that the removal of blood will greatly facilitate in the treatment, for
without the blood, the fluid will have more chance to act on the parts
containing the gas. This gas may be in the blood vessel itself, and
the removal of that blood then will relieve the gas and the pressure
exerted by the gas, which will aid in the injection of the fluid.

(4) To prevent a hasty decomposition. It may be that our subject is
very heavy and fleshy which will mean that there is more tissue to be
preserved and necessarily more fluid will have to be used. To make room
for this increased amount of fluid, blood should be removed.

It may be that the body is in a hydropic condition. The tissues and
the blood vessels will be filled with water. This will mean a hasty
decomposition. The watery blood should be drawn from the blood vessels
in order to make room for more fluid than ordinarily.

It may be that the body has died of a fever, which will also mean a
hasty decomposition. This will mean that the blood will soon coagulate
after death, and therefore the sooner it is removed, the better for the
general cosmetic effect.

We do not however believe that blood should be removed from every
subject, in order to get good cosmetic effect. Rather there are times
when blood should not be removed, the conditions which are as follows:

(1) In the thin emaciated subject where there is no discoloration. An
example of this condition would be in the tubercular subject, where
before death the body has become very thin and emaciated. We would not
remove blood when the subject is in this condition, for as a rule the
body will take plenty of fluid, the arteries are as a rule empty after
death, and besides we desire to leave the blood in the body, in order
to give the skin of the face a more filled out healthy cosmetic effect.

(2) In the pale, marble-like, anemic subject. We would not remove blood
in this case, first because it is not necessary, for there is a lack of
blood in the surface capillaries showing that the arterial system is
completely empty, and there is no congestion of the veins; secondly,
experience teaches us that in these cases, you probably would not get
any blood if you did try to remove it, and thirdly what little blood
is in the surface capillaries is needed to build up a more healthy
cosmetic effect.

There are times when blood should be removed from the subject after
death which are as follows:

(1) Whenever blood is found in the arterial system. An example of
this might be found in those cases of sudden death, such as drowning,
suffocation, electric shock, or general heart failure. Whenever there
has been a case of sudden death, the operator may expect to find blood
in the arterial system. The last contraction of the heart normally
would drive all the blood out of the arteries and arterial capillaries
into the venous capillaries and veins, but this is not accomplished in
the cases of sudden death. Whenever, on incising an artery, you find
blood in the artery, and it runs freely, it indicates that there is a
considerable quantity of blood in the arterial system. This blood then
should be removed, because, were fluid to be injected into the artery,
when it is full of blood and in this congested condition, all of this
blood would be pushed ahead of the fluid toward the center of pressure,
and from there large quantities would be pushed back into the tissues
of the face, which would result in a greatly discolored face and a very
poor cosmetic effect. DO NOT FORGET. Always remove blood when you find
it in the arteries. The regular blood drainage tube should be placed
in the artery, and all the blood removed that is possible, before
attempting to inject. If this blood is not removed, the operator need
not be surprised if he causes a decided blood discoloration of the face
and a bad cosmetic effect. In these cases blood should be removed from
the veins too, for that procedure will help to make room for what blood
does remain in the arteries and capillaries, so that it can be pushed
by the fluid into the veins rather than the tissues of the face.

(2) When the venous blood vessels are congested with blood and gas. An
example of this might be found in almost any case. When the operator
makes the incision to disclose the vessels and finds the venous
channels congested, or when over the body the surface veins show signs
of congestion and distention with gases, then blood should be removed.

(3) In dropsical cases. Often in these cases the tissues throughout
the body are in a hydropic condition (filled with water), the arteries
as well as the veins are filled with a watery, bloody colored fluid.
It will be best for the operator to remove all this watery blood from
the arteries, veins, and the tissues also, in order to get the greatest
amount of preservative action from his fluid.

(4) In heavy, fleshy subjects. Experience teaches us that these bodies
are as a rule difficult to handle from a cosmetic, as well as from
a preservative standpoint. It seems advisable to draw blood from
these subjects whenever possible, and by so doing bring about a clear
non-discolored cosmetic effect; also the removal of blood will give
more room for a greater supply of fluid, and thus the tissues will be
better preserved.

(5) When the face is discolored. Whenever the operator takes charge of
a body and finds the face discolored, no matter what the cause of the
discoloration may be, it is a good indication to remove blood from that
body.

By removing blood from the larger venous channels, the operator will
make room for the blood to leave the face, and in this way better
cosmetic effect is assured. Massage the face toward the internal
jugular vein, and push the discoloring blood from the tissues of the
face, out into the larger channels, that have been emptied by the
removal of blood.

(6) In fever. Whenever a body dies in a high state of fever, it
indicates a hasty coagulation of the blood, and a tendency to a
discoloration of the face. Whenever the operator knows that the subject
has died of a fever, or when there has been considerable fever on the
body before death, then blood should be removed.

(7) To make room for fluid. The average embalmer only injects a gallon
to a gallon and a half of fluid into a body. There are times when the
operator desires to use more fluid. It may be that the body will have
to be shipped a long distance, perhaps to another country or a distant
state. After a certain amount of fluid has been injected the vessels
become filled up and there is a great resistance established. If the
operator disregards this pressure, and forces still more fluid into the
arterial system, the fine capillary network will be broken, especially
in the lung where the result will be a leakage of fluid through the
mouth and nose from the ruptured air cells in the lung, or in the
tissues of the skin, where the result will be a leakage into a certain
area of tissue later causing a condition known as leathery skin. To
have prevented this the operator should not have forced the fluid
beyond a certain maximum resistance. He could, though, have reduced
this resistance by removing the blood from the venous system, and then
succeeded in the further injection of fluid.

There are times when blood ought to be removed from a subject after
death, but for some reason it seems impossible to remove any. The
reasons may be stated briefly as follows:

(1) The blood may already be in a coagulated condition, owing to the
fact that the body has died in a state of high fever.

(2) The blood may be in a coagulated condition owing to the fact, that
the bacteria of decomposition and putrefaction, have so altered the
blood as to make its removal impossible.

(3) Certain drugs may have been previously given, or taken during life
which would cause a hasty coagulation of the blood.

(4) The body may still be in a condition of rigor, and although the
operator may have released the rigor in the joints, still all the
tissues are in that condition, a condition which might prevent the
blood from draining from the veins no matter what method was used.

Arterial blood is removed from the aorta indirectly, and from the
arteries, only when the arterial system contains blood after death.

Venous blood is removed from the right side of the heart directly or
indirectly, and the veins, only when it is deemed necessary by the
operator.

There are two methods of removing this arterial or venous blood from
the body. These two methods are aspiration and drainage. Besides these
two methods some modified methods or combinations of the two, are
given.

Aspiration consists in actually pumping the blood from the heart,
arteries or veins. In this method, if blood is to be taken from the
heart directly, the trocar is used; if the blood is to be taken from
the heart indirectly or from the arteries or the veins one of the
drainage tubes is used. Either the trocar or the drainage tube is
connected by rubber tubing, to the goose neck on the blood bottle,
which in turn is connected by rubber tubing to the aspirator side of
the aspirator and injector pump. When the air is drawn from the blood
bottle, there is a vacuum formed, which will aspirate or draw the blood
from the heart directly or indirectly from the arteries or veins. The
one great disadvantage of this method is that if the vacuum is made too
great, the artery or vein will collapse ahead of the drainage tube and
thus prevent the successful aspiration of the blood.

Drainage or gravity consists in opening one of the principle arteries
or veins of the body, inserting a blood drainage tube into the artery
or vein as far as it seems practical, and then connecting the blood
drainage tube to the blood bottle by means of rubber tubing. The blood
bottle should be placed considerably lower than the body in order to
have the blood drain successfully. If the femoral artery or vein is
used, the body ought to be on a considerable incline, the head at least
one foot higher than the feet in order to get the maximum amount of
blood.

If the axillary, brachial, or carotid, or their corresponding veins
are used, the body ought to be on a level or turned to the side of the
opening veins.

Simple drainage in itself is not a very successful method of getting
the maximum amount of blood from the body.

The process can be modified in three ways which are as follows:

(1) By placing the blood drainage tube in the vein and the arterial
tube in the corresponding artery. Inject fluid into the arteries
which will tend to push the blood in turn from the capillaries into
the veins, and out into the drainage tube into the blood bottle. This
modified method has been called by Robbins “Displacement.” This is a
good name and one which should be generally adopted.

(2) By placing the blood drainage tube in the artery or vein,
preferably the femoral, and connect it by means of rubber tubing to
the blood bottle. The operator now stands at the head of the subject,
he reaches over, takes hold of each hand of the subject, raises the
arms of the subject to right angles with the subject, then crosses the
arms and with a steady gentle pressure bears down on the chest of the
subject over the heart region.

If the axillary is used the operator is able to manipulate but one arm,
the one opposite. Raise this arm to right angles with the body then
fold down on the chest, exerting an even steady pressure. By raising
the arms the blood will leave the hands, and each time pressure is
exerted on the chest blood begins to flow from the artery or the vein,
and will continue to flow as long as the even pressure is exerted.

(3) By the combination of number one and two. The operator opens the
artery, preferably the femoral, inserts the arterial tube, and injects
a pint of fluid to exert a pressure on the venous system. He then opens
the vein, inserts the blood drainage tube which is connected with the
blood bottle. With the pump in his right hand (granting that he is
using the aspirator and injector pump), he stands at the head of the
subject and slowly injects the fluid. If at any time the blood ceases
to flow, by taking hold of the hands, raising both arms at right angles
to the subject, crossing, and while in this position injecting a few
ounces of fluid, then bear down gently on the chest with a steady
pressure. If the blood will not flow by this method and the operator
is using either the axillary or the femoral, there is hardly any use of
trying any other method. The operator will be able to draw the maximum
amount of blood with this method, if it is at all possible to draw
blood.

Often when the blood stops flowing, there is a blood clot formation
ahead of the drainage tube. By injecting just a few ounces of fluid or
salt water through the tube into the vein, the clot may be pushed to
one side, and the blood will continue to flow.


=Removal of Blood from the Right Auricle of the Heart. Direct
Method.=—Insert the trocar in the third intercostal space, just to
the right edge of the sternum or the breastbone. The trocar should be
inserted obliquely, the point of the trocar is to pass in the general
direction of the left hip joint, while the open end of the trocar is to
point in the general direction of the right ear. A general knowledge of
the anatomy as far as the location of the heart is absolutely necessary
to master this procedure. The object is to have the point of the trocar
pierce the right auricle of the heart. When the trocar has pierced the
right auricle, which the operator will have to judge through practice,
attach rubber tubing to the gooseneck of the blood bottle and by the
use of the aspirator pump, draw the blood from the heart into the blood
bottle. This is removal of blood by aspiration.


=Removal of Blood from the Right Ventricle of the Heart. Direct
Method.=—Insert the long thin twelve or fourteen inch trocar two inches
above and two inches to the left of the navel and pierce the abdominal
wall, pass the trocar keeping the point close to the abdominal wall,
in the general direction of the right shoulder as far as the lower
border of the third intercostal space, without fear of breaking any
circulation. The right ventricle will thus be reached from which blood
can be aspirated as in the previous method. Here again a general
knowledge of the anatomy as far as the location of all the organs
in the upper abdominal and thoracic cavity is necessary to perform a
successful operation. This is removal of blood by aspiration.


=Removal of Blood from the Right Auricle of the Heart. Indirect
Method.=—Make the incision for the femoral artery and vein.

Raise the artery and inject about a pint of fluid in order to cause a
pressure on the venous system. Open the vein and insert the flexible
rubber drainage tube, known on the market as the Red Seal drainage tube
or the Worsham drainage tube. Push this tube up through the femoral,
external iliac, the ascending vena cava, through the eustachian valve,
and into the right auricle of the heart.

In order to determine when the tube is inside the right auricle, the
operator should have laid the tube on the external surface of the
body from the point of entrance to the point where the right auricle
normally should be, allowing for the bend of the vein in its course.
Mark the tube, then when it has been pushed into the vein to that point
the operator is reasonably sure that the end is in the right auricle.

In order to make the tube slip easily it should be greased with a
liquid solution of vaseline.

After the tube has reached the right auricle the blood may be allowed
to drain, or it may be aspirated.

Either femoral may be used, but the left femoral is preferable owing to
the fact that, the angle at the bifurcation of the ascending vena cava
is more obtuse.

If the operator desires to remove blood from the heart, we believe that
the indirect method is the better way. By the use of the direct method
to draw blood from the right auricle by means of the trocar there is
always danger of rupturing the circulation. The aorta may be accidently
pierced. When the trocar is inserted from below to reach the right
ventricle the stomach may be punctured and the liver and diaphragm will
have to be pierced which, too, may mean an injured circulation. If any
accidental damage has been done, it can not be remedied. The direct
method is a blind procedure and is always uncertain. On the other hand
if the flexible rubber drainage tube is inserted into the vein it must
follow the channel of that vein. It is more certain than the trocar
method and there is no danger of rupturing the circulation.

The basilic or axillary vein may be used to remove blood from the heart
instead of the femoral. These veins should be used on the left side
of the body owing to the fact that the angle at the junction of the
subclavian and internal jugular veins is not so acute as on the right
side.


=Removal of Blood by the Use of the Femoral Vein.=—The use of the
femoral vein is considered by some operators a very good method. The
femoral should be employed in the upper third. Make the incision in
the center of Scarpa's triangle, just below Poupart's ligament. The
incision should be about two inches in length, the length of the
incision usually depends upon the size and thickness of the thigh and
the depth of the vein in the tissue. Expose the artery and the vein.
The vein at this point will lie to the inside of and a little below
the femoral artery. Open the artery and inject about a pint of fluid to
cause a pressure on the venous system.

Have all the blood drainage outfit in readiness then open the vein
and quickly insert the drainage tube. Any of the drainage tubes now
commonly sold on the market are good. For the femoral, though, the
flexible rubber drainage tube seems to be the best, because the femoral
vein dips deep down into the posterior part of the abdomen after
it leaves the Poupart's ligament. The flexible rubber drainage tube
will follow this bend and can be pushed as far as is desired by the
operator, in contrast the steel drainage tube could only be pushed into
the vein for a few inches.

Blood ought to drain out into the blood bottle, if it does not, inject
a little more fluid to cause more pressure on the venous system, and if
it will not flow by the drainage method or any of its modifications try
the aspirator. If blood still will not flow, it may mean that there is
a clot ahead of the drainage tube. Pump some fluid through the drainage
tube into the vein, to see if the tube is open, then let the fluid
drain out which usually will bring some blood. After you have tried all
the methods, if blood still does not flow, it will indicate that the
blood is either in a coagulated condition, or there is not very much
blood in that particular vein, which in this case is the femoral. The
blood may be more in the dependent parts of the body.


=Removal of Blood from the Axillary Vein.=—The axillary vein is of
large size, and is formed by the junction of the venae comites or
deep brachial veins with the basilic. The axillary vein begins at the
lower part of the axillary space, increases in size as it ascends by
receiving tributaries corresponding in name with the branches of the
axillary artery and terminates immediately beneath the clavicle at the
outer margin of the first rib where it becomes the subclavian vein. To
remove blood from the axillary vein, raise the vein to the surface,
and insert the drainage tube. The Eckels-Genung steel drainage tube
will perhaps be the best tube to use. Insert the drain tube high up in
the arm pit, pass through the subclavian, to beyond the valve located
in the subclavian vein outside the point at which the internal jugular
vein unites with the subclavian to form the innominate. There being no
more valves the blood should pass out freely. If the blood does not
flow, raise the axillary artery, begin the injection of fluid which
will tend to cause a pressure through the capillaries on the venous
system pressing the blood back to the right auricle of the heart as
in life, and as there is no obstructed passage the blood should flow
freely from the tube. The vein tube is of metal having a plunger rod
within, and a Y attachment at the upper end. The blood runs from the
Y shaped attachment into a rubber tube which is connected with the
blood bottle. A flexible arterial tube should be used in the artery,
which will measure eight to ten inches in length and constructed with
a shut-off valve. The tube will reach the innominate artery close to
the arch of the aorta. With these arterial and drainage tubes the arms
can be folded and placed in position, with the hands over the abdomen
and the tubes will extend out over the upper border of the arm. This
method will enable the operator to inject the body and have the arms in
their natural position. If a short circuit through the internal mammary
vessels occurs, and this will be evidenced by the premature flow of
thin blood, close the vein tube now and then during the operation,
continuing the injection until the proper results are obtained.


=Removal of Blood from the Basilic Vein.=—To withdraw blood from
the basilic vein the left arm should be employed, because of a more
direct route to the right auricle. Make the incision in the middle
or the upper third of the arm. The basilic vein lies in the upper arm
and extends from the elbow to the shoulder, and can be found a short
distance from the brachial artery, either above or below, but generally
below and toward the body. Its position is not always the same, owing
to the many anomalies that might occur. As a rule the vein is quite
large and prominent and when secured, raise to the surface freeing it
from the surrounding tissues.

Prepare two ligatures, make the incision in the vein and pass gently
the basilic drainage tube upward toward the heart. Either a steel or
rubber tube may be used. If the flexible rubber tube is used, it will
find its way to the right auricle of the heart, its course is through
the basilic, axillary, sub-clavian, innominate, superior vena cava, to
the right auricle. Either the aspiration or the drainage methods may be
used. If these fail try the displacement method.

The use of the basilic for the removal of blood is fast disappearing
from general practice. Larger veins can be used, which will always
insure greater success.


=The Removal of Blood from the Internal Jugular Vein.=—The internal
jugular vein is the largest tributary vein in the body, and accompanies
the carotid artery. The operator will cut through the skin at a point
from one half inch above the clavicle or collar bone and in the valley
formed by the sterno-mastoid muscle to the outside and the muscles
of the wind pipe to the inside, cut upward making the perpendicular
incision. Raise both the artery and the vein according to the usual
method. It seems best to raise the artery and the vein together, and
by so doing this will tend to give added strength to the vein which is
very large but has quite thin walls.

Direct the hook around the vein first then around the artery toward
the wind pipe or trachea, raise both to the surface, place on the
bone separator, and remove the sheaths. Use any of the drainage tubes.
Insert the vein drainage tube and the arterial tube, the point of both
tubes being directed toward the heart. The injection should be made
slowly, which will cause the blood to flow from the vein through the
tube and into the blood bottle.

This vein is not as much used as the axillary or the femoral for the
removal of blood.

It is true that it is very close to the center of circulation and a
gateway for the blood from the face. The chief disadvantage is that the
vein lies quite deep, is very large and has such thin walls, that it is
almost impossible to raise it without a rupture.

About one-thirteenth of the body's weight is calculated to be blood.
Granting for the sake of argument that the average body that we
would desire to draw blood from would weigh 208 pounds, then that
average body would contain 16 pounds of blood. One pound of blood is
practically equal to one pint, making the average body to contain about
16 pints of blood.

After death about one-fourth of the blood of the body is found in the
portal system. The portal system has capillaries at both ends so that
it is impossible to draw this blood.

After death about one-fourth of the blood of the body is found in the
tiny capillaries and tissues, blood which by the ordinary methods used
today the embalmer is unable to draw.

After death about one-fourth of the blood of the body is found in the
azygos system, and points dependent in the body, which blood, too, it
is impossible to draw.

This leaves about one-fourth of the blood of the body, which we are
able to draw. One-fourth of 16 pints, is 4 pints which is the maximum
we can draw from the average body.

The point of this argument is that if from the average body you have
taken from two to four pints of pure undiluted blood, then you should
be satisfied. If the majority of this blood has been taken from the
face you will get the desired cosmetic effect. The claims by some that
they are able to draw a gallon or more of blood is in our judgment
erroneous, as we feel the blood has been greatly diluted. We have
tested this out many times with the aid of control solutions and have
found that what the embalmer would ordinarily call thin blood was
composed of from 10 to 30% blood and from 70 to 90% fluid.



PART IV.

TREATMENTS



Infectious Diseases



CHAPTER XIX.

TREATMENT OF SPECIAL DISEASES.


=Anthrax.=—_Synonyms._—Malignant Pustule; Splenic Fever, Wool-sorter's
Disease; Carbuncle; Charbons.

_Definition._—An acute infectious, non-contagious disease, caused by
the bacillus anthracis, and characterized by the formation of a boil
with a circumscribed, infiltrated base and dark center, and a systemic
infection of a severe type, the toxemia being of the gravest character.

_Pathology._—The blood is dark, thick, diffluent, and rich in the
spores of this disease.

_Treatment._—Wash the body with 1 : 500 bichloride of mercury or 5%
carbolic acid. Inject the arteries, using 64 ounces of half strength
fluid followed by enough normal fluid to secure preservation. Inject
the cavities with normal fluid. Drain blood from the veins, and
disinfect the blood before disposing of it. Close the openings of the
body. For transportation, govern yourself according to the provisions
of the transportation rules.


=Cerebro-spinal Fever.=—_Synonyms._—Spotted fever; Cerebro-spinal
meningitis; Typhus syncopalis; Malignant purpuric fever.

_Definition._—An acute, infectious non-contagious disease, occurs
sporadically, epidemically and endemically characterized by hyperemia
of the brain and spinal cord, and sometimes attended by a petechial
eruption.

_Cause._—The meningococcus intracellularis of Weichselbaum.

_Pathology._—In those cases that speedily prove fatal, there are
little, if any, changes in the blood or tissues after death. Where
the disease has continued for several days, however, we find the
characteristic suppurative exudation. The sinuses of the brain contain
blood clots. Sometimes pus is found in the internal ear, and the
chamber of the eye. The liver, spleen and kidneys are usually slightly
engorged and somewhat softened. There occurs in quite a number of cases
a petechial eruption; the purpuric spots may be quite profuse, or but
one or two may be seen.

_Treatment._—As the means of ingress and egress of the infectious
material is not known, it is best that we give these cases a thorough
treatment; which should include a full arterial injection, drainage
from the vein, injection of the cavities, and full care of the exposed
portions of the body by washing same with a 1 : 500 solution of
bichloride of mercury. The ears should be treated by packing them with
absorbent cotton saturated with the fluid or with bichloride of mercury
solution. The eyes should be carefully cleansed with a soft cloth or
with cotton saturated with bichloride of mercury solution. The arterial
injection should consume an amount of fluid equal to 10 per cent. of
the body weight. Give full cavity injection. Govern yourself by the
regulations of your district for transportation of these cases.


=Erysipelas.=—_Synonym._—St. Anthony's fire.

_Definition._—An infectious, non-contagious disease, characterized
by an acute and specific inflammation of the skin and subcutaneous
tissues, attended by a shining redness, which spreads rapidly, marked
swelling and pain, and which finally terminates in desquamation.

_Cause._—This disease is supposed to be caused by the streptococcus
erysipelatis.

_Pathology._—The blood vessels are dilated and distended with
blood, the cell infiltration may extend into the deeper tissues with
suppuration. The cocci are found in the lymph spaces of the affected
area, also in the lymph vessels. There is a true dermatitis, involving
the skin, subcutaneous, and mucous surfaces.

_Treatment._—Operator should wear rubber gloves. Wash the body
externally with 1 : 500 solution of bichloride of mercury using
absorbent cotton in the process. If crusts have formed bathe the spots
with sweet oil, which will soften them and which will allow you to
remove them; destroying them by burning would be the best means of
disposal. If the face be the part affected, treat as above and then
apply the following solution to the part with lintine (Moadinger) or by
simple saturation: boric acid, one drachm; glycerine, one ounce; water,
three ounces.

Inject the first 64 ounces of fluid at half the normal strength,
gradually strengthening the fluid until the tissues become firm. Drain
blood freely from a large vein and disinfect the drawn blood before
disposing of it. Allow the softening solution mentioned above to remain
on the face until you are ready to place the body in the casket, when
the face can be dried and the usual cosmetic powders applied. Should
the peritoneum or the pleura be affected, inject the proper cavities
with very strong fluid. For transportation, govern yourself according
to the provisions of your district rules.


=Glanders.=—_Synonyms._—Farcy.

_Definition._—A specific, infectious, non-contagious disease of the
horse, communicable to man by inoculation, and characterized by the
formation of nodules in the mucous membrane of the nose-glanders; and
also beneath the skin and lymph structures—farcy.

_Cause._—In 1882, Loeffler and Schütz discovered the bacillus mallei
which is the exciting cause of this disease. The infectious material
is transmitted directly from horse to men, usually through an abraded
surface, and occurs most frequently among hostlers, veterinarians,
farmers, and those who come in contact with horses. It has been
communicated from man to man, but this is rare.

_Pathology._—There are found nodules located in the nose, in which case
the disease is called glanders; or beneath the skin, in which case it
is called farcy. These nodular masses discharge a yellow pus, which
will infect any abraded surface.

_Treatment._—Disinfect the oral and nasal openings, and wash the body
with a good germicide. Give a thorough arterial injection, using half
strength fluid in the first bottle and normal thereafter. Drain blood
from a large vein, disinfecting the blood before disposing of it. Give
a complete cavity injection. Close openings. For transportation, govern
yourself according to the provisions of the transportation rules.


=Hydrophobia.=—_Synonyms._—Rabies.

_Definition._—A specific infectious, non-contagious disease peculiar
to animals, especially the dog, and communicable to man by inoculation,
generally by a bite. It is characterized in many by melancholia; great
fear of water; violent spasms of the pharynx and larynx, rendering
deglutition and respiration very difficult; great prostration, a stage
of paralysis, which generally terminates in death.

_Cause._—The specific cause has not been determined, though
bacteriologists agree that it is of microbic origin.

_Pathology._—The blood vessels of the cerebrospinal system are
congested.

_Treatment._—Wash the body with 1 : 500 solution of bichloride of
mercury, or 5% carbolic acid. Inject half strength fluid into a large
artery for the first part, followed by enough normal fluid to secure
preservation. Drain blood from the veins and disinfect the blood
before disposing of it. If circulation to face and head is impaired
through the cerebral congestion, open the common carotids and inject
upward, draining from the internal jugular vein. Give thorough cavity
injection. Close all openings of the body. For transportation, govern
yourself according to the transportation rules.


=Relapsing Fever.=—_Synonyms._—Typhus recurrens; Bilious fever; Famine
fever; Hunger pest; Spirillum fever.

_Definition._—An acute, infectious and non-contagious disease,
characterized by a series of exacerbations and remissions, each lasting
from five to seven days, and prevailing epidemically.

_Cause._—The spirillum of Obermeier.

_Pathology._—There is no characteristic change in the solids of the
body. There is sometimes icteric discoloration during the disease and
the tissues are stained after death. The liver, kidneys and spleen are
somewhat enlarged. The heart becomes soft. The body retains its heat a
long time after death and the blood coagulates slowly if at all.

_Treatment._—Arterial injection with half strength fluid, followed, in
the second and third parts, with normal fluid. Drainage of blood. Spray
fluid over abdominal viscera, through the usual puncture.

For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.


=Syphilis.=—_Synonyms._—Pox; mal-venereal; lues venereal.

_Definition._—A specific infectious, non-contagious disease, weeks
or months are occupied in its development; contracted by inoculation
which is known as acquired syphilis, or hereditary, which is congenital
syphilis, and is characterized by three distinct stages; primary,
secondary, tertiary.

_History._—”In all probability syphilis is as old as the human race;
for we can readily believe that illicit intercourse was practiced in
the cities of the ancient world when the morals of the people were more
lax than those of today. Our knowledge of the disease, however, dates
from the fifteenth century. Breaking out among the troops of Charles
VIII, King of France, it rapidly spread over Europe. From then to
the present day our knowledge of the disease has grown, till today we
are able to classify and separate the various lesions resulting from
illicit and promiscuous intercourse. All forms of venereal disease were
included under the name of syphilis till Ricord, in 1831, demonstrated
that gonorrhea and syphilis were two distinct diseases.”

_Etiology._—Predisposing causes are injuries or abrasions of the mucous
surfaces of exposed parts, for the disease can originate in only one
way, by inoculation.

_Modes of Infection._—There are three modes of infection; illicit
intercourse, heredity and accidental. Of these the embalmer need only
consider the accidental form of infection.

_Pathology._—The initial lesion is the chancre, the secondary lesions
are ulceration of the mucous surfaces and cutaneous eruptions, and the
tertiary lesions are inflammatory products known as gummata, and are
found upon the bones and periosteum, or in the skin, muscles, liver,
kidneys, lung, heart, brain; in fact in any of the viscera of the body.

_Treatment._—Wash body thoroughly with 5% carbolic acid or 1 : 500
solution of bichloride of mercury. Work with rubber gloves. Inject half
strength fluid for the first 64 ounces of fluid and follow that with
normal fluid until disinfection and preservation are assured. Give the
body a complete cavity injection with normal fluid. Drain blood from
a large vein, and disinfect the blood before disposing of it. Close
all openings of the body with absorbent cotton saturated with normal
fluid. Bandage any large sores and saturate the bandage with normal
fluid. When purpura (characterized by a blue spot on the face) exists,
the discoloration cannot be removed. If anything is to be done at all
for the discoloration, it must be of the nature of a covering for the
spot, such as paint or other cosmetics. For transportation of the body,
govern yourself according to the transportation rules.


=Tetanus.=—_Synonyms._—Lockjaw; Trismus.

_Definition._—An acute infectious, non-contagious disease,
characterized by painful spasmodic contraction of the voluntary
muscles, most frequently those of the jaw, face, and neck; less
frequently those of the trunk, the extensors of the spine and limbs.

_Cause._—The cause is recognized as the bacillus tetanus.

_Pathology._—The infection usually enters by way of a wound, especially
of the hands and feet, and a punctured wound rather than an incised
one. The post-mortem lesions are not constant.

_Treatment._—The body should receive a complete arterial injection
using half strength fluid for the first part of the injection, followed
by sufficient normal fluid to secure preservation and disinfection.
Blood should be drained from the veins and should be disinfected before
being disposed of. Wash the wound with 1 : 500 solution of bichloride
of mercury and bandage it to avoid infection from it. Inject the
cavities of the body. Close the openings. For transportation, govern
yourself according to the provisions of the transportation rules.


=Actinomycosis.=—_Synonyms._—Big Jaw; Lumpy Jaw.

_Definition._—A specific infectious, non-contagious disease of domestic
animals, particularly cattle, communicable to man, and caused by the
ray-fungus.

_Pathology._—Infection takes place, as a rule, through the mouth,
through a cut or abrasion of the skin and rarely through the
respiratory tract. The fungus produces a tumor, with a rapid
proliferation of the neighboring connective tissue. The disease is not
limited to any organ as the name lumpy jaw would imply; we may have
actinomycosis of the lung, digestive tract, and of the skin.

_Treatment._—Disinfect the outside of the body by washing with a good
germicide. Care should be exercised against inoculation through an
abrasion of the skin. Give the body a thorough arterial injection,
draining blood, and disinfecting the blood before disposing of it.
Close all openings. For transportation, govern yourself according to
the provisions of the transportation laws.


=Dengue.=—_Synonyms._—Break-bone fever; dandy fever; broken-wing fever.

_Definition._—An acute, specific, infectious, non-contagious fever,
occurring epidemically in tropical and subtropical climates and
characterized by two severe paroxysms of fever, separated by an
intermission, great muscular pain, and usually attended by an eruption.

_Cause._—The nature of the infection or contagion is not known. That it
is infectious is shown by the rapidity with which it spreads when once
it invades a section. In 1885, within a few weeks, sixteen thousand,
in Austin, Texas, were stricken. Neither age, sex, race, nor position
exert an influence in staying the disease.

_Pathology._—As few cases prove fatal, but little opportunity has ever
been given to study its pathological character. There has been found
infiltration of the tissues about the joints. It is rare for a case to
end fatally, only few succumbing to its influence. For this reason the
embalmer will not have many of these cases to treat.

_Treatment._—As this rarely comes excepting in the epidemic form,
that form will be treated on. The body should be washed with a good
germicide, and all openings should be closed with absorbent cotton. The
body should then receive a very heavy arterial injection, with drainage
of blood, and cavity injection. As is the case in epidemics, the body
should be buried as soon as possible. While the mortality is light, yet
the most strenuous treatment should be given to assist in the campaign
of the health authorities against the disease and its spread. When more
is known about the characteristics of the disease, it is likely that a
more definite treatment can be advised.


=Malarial Fever.=—_Synonyms._—Ague; Chills and fever; Intermittent
fever; Swamp fever; Marsh fever; Paludal fever.

_Definition._—A specific, infectious, although non-contagious disease,
caused by the hematozoa of Lavaran, and consisting of two distinct
parts; first, a succession of exacerbations and intermissions, or a
series of short fevers separated by short intervals of health; second,
a continued fever made up of exacerbations and remissions, there being
but one cold stage.

_Cause._—The hematozoa of Lavaran.

_Pathology._—There is a destruction of the red blood corpuscles, due
to the action of the parasite. There is an increase of pigment, in the
spleen, liver, kidneys, bone marrow, skin, and in fact, in all the
tissues, due to the conversion of hemoglobin into pigment granules.
The spleen is enlarged as are also the liver and the kidneys. The skin
presents a jaundiced appearance in chronic malarial fever.

_Treatment._—Arterial injection of 64 oz. 1% solution of borax or
oxalic acid followed by 64 oz. of half strength fluid and then a
sufficient quantity of normal fluid to complete preservation. Drainage
of blood and solution to wash stain from capillaries. Application of
full strength peroxide hydrogen to face, and massage during injection.

For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.


=Yellow Fever.=—_Synonyms._—Typhus ichteroides; Febris flava; Black
vomit; Yellow jack.

_Definition._—An acute, infectious, though non-contagious disease of
the tropics or sub-tropics, characterized by a high grade of fever,
lasting from two to seven days, tenderness over the epigastrium
(stomach), vomiting of black, broken down blood, and yellow
discoloration of the skin.

_Cause._—Not known, although it is definitely known that the infection
is spread through the bite of a species of mosquito, the stegomyia
fasciata.

_Pathology._—The skin and the mucous membranes show a varying degree
of jaundice, from a light yellow to a dark brownish or orange color;
the color deepening over the course of the blood vessels. The stomach
contains more or less of broken down blood, the so-called black vomit.
The blood is dark and broken down.

_Treatment._—Arterial injection of 64 oz., of half strength fluid
followed by sufficient normal fluid to assure disinfection and
preservation. Drainage of contents from vein and massage of face with
full strength hydrogen peroxide in an attempt to clear the complexion.
Full abdominal cavity treatment, and close orifices of the body.

For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.


=Diphtheria.=—_Synonyms._—Diphtheritis; angina maligna; membranous
croup.

_Definition._—An acute infectious, contagious disease characterized by
a grayish-white, fibrinous exudate, usually located on the tonsils or
the neighboring tissues.

_Cause._—This is the bacillus diphtheriae, although some still hold
that the specific cause has not as yet been determined.

_Pathology._—In the severe forms the deeper connective tissues are
involved, and there may be extensive destruction of tissue, including
the blood-vessels. There is more or less discoloration of the tissues
from extravasation of the coloring matter. The kidneys and spleen
may be enlarged. The blood is more or less broken down, the fibrin is
deficient.

_Treatment._—Disinfect the oral and nasal cavities with the embalming
fluid. Wash the body externally with 1 : 500 solution of bichloride
of mercury. Inject an amount of fluid equaling 10% of the body weight
into the arteries, and give cavity injection. Drain blood and inject
additional fluid to make up for that which will be lost in drainage.
In young persons the strength of the fluid for the first 64 ounces of
the injection should be cut to half of the normal strength. Close all
openings of the body with absorbent cotton. Dress the body and then
place it in the casket, drawing the glass slide and closing it, after
which, it should not be re-opened. Abide by the regulations of your
district concerning the amount of time to elapse between the time of
death and of burial in these cases. For transportation govern yourself
according to the provisions of your district rules.


=Tuberculosis.=—_Definition._—An infectious, slightly contagious
disease, characterized by the formation of small nodules, tubercles,
varying from the size of a millet-seed to that of a mustard-seed or
even larger.

_Cause._—Tubercle bacillus of Koch.

_Pathology._—Any organ of the body may be the seat of the disease. In
the adult the lungs are the most frequently affected, while in children
the lymph glands, joints, and intestines are favorable seats for the
disease. Probably the only form that will give the embalmer any trouble
is tuberculosis of the lungs. Here either from the poison, developed by
the bacilli, or from some other source, necrosis of the cells occurs,
forming a cheesy condition known as caseation. At a later period
this breaks down, forming an abscess, the cavity being filled with a
purulent material. At other times there is a calcareous deposit, and
the tubercular mass is said to undergo calcification.

_Treatment._—In pulmonary tuberculosis, give the body a complete
arterial injection using half strength fluid for the first part of
the injection, followed by three-fourths strength for the latter part.
Hohenschuh prefers to drain blood from all cases; the authors prefer
to drain blood in tuberculosis, only when it is necessary as a means of
preventing discolorations, and that would be in case the blood vessels
contained much blood. Massage the face carefully with one of the
commercial solutions, or, with water which of course has no bleaching
action. For transportation, govern yourself according to the provisions
of the transportation rules.


=Typhoid Fever.=—_Synonyms._—Typhus abdominalis; Typhus nervosus;
Ileo-typhus and Autumnal fever, are the most common terms, although
Murchison's list includes forty others.

_Definition._—An acute, infectious and slightly contagious disease,
derived from a specific cause and characterized by inflammation and
generally sloughing of Peyer's glands, swelling of the mesentery,
engorgement of the spleen and a rose colored eruption.

_Cause._—A specific germ called the bacillus of Eberth or the bacillus
typhosus.

_Pathology._—The lesions resulting from this disease may be divided
into two parts. First, the lesions of the intestinal canal, Peyer's
patches, the solitary glands of the ileum and caecum, and more rarely
of the colon and the rectum, and changes in the spleen. Secondly,
those lesions resulting from sepsis occurring during the long period
of fever, and affecting the tissues and organs at large. The first
effect of the poison or bacilli is to cause hyperemia (swelling) of
the lymphatics, the capillaries become engorged and cell infiltration
takes place in the solitary glands of the intestines. Frequently the
infiltration is so excessive that the capillaries become engorged and
entirely choked with the infiltration. Ulcers form, which are shallow
or deep, according to the amount of necrosis (sloughing), and when very
deep, perforation of the bowel may follow, although this condition is
rare. The spleen is nearly always involved, congestion takes place,
followed by softening. The liver becomes hyperemic, swollen and soft,
and often shows abscess formation. There is granular degeneration in
the kidney, ulceration of the larynx and sometimes congestion of the
lung. The heart muscles too often become weakened the result of the
poison.

_Treatment._—If death occurs early in the disease, the body will not
be greatly emaciated, and the following treatment may be followed in
detail:

If intense abdominal fermentation exists, relieve the accumulated gas
with trocar, aspirate as much serous matter as possible from the pelvic
cavity, introduce a strong fluid into the cavity, taking care to have
as much of this fluid reach the cavities of the intestines as possible.
Open one of the arteries commonly used in one of the drainage processes
and inject 64 ounces of half strength fluid, draining blood from
the vein simultaneously with the injection. Then inject a sufficient
quantity of normal fluid to complete preservation. Close all openings
of the body with absorbent cotton. Massage the face with water or a
commercial solution during the injection.

If death occurs late in the disease, the abdomen may require a stronger
treatment such as we would give in acute peritonitis. The trocar may
not prove efficient in reaching the affected parts and in such a case
we would make a 4 inch incision along the median line and between the
umbilicus and the pubic arch, exposing the ileum and caecum, which
should be incised, their contents removed, and then all replaced in
the cavity thoroughly surrounded with hardening compound. After this
the wound should be closed with stitches. After preservation has been
completed in either this form of the disease or the one mentioned
above, dust on a good quality of face powder to remove the moist
appearance from the skin. When a body dead of this disease is to
be transported, consult the state or local transportation rules in
addition to these treatments.


=Leprosy.=—_Definition._—A chronic, infectious, contagious disease,
which usually terminates fatally.

_Cause._—The bacillus leprae. There are tuberculous growths in the
skin, which push outward, form nodular masses, between which are seen
areas of ulceration and cicatrization, which in the face, distort the
features. These tubercular masses discharge a thick purulent material.
The destruction of tissue proceeds gradually, years being occupied in
destroying a patient. The deep, ulcerative process may amputate fingers
and toes in its progressive march.

_Treatment._—The body is rarely presentable for sometime before death,
and this should not be a consideration in our treatment. If an arterial
injection is possible, give it, using normal fluid for the injection.
Work with rubber gloves. Give a complete cavity injection. Wrap the
body in absorbent cotton and then in a sheet. For transportation,
govern yourself according to the provisions of the transportation
rules.


=Influenza.=—_Synonyms._—Epidemic catarrhal fever; la grippe.

_Definition._—An acute, infectious disease, the contagion of which is
questionable occurring pandemically.

_Cause._—The bacillus influenza.

_Pathology._—There is no characteristic lesion in the uncomplicated
case. When death occurs it is usually from complication.

_Treatment._—Disinfect the oral and nasal cavities with embalming
fluid. Inject as much fluid as you can into the arteries and cavities.
The usual 10% of the body weight must be given for transportation.
If blood vessels are filled with blood, drain from a large vein, and
add more fluid to your injection, to make up for the loss of blood
to the blood bottle. Close all openings with absorbent cotton. For
transportation, govern yourself according to the provisions of your
district rules.


=Cholera.=—_Synonyms._—Cholera Algida; Cholera Asiatica; Cholera
maligna.

_Definition._—Cholera is an acute, specific, infectious slightly
contagious disease, occurring epidemically and endemically, and
characterized by severe vomiting and copious watery stools, violent
cramping of the muscles and collapse.

_Cause._—The exciting cause is now generally recognized as the comma
bacillus of Koch, or spirillum cholerae.

_Pathology._—The tissues after death are shrunken and drawn, and
the extremities are inclined to be mottled; in some cases there is
a postmortem rise of temperature. Rigor mortis sets in very early.
Spasmodic contractions sometimes occur for some moments after death;
hence the eyes and jaws have been seen to move after life was extinct.
Owing to this marked contraction, the limbs have been distorted and
the partial turning of the body is thus accounted for, and is not, as
many have supposed, the result of being buried alive. The tissues are
dry, having been drained of these fluids before death, hence some time
elapses before decomposition begins after death. The chief visceral
lesion is that of the intestinal canal. The intestines contain a more
or less quantity of rice-water, fluid rich in the comma bacillus. The
blood is very dark, but slightly coagulable and robbed of its salts and
fluids.

_Treatment._—Arterial and cavity embalming, closing all orifices of the
body. Any discharges from the bowels should be disinfected before being
disposed of. In epidemics, cosmetic effect is a non-essential and in
that case the most thorough treatment must be given without regard to
appearances.

For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.


=Bubonic Plague.=—_Synonyms._—The Pest; Black Death; Plague of Egypt.

_Definition._—A specific, infectious, contagious disease, running
a rapid course, and characterized by inflammation of the glands
(buboes), carbuncles, ecchymoses, and petechiae upon the surface. It is
endemic on the eastern coast of the Mediterranean Sea and the Oriental
countries adjacent. Epidemics occur when it spreads to other parts
of the world, traveling along the great thoroughfares of travel and
commerce.

_Cause._—To Kitasato belongs the honor of discovering the specific
cause, the bacillus pestis. On entering the body, either by inoculation
or by way of the digestive or respiratory tracts, it multiplies with
great rapidity. It is found in the blood, in the internal organs, in
the intestinal canal, lymphatic glands and in great numbers in the
suppurating buboes.

_Pathology._—Rigor mortis occurs early, and often there is elevation
of temperature immediately after death. Petechiae, ecchymoses, and
carbuncles are generally found upon the skin. The lymphatic system is
generally affected, the lymph glands of the groin and axilla showing
evidence of inflammation.

_Treatment._—Wash the body thoroughly with a good germicide, close all
openings, first however, disinfect the oral and nasal openings. Nothing
should be done for the ecchymotic spots, the cosmetic effect in these
cases being secondary to disinfection. The arteries should receive a
heavy injection of normal fluid, blood being drained from the veins.
The blood should be disinfected before being disposed of. The cavities
should receive a heavy injection of normal fluid. For transportation
of these cases, govern yourself according to the provisions of the
transportation rules.


=Scarlet Fever.=—_Synonyms._—Scarlatina; scarlet rash.

_Definition._—An acute, contagious disease, characterized by a bright
scarlet colored eruption, diffused over the entire body, terminating by
desquamation of the skin.

_Cause._—Not definitely known, although thought by Klein and Gordon to
be the streptococcus scarlatinae.

_Pathology._—The blood is dark, diffluent, and does not coagulate
readily, owing to a defect in the fibrin. The eruption disappears after
death, except in those malignant cases where the eruption failed to
appear during life, and appears upon the death of the patient.

_Treatment._—First protect yourself by wearing a bandage of surgical
gauze over your mouth and nose, then enter the room of death and
wash the body thoroughly with a 1 : 500 solution of bichloride of
mercury. Inject an amount of fluid equaling 10% of the body weight
into the arteries and inject into the cavities. Drain blood through
one of the drainage processes, and add an amount of fluid to the
arterial injection equal to that which is lost to the blood bottle.
Close all openings with absorbent cotton, dress the body, and then
place it in the casket, drawing the glass slide and closing it, after
which, it should not be reopened. Abide by the regulations of your
district concerning the amount of time to elapse between the time of
death and of burial in these cases. For intra-state and inter-state
transportation, govern yourself according to the provisions of your
district rules.


=Variola.=—_Synonyms._—Small-pox; German Blattern; French, La Petite
Verole.

_Definition._—A specific, infectious, highly contagious febrile
disease, characterized by a dermatitis, in which the eruption passes
from the papule to vesicle, and this in turn into pustule, finally
dessicating.

_Cause._—The true nature of the virus is not known, and although
certain microorganisms have been described which are found in the pock,
there is no proof that they are responsible for producing the poison.
All that is positively known is, that it is developed in the system and
reproduced in the pustule.

_Pathology._—The most marked change occurs in the skin, where an
eruption takes place, finally with the formation of scabs or crusts.
The blood does not reveal any microscopic changes, although darkened in
color.

_Treatment._—No one but an immune should handle these cases, and he
should first wash the body with a 1 : 500 solution of bichloride of
mercury. After this has been done, inject an amount of fluid equal
to 10 per cent. of the body weight, distributing same by arterial
injection. If blood is drained, and it is proper to do so, add fluid
to the injection to make up the loss into the blood bottle. Give full
cavity injection. Bodies dead of this disease should be buried within a
reasonably short length of time, so that the apartments may be rendered
safe by fumigation, and under no circumstances should a public funeral
be held. After the body has been placed in the casket, the slide,
preferably of glass, should be closed and should not be reopened under
any circumstances. Govern yourself by the regulations of your district
for transportation of these cases.


=Measles.=—_Synonyms._—Morbilli; rubeola.

_Definition._—An acute, infectious, contagious fever, characterized by
a general papular eruption.

_Cause._—The efforts to isolate a specific germ which will produce the
disease has thus far failed, though many organisms have been found in
the secretions.

_Pathology._—There is a lack of coagulability of the blood, which is
dark in color. The internal organs are congested and softened. The
lesion of the skin consists of an acute hyperemia with exudation in the
vascular papillae of the corium, the sebaceous and sweat glands.

_Treatment._—Bodies rarely die from this cause; the usual immediate
cause of death is exhaustion. An injection of half strength fluid
for the first part of the injection followed by normal fluid for the
balance of the injection, with full cavity injection, closing the
orifices is all that is necessary. For transportation, govern yourself
according to the provisions of the transportation rules.


=Parotitis.=—_Synonyms._—Mumps, epidemic parotitis.

_Definition._—An acute, infectious, and contagious disease,
characterized by an inflammation of one or both of the parotid glands.

_Cause._—The specific cause is a contagion generated during the course
of the disease, the exact nature of which is not known, although
thought by some to be the tetrad of mumps.

_Pathology._—The parotid glands become swollen and hard. Death very
seldom occurs from this disease.

_Treatment._—Disinfect the oral cavity with embalming fluid. The
swelling cannot be reduced, so that the next concern to the embalmer
will be to preserve the body. This should be done by injecting 64
ounces of half strength fluid, followed by enough normal fluid to
secure preservation. If blood vessels contain much blood, drain from a
large vein, and then inject additional fluid to make up for that lost
by drainage. Close all openings with absorbent cotton. Abide by the
regulations of your state governing the transportation of these cases.


=Pertussis.=—_Synonyms._—Whooping-cough; tussis convulsiva.

_Definition._—A specific infectious, contagious disease occurring
epidemically, and characterized by a peculiar, spasmodic cough, ending
in a whoop.

_Cause._—The cause of whooping-cough has always been a matter of
conjecture.

_Pathology._—In the uncomplicated form there is no lesion which can be
said to be characteristic. There might in complications be hemorrhage
from the lung.

_Treatment._—Disinfect the oral and nasal cavities with embalming
fluid. Inject 64 ounces of half strength fluid followed by enough
normal fluid to secure preservation. If blood vessels contain much
blood, drain from a large vein, and then inject additional fluid to
make up for that lost by drainage. Close all openings with absorbent
cotton. Discourage public funerals in these cases. For intra-state or
inter-state transportation of these cases, govern yourself according to
the provisions of your district rules.


=Typhus Fever.=—_Synonyms._—Famine fever; Ship fever; Jail fever;
Hospital fever; and Putrid fever.

_Definition._—An acute, infectious, very contagious, endemic, and also
epidemic disease, characterized by a high grade of fever and a peculiar
rash.

_Cause._—Not known.

_Pathology._—The blood is dark and diffluent the result of the
intense fever and rapid work of the poison. The liver is somewhat
enlarged and softened, as are also the kidneys and spleen. There is
an extravasation into the pericardium which gives it an ecchymotic
appearance. There is also a slight engorgement and infiltration of the
capillaries. The muscular tissues are of a dark red color. The skin
shows a characteristic rash and ecchymotic spots are found on the more
dependent parts of the body after death.

_Treatment._—Slow arterial injection and drainage of blood. On account
of rash, apply bichloride of mercury 1 : 500. In the presence of
fermentation, give the abdomen a special treatment.

For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.


=Varicella.=—_Synonym._—Chicken-pox.

_Definition._—An acute, specific, and infectious disease, characterized
by an eruption that rapidly passes through the stage of papule,
vesicle, and pustule, and terminates by dessication.

_Cause._—This is not known. All attempts to isolate the microorganisms
or the contagium, whatever that may be, have failed.

_Pathology._—The only pathological lesion is the eruption that appears
on the skin.

_Treatment._—These cases should be thoroughly washed with 1 : 500
solution of bichloride of mercury, after which a thorough arterial and
cavity injection should be given, consuming for this purpose an amount
of fluid equal to 10 per cent. of the body weight in the arteries.
Blood should be drained from the veins, and an amount of fluid equal to
what is lost to the blood bottle should be injected in addition to the
10 per cent. mentioned above. After the body is placed in the casket,
close the slide which should be of glass, and do not reopen again.
Public funerals of these cases should be discouraged, to avoid the
indiscriminate transfer of the disease.


=Septicemia.=—_Definition._—A morbid process commonly known as blood
poisoning, in which there is an invasion of the blood by bacteria or
their toxins.

_Cause._—Any bacteria or its toxin.

_Pathology._—The blood is found to be dark, diffluent, and rich in
bacteria. The liver and spleen are soft, dark in color, and show
swelling. The lymphatics are also swollen.

_Treatment._—The operator should approach these cases with unbroken
skin on his hands, or if that be impossible, with rubber gloves,
as the disease is disseminated through abrasions. Take up a large
artery and vein, inject half strength fluid for the first bottle and
normal fluid thereafter in the arteries, and drain from the veins.
Disinfect the blood obtained from the vein before disposing of
it. Give the body a complete cavity injection. Massage the face to
stimulate capillary circulation while the arterial injection is being
made. For transportation, govern yourself according to your district
transportation rules.


=Pyemia.=—_Definition._—An infectious disease due to the absorption
of animal poisons, principally pyogenic organisms, and characterized
by the formation, in the various tissues and organs, of multiple
metastatic abscesses.

_Cause._—One of the forms or a combination of pyogenic micrococci are
held to be responsible, for this condition. The streptococcus and the
staphylococcus are the forms most common, though it is not uncommon
to find the micrococcus lanciolatus, the gonococcus, the bacillus coli
communis, bacillus typhosis, bacillus pyocyaneus, and many others.

_Pathology._—The body does not undergo putrefaction as rapidly as in
septicemia. The first effects of the morbid changes are found in the
veins, which result in thrombi. These thrombi are found in the various
organs and tissues of the body.

_Treatment._—Use the precautions observed in the treatment for
septicemia. Give the body a complete arterial injection using half
strength fluid for the first bottle of the injection. Drain as much
blood from the veins as possible. Thrombi may complicate the drainage,
and if none can be obtained from several of the larger veins, tap the
heart as a last resort. Disinfect the blood before disposing of it.
Streptococcus infection of the embalmer from abrasions of the skin is
very dangerous and every possible precaution should be carefully taken.
Give the body a complete cavity injection. For transportation, govern
yourself according to the provisions of the transportation rules.



CHAPTER XX.

TREATMENT OF SPECIAL DISEASES.—Continued.

DISEASES OF THE RESPIRATORY SYSTEM.


=Gangrene of the Lung.=—_Definition._—A putrefactive necrosis of the
lung.

_Cause._—Many putrefactive bacteria thrive in the necrotic soil, but
whether they are the cause or the result is not known.

_Pathology._—When the gangrene is due to the plugging of one of the
large branches of the pulmonary artery, a large part of the lung
becomes dark, greenish brown, or a black fetid mass, softening rapidly
in the center, forming an irregular cavity, containing a foul-smelling
disgusting, greenish fluid.

_Treatment._—Give complete arterial injection. Inject the pleural sac
on the affected side through the first intercostal space or through
the apex of the cavity. Spray fluid into the mouth and nose and close
them with absorbent cotton. For shipment of these cases govern yourself
according to the transportation rules.


=Pulmonary Hemorrhage.=—_Synonyms._—Hemoptysis; Broncho-pulmonary
hemorrhage; Bronchorrhagia; Pneumorrhagia.

_Definition._—An expectoration of blood, due to hemorrhage from the
mucous membrane of the bronchi, trachea, or larynx and from erosion or
rupture of capillaries in lung cavities.

_Cause._—The hemorrhage may result from congestion of the lungs,
due either to pulmonary lesions or from cardiac derangements. It may
accompany malignant affections, infectious fevers, scurvy, cancer of
the lung, gangrene, and abscess of the lung.

_Pathology._—There is, in most cases rupture of the capillaries of
the bronchial mucous membranes. If tubercular cavities are formed, a
ruptured aneurism is sometimes seen, or large blood vessel eroded by
ulceration. If pulmonary apoplexy has existed, the parenchyma may be
lacerated.

_Treatment._—Some operators wait until fluid passes from the mouth
before taking steps to stop the hemorrhage due to the injection of
fluid. We prefer to use plaster of paris and cotton, making a paste
of them and forcing the paste down upon the epiglottis to prevent the
waste of fluid from that source. When the cause of death is known, this
operation must be done before the injection is begun or the throat will
have to be dried out before the plaster of paris will set properly.
Another treatment to prevent the leakage of fluid would be to tie off
the trachea just above the upper border of the sternum.

The body is usually emaciated and should be injected arterially with
comparatively mild fluid, in order to avoid drying or dessication of
the features. Whenever fermentation exists in the abdomen, the cavity
should be injected; otherwise it is not usually necessary. The amount
of fluid for the injection should be based on the amount that will
be taken by the vessels of a body the size of the one being injected.
For transportation of these cases the provisions of the transportation
rules should be your guide.


=Pulmonary Abscess.=—_Synonyms._—Abscess of the lungs; Suppurative
pneumonitis.

_Definition._—A collection of pus in the lung, accompanied by
degeneration of tissue.

_Pathology._—The abscess may involve one or more lobules, or engage
almost the entire lobe, or the abscesses may be scattered throughout
the whole lung.

_Treatment._—Should hemorrhage occur, treat this case the same as for
pulmonary hemorrhage. If no hemorrhage occurs, give the body a complete
injection with a mild fluid and inject the pleural sacs from the first
intercostal space or the apex of the cavity. For transportation, govern
yourself according to the provisions of the transportation laws.


=Pneumonia.=—This disease is divided into different subdivisions as
follows: Lobar Pneumonia, broncho-pneumonia, and chronic interstitial
pneumonia.

(A) _Lobar Pneumonia._—_Synonyms._—Croupous or Fibrinous Pneumonia;
Pneumonitis; Inflammation of the lungs; and Winter fever.

_Definition._—This is an acute infectious disease characterized by an
inflammation of the lung tissue in which there is, first, congestion
and engorgement, second, exudation or consolidation; and third,
resolution or suppuration.

_Pathology._—The right lung is more frequently affected than the left,
and one lobe, or one entire lung, rather than both lungs at the same
time.

_Treatment._—Should suppuration occur, turn the body on its side, press
on the sternum and cause the suppurative matter to leave the windpipe
by purging it into the folds of a towel which should be placed at the
mouth. Spray the mouth with fluid and close the oral and nasal cavities
with absorbent cotton.

Give the body a thorough arterial and cavity injection, paying especial
attention to the pleural sacs, which should be injected independently
from the first intercostal space on each side or from the apex of the
cavity. Drain blood and disinfect the contents of the blood bottle
before disposing of same. For transportation, govern yourself according
to the provisions of the transportation laws.

(B) _Broncho-Pneumonia_—_Synonyms._—Capillary Bronchitis; Lobular
Pneumonia; Catarrhal Pneumonia.

_Definition._—An inflammation of the terminal bronchi, air vesicles,
and interstitial tissue of a few or many of the lobules.

_Pathology._—The interstitial tissue between the air cells and the
capillaries are greatly weakened. In most cases the lung will float
when placed in water, though the small mahogany-colored nodules found
distributed throughout the lung when excised sink in water.

_Treatment._—The nature of the disease is such that preservation is
comparatively simple, the disease affecting the extremities of the
respiratory system. Arterial injection together with special attention
to the pleural sacs will suffice for the cases. For transportation,
govern yourself according to the provisions of the transportation
rules.

(C) _Chronic Interstitial Pneumonia._—_Synonyms._—Cirrhosis of the
lungs; Fibroid Pneumonia.

_Definition._—A chronic inflammation of the lungs, in which the normal
air cells are replaced by fibrous or connective tissue, followed by
induration and atrophy of the lung.

_Pathology._—The disease is nearly always confined to one lung, though,
in very rare cases, both lungs may be involved, while localized areas
are the rule. The affected lung becomes atrophied and in extreme cases,
may be no larger than the closed hand. As a result of the shrinkage of
the lung tissue, the heart undergoes hypertrophy. When tuberculosis
exists, cavities of varying size and number are found, and the
interstitial tissue between the capillaries and the air cells is very
much weakened.

_Treatment._—Should this disease be followed by a rupture of the
capillaries during the injection, thereby causing a hemorrhage
from the oral and nasal openings, treat it as you would a case of
pulmonary hemorrhage. Otherwise give the body a thorough arterial
and cavity injection with special attention to the pleural sacs. For
transportation, govern yourself according to the provisions of the
transportation laws.


=Hydrothorax.=—_Synonyms._—Thoracic dropsy; Dropsy of the chest; Dropsy
of the pleura.

_Definition._—A collection of serous fluid within the pleural cavity
without inflammation.

_Pathology._—Hydrothorax, unless due to cardiac affections, is usually
bilateral. The quantity of fluid varies, and is generally greater on
one side than on the other. The fluid is free, and of a low specific
gravity, alkaline in character, clear, and of an amber color.

_Treatment._—To prevent the formation of blisters on the posterior
surface of the thorax, aspirate the serous fluid from the pleural
sacs, introducing the trocar through the apex of the cavity, and
extending it into the cavity until it has almost reached the diaphragm.
This must be done with both the right and left sacs. Give the body a
complete injection, using normal fluid throughout the entire injection.
Inject the pleural sacs after the serous fluid has been withdrawn.
For prevention of post-operative dangers such as bursting blisters,
etc., line the casket with rubber for a distance of 3 inches above the
bottom. For transportation of these cases, govern yourself according to
the provisions of the transportation laws.



CHAPTER XXI.

TREATMENT OF SPECIAL DISEASES.—Continued.

DISEASES OF THE CIRCULATORY SYSTEM.


=Pericarditis.=—_Definition._—An acute inflammation of the pericardium
and the serous covering of the heart.

_Treatment._—Give the body a thorough injection of half strength fluid
followed by normal fluid. Drain from the veins. Inject the abdominal
cavity. For transportation of these cases, govern yourself according to
the provisions of the transportation rules.


=Hydropericardium.=—_Synonym._—Dropsy of the pericardium.

_Definition._—Hydropericardium is a non-inflammatory condition of the
pericardium, attended by an accumulation of sero-albuminous fluid.

_Pathology._—Hydropericardium is not a disease of itself, but it is
always secondary. The accumulated fluid is usually clear, of an amber
color, though it may become turbid by the presence of fibrin or red
blood corpuscles. The fluid is alkaline in reaction.

_Treatment._—As this disease is always secondary to another, the
treatment will also be secondary and all that can be said is that the
heart sac should be relieved of its accumulated serous fluid, after
the body has received the treatment necessary for the immediate cause
of death. Transportation will also be covered by the disease causing
death.


=Hemopericardium.=—_Definition._—Hemopericardium is an infiltration
of blood into the pericardium. It is the result of a rupture of an
aneurism of the aorta or coronary arteries, or in rare cases from
rupture of the heart. It may also arise from injuries such as bullet
wounds, fracture of the ribs, sternum, etc.

_Treatment._—This condition is usually secondary to another such as
gun shot wound, aneurism of the aorta, etc., so that the treatment
must be given under the heading of the immediate cause of death. For
transportation requirements also refer to the immediate cause of death
and the transportation rules.


=Pneumo-Pericardium.=—_Definition._—Pneumo-pericardium is an
accumulation of air in the pericardium. Although this is a rare
disease, it does occasionally occur, either through diseased processes,
such as cancerous or tubercular ulceration or through injuries; thus
a ruptured pulmonary cavity might result in this condition, or the
perforation of the esophagus, by malignant processes would give rise to
this lesion. Sometimes pus in the pericardium will generate gas.

_Treatment._—As the accumulation of air or gas is secondary to some
other process of disease, the immediate cause of death will carry with
it the proper treatment. The gas itself should be removed by piercing
the pericardium with a small needle or trocar, after which a small
quantity of fluid should be injected.


=Endocarditis.=—_Definition._—Endocarditis is an inflammation of the
lining membrane of the heart, and is generally confined to the valves,
though other parts may be affected.

_Pathology._—The morbid changes are, first, a reddened and injected
appearance of the endothelium, which soon becomes opaque and swollen
from congestion of the small blood vessels. This swelling or thickening
of the membrane furnishes a favorable resting place for deposits of
fibrin, and we have small, beady deposits from the size of a pin point
to that of a pea, or even larger. These small, beady excrescences may
become detached, and floating off in the general current, give rise to
embolism in distant parts.

_Treatment._—An embolism means the obstruction of a blood vessel
by some foreign material. If in the injection of fluid, there is an
obstruction in one of the blood vessels, leading to one of the organs,
you will never be any the wiser, but if the obstruction is in one of
the vessels supplying a certain area of skin, the condition will show
up sooner or later, when that certain part will have to be treated
hypodermically. Slow arterial injection with drainage of blood should
be given and when symptoms of fermentation are present, include special
attention to the abdominal cavity.


=Aortic Incompetency.=—_Synonyms._—Aortic Insufficiency; Aortic
Regurgitation.

_Definition._—Inability of the aortic valves to properly close an
abnormally large aortic opening, or a change in the segments whereby
they are shortened by curling of the leaflets, or by calcification.

_Treatment._—Bodies dead of this disease will be found with very
much blood, and the elimination of the blood by drainage should be
the first consideration along with the injection of fluid. The fluid
should be diluted one-half for the first part of the injection, and
sufficient fluid used to reach all parts of the circulatory system.
It will be well to add fluid equal to the amount of blood and fluid
taken from the vein to your normal injection in a body the size of the
one to be operated on. A complete cavity injection should be given.
For transportation, govern yourself according to the provisions of the
transportation rules.


=Aortic Stenosis.=—_Definition._—Aortic stenosis is an obstruction of
the aortic orifice, due to changes in the segments of the semilunar
valves, or arterio-sclerosis, or atheromatous deposits.

_Treatment._—Give same treatment advised for aortic incompetency, with
special care in the injection. Sclerotic conditions may complicate
the injection, and in that case as many arteries should be injected as
possible together with full blood drainage.


=Mitral Incompetency.=—_Synonyms._—Mitral Regurgitation; Mitral
Insufficiency.

_Definition._—This condition is an incomplete or imperfect closure of
the auriculo-ventricular opening, permitting the regurgitation of blood
during the contraction of the left ventricle, and due to an abnormal
condition of the leaflets or an enlarged opening.

_Treatment._—Give same treatment as advised for aortic incompetency,
with special care to remove as much blood as possible, which, with
massaging the face downward, should relieve any blood discolorations.


=Mitral Stenosis.=—_Definition._—Mitral stenosis is a constriction
of the left auriculo-ventricular orifice, usually due to valvular
endocarditis.

_Treatment._—Give this body the same treatment as advised for aortic
incompetency, with special care indicated in mitral incompetency.


=Tricuspid Incompetency.=—_Synonym._—Tricuspid Regurgitation.

_Definition._—This condition is an imperfect closure of the tricuspid
valves, due to dilation of the right ventricle or to disease of the
valves.

_Treatment._—Drain as much blood as possible from this case. Massage
the face downward, and inject the maximum amount of fluid; diluting
the first bottle to half strength. In obstinate cases of blood
discoloration, open the common carotid arteries and internal jugular
veins, inject upward in the arteries and drain from the veins, so as
to wash out the vessels of the face. For facial injection use nothing
stronger than half strength fluid. Give thorough cavity injection.
For transportation, govern yourself according to the provisions of the
transportation rules.


=Tricuspid Stenosis.=—_Definition._—Tricuspid stenosis is an
obstruction of the tricuspid opening, usually congenital, though it may
be acquired.

_Treatment._—Treat the same as for tricuspid incompetency.


=Pulmonary Incompetency.=—_Synonym._—Pulmonary Insufficiency.

_Definition._—Pulmonary incompetency is an imperfect closure of
the pulmonary orifice of the right ventricle due to changes in the
pulmonary valves.

_Treatment._—Treat the same as for tricuspid incompetency.


=Pulmonary Stenosis.=—_Definition._—Pulmonary stenosis is an
obstruction of the pulmonary opening of the right ventricle, due to
congenital defects or to endocarditis.

_Treatment._—Treat the same as for tricuspid incompetency.


=Cardiac Thrombosis.=—_Definition._—Cardiac thrombosis is the formation
of blood clots in the cavities of the heart.

_Pathology._—The blood clots are found most frequently in the right
side of the heart. They vary in size, from that of a pin head to that
of a hen's egg. When degeneration takes place, softening follows, and
sometimes particles become dislodged and float off to set up thrombi in
other viscera.

_Treatment._—Remove the maximum amount of blood by drainage along with
the injection of fluid. The fluid in this case should be not more than
half strength for the first part of the injection, to be followed by
enough normal fluid to secure preservation. If thrombi have lodged
in any of the larger arteries, the circulation to the part reached
by the branches of the artery will be affected. This can be overcome
by injecting an artery close to the part which is not receiving the
fluid. Massage the face downward to assist capillary circulation.
Give a complete cavity injection. For transportation, govern yourself
according to the provisions of the transportation rules.


=Hypertrophy of the Heart.=—_Definition._—Hypertrophy of the heart is
an enlargement of the organ, due to an increase in the volume of its
muscular fibers, and usually also to dilatation of its cavities.

_Treatment._—Secure full drainage from the veins. Drainage will be
stimulated by an injection of half strength fluid for the first part
of the injection and a massage of the face. Follow the first part of
the injection with enough normal fluid to secure preservation. Give
a complete cavity injection. For transportation, govern yourself
according to the provisions of the transportation rules.


=Cardiac Dilatation.=—_Definition._—Cardiac dilatation is an increase
in the size of the cavities of the heart, due either to thickening or
thinning of the walls.

_Treatment._—Treat the same as for hypertrophy of the heart.


=Cardiac Atrophy.=—_Definition._—Cardiac atrophy is a decrease in the
size, strength, weight, and activity of the heart.

_Treatment._—Remove blood by drainage, and inject half strength fluid
for the first part of the injection. The amount of fluid need not be as
great as in the acute disease of the heart. Massage the face downward.
Give cavity injection. For transportation, govern yourself according to
the provisions of the transportation rules.


=Arterio-Sclerosis.=—_Synonyms._—Endarteritis; Atheroma; Arterial
Sclerosis.

_Definition._—Arterio-sclerosis is an inflammatory and degenerative
condition of the arterial system, primarily of the intima, although
later degenerative changes may involve the whole structure. Calcarine
deposits are quite common.

_Pathology._—As a result of proliferation, infiltrated areas begin
in the middle and outer coats. These nodules vary in size from that
of a small shot to that of a large coin. As they increase in size,
the intima loses its smoothness and becomes thickened and rough.
As these changes progress, the middle and outer coats are weakened.
Calcification may also occur in the wall.

In the diffuse form the change in the coats of the vessels extends
throughout the greater part of the arterial system, and in some cases
invades the capillaries and veins.

In the senile arterio-sclerosis calcareous deposits occur, which render
the vessels rigid. Where these tissue-changes involve the capillaries,
there may be complete obliteration of their lumen in some places.

_Treatment._—In some cases the artery appears to be closed at a point
ahead of the tube and will resist the injection of fluid. Usually,
however, the injection can be made without resistance. Blood should be
drained from these cases so as to allow as full capillary penetration
as possible. When no arterial injection can be made, open the internal
jugular and several other large veins, drain blood from them and then
inject fluid while the tube is within the vessel. If necessary add a
complete hypodermic injection to all parts of the body excepting the
face. Give the cavities full treatment. For transportation, govern
yourself according to the transportation rules.


=Fatty Degeneration of the Arteries.=—In the fatty degeneration of
arteries the process consists in the gradual replacement of certain
parts of the muscular cells by fat droplets. The fat makes its
appearance as minute droplets or granules in the cells. These granules,
which are characterized by their dark color, gradually increase
in number and ultimately the whole of that part of the cell may be
transformed. During the process the granules coalesce, and in this
manner form distinct drops of fat. As the process proceeds the cell is
increased in size and becomes more globular in shape. The cell wall is
destroyed and the cell may thus be converted into a mass of granular
fat. Ultimately the matter between the granules of fat liquify. The
corpuscles break up and the fat becomes distributed in the surrounding
tissues. The immediate effect of this fatty degeneration is to produce
more or less softening of the fatty part, which will impair or destroy
its function. In the case of the artery, the internal, middle and
external coats may be affected, but the external is the one usually
first attacked. The inner layer or endothelium, and the connective
tissue cells in the deeper layers of the inner coat may become affected
in various parts of the vessel. The process may involve a great
portion of the inner coat, even the whole thickness of the intima may
be destroyed. The walls of the artery may be entirely solidified, the
canal being closed completely with a soft, yellowish substance as a
result of the disease. The artery might appear to be a solid mass when
the dissecting knife is passed through. We have seen the anterior and
posterior tibial, the popliteal, radial, ulnar, the aorta arteries, and
especially the arch of the aorta thus affected. Calcification may be
present at many places. These cases are frequently met with in old age.

A body of this kind, where there is fatty degeneration of the arteries,
is sometimes hard to embalm. The walls of the artery will be very
much weakened, and too much pressure must not be made on them while
injecting fluid. Inject the fluid so that it will take several hours
to fill the tissues. The pressure should be gentle and regular when
the aspirator and injector pump is used. If this precaution is taken
often the whole body can be embalmed without a rupture of the arterial
system, the fluid reaching all the extremities by means of collateral
circulation.

If the embalmer should be so unfortunate as to rupture the circulation
then he will have to resort to cavity embalming, and the subcutaneous
tissues will have to be embalmed by the hollow needle trocar.


=Aneurism.=—_Definition._—An aneurism is a circumscribed dilatation
of an artery, formed by the giving away of one or more of its coats. A
false aneurism is where there is a rupture of the coats, and the blood
is found in the adjacent tissues.

_Treatment._—Drain blood from a large vein. Inject half strength
fluid for the first part of the injection, followed by enough normal
fluid to secure preservation. The aneurism itself, will not affect the
circulation of fluid to any great extent. Massage the face downward.
Give a complete cavity injection. For transportation, govern yourself
according to the transportation rules.



CHAPTER XXII.

TREATMENT OF SPECIAL DISEASES.—Continued.

DISEASES OF THE DIGESTIVE SYSTEM.


=Jaundice.=—_Synonym._—Icterus.

_Definition._—Jaundice is a symptom rather than a disease, and is
found in the various affections of the liver. It is characterized by a
deposit of bilirubin in the various structures and fluids of the body,
which gives them a yellow or jaundiced hue.

_Etiology._—Most pathologists agree that all the forms of jaundice can
only come from obstruction. The obstruction is due to inflammation
tumefaction of the duodenum or bile-ducts; to foreign bodies, such
as gall stones or parasites, within the ducts; tumors within the duct
or by pressure from without, such as tumors, gravid uterus, or fecal
matter; or to stricture or obliteration of the duct.


=Catarrhal Jaundice.=—_Definition._—Catarrhal inflammation of the
lining membrane of the biliary ducts, and the duodenum, and attended
with discoloration of the skin and tissues from the consequent
retention and absorption of the bile.

_Pathology._—That portion of the duct lying in the intestines is more
frequently and seriously affected, though the inflammation may extend
to the cystic and even the hepatic duct. The membrane lining the ducts
is swollen and inflamed. The liver is usually congested, slightly
enlarged, and of a deep yellow color. The gall bladder is usually
distended with bile. The ducts are occluded by the swollen mucosa and
plugs of inspissated mucous.

Discoloration of the skin and conjunctiva occurs. The yellow tinge
begins in the eyes, forehead, and neck, gradually extending over
the body, the color being the deepest in the wrinkles and folds of
the skin. The color is generally of a lemon hue, becoming darker and
assuming a bronze or greenish tint as the hepatic lesion assumes a
graver character.


=Infantile Jaundice.=—_Etiology._—It is not known positively what
causes give rise to temporary jaundice in the new-born. Some say it
is due to a reduction of blood pressure in the hepatic capillaries,
while others say it is due to a stasis in the smaller bile ducts,
which are compressed by the distended radicles of the portal vein. The
severe form may be due to congenital closure or absence of the common
or hepatic duct, to hepatic syphilis of congenital form, or to septic
infection due to phlebitis of the umbilical vein.

In the child the skin becomes a yellowish hue of various shades. In the
severe form the hue increases in intensity, the skin assuming a bronze
or yellowish-green color. The abdomen becomes full and tumid, owing to
the congestion of the liver and spleen. When due to syphilis, there is
usually skin eruption.


=Malignant Jaundice.=—_Synonyms._—Acute Yellow Atrophy of the Liver.

_Definition._—A grave form of jaundice characterized by neurosis of the
hepatic cells and atrophy of the liver.

_Pathology._—The liver shows marked atrophy, being not more than
two-thirds or one-half of the normal size, is thin, flabby. On making a
section a yellow or a reddish yellow surface is presented. The hepatic
cells are found in every stage of necrosis. Most of the organs are bile
stained, as well as the skin, and hemorrhages are frequent.

_Treatment for Jaundice._—Since the conditions are similar and since
the conditions after death are identical in reference to pigmentation,
we will consider the treatment of infantile, malignant, and catarrhal
jaundice under one head.

The pigmentation of the skin, no matter how small, is the condition
which presents itself most forcefully, and is the most annoying to the
embalmer. Much study has been given to the subject, but with little
success. It is claimed by some that certain fluids will bleach and
bring out the natural color.

A small amount of bile is sufficient to tint the surface of the body.
Bile is composed of salts, fats, organic matter, acids, and also
coloring matter, called the bile pigments. Bilirubin is the principal
coloring matter, and when dissolved in alkali, forms, when coming in
contact with the air and also in the dead body, a green precipitate
known as biliverdin. The bile pigments in the blood are carried with
the serum from the capillaries to the tissues, being deposited in the
internal coat or deep layer of the epidermis as well as the papillary
of the dermis. The amount deposited regulates the extent of the
pigmentation.

One of the most beneficial things to do, where pigmentation is present
is to wash out the arterial system, draw blood from the veins, massage
the exposed parts. Inject a diluted fluid at first, follow with a fluid
of full strength, until complete disinfection and permeation of the
tissues has taken place. Keep up constant massaging during the whole
course of injection. This may bring fair results, with the addition of
face tints and showing the body under artificial light.

Strong solutions of formaldehyde when used at first are deleterious,
causing the skin to become green. This greenness is more pronounced
when chemicals such as methylene blue have been administered by the
attending physician before death. Bilirubin is a red yellow color, and
alkalies precipitate the bilirubin and form biliverdin. Biliverdin is
a greenish color.

All fluids contain alkalies, and are mostly alkali in reaction, and
this may account for the greenish color of the skin after the injection
of fluid. Acids do not precipitate the biliverdin and there is a
tendency to dissolve it and keep it in solution.

Moadinger suggests that a weak solution of some acid be injected into
the arterial system before the injection of embalming fluid. He prefers
a two per cent. solution of oxalic acid.

Dhonau prefers the use of a one or two per cent. solution of borax, to
be injected into the arterial system, followed by half strength fluid,
and this followed by full strength fluid. Dhonau also applies full
strength peroxide of hydrogen to the skin while massaging the face.

Eckels prefers the use of a fluid containing a peroxide.

If methylene blue has been administered by the attending physician and
you have learned this fact before hand, it is then not advisable to
use a formaldehyde fluid. There is a chemical action set up between
the methylene blue and the formaldehyde which will give to the tissues
a greenish color which is quite objectionable. In this case you would
inject some fluid which does not contain formaldehyde. A benzoate of
soda or borax, or peroxide solution would do.

A good formula to use, when you know methylene blue has been used by
the attending physician is:

  Rx  Carbolic acid     5 oz.
      Borax            12 oz.
      Glycerine         1 oz.
      Water, qs.        1 gal.

For transportation, govern yourself according to the transportation
rules.


=Cirrhosis of the Liver.=—_Synonyms._—Interstitial Hepatitis; Sclerosis
of the Liver; Nutmeg Liver; Hobnailed Liver.

_Definition._—A chronic disease of the liver, characterized by an
increased connective tissue, a reduction in the size of the organ, and
a degeneration of the parenchymatous constituents.

_Etiology._—In a great majority of cases the disease is due to alcohol,
syphilis, highly spiced and very rich foods. Cirrhosis may result
from chronic obstruction of the bile ducts, due to gall stones, or
tuberculosis. Cirrhosis frequently occurs between the ages of thirty
and sixty years, though it may be found in the extremes of life. Men
are more liable to contract the disease, owing to greater dissipations.

_Pathology._—The liver is increased in size by the increase of
connective tissue, and hyperaemic. On the surface it exhibits a knobbed
appearance (hobnailed liver) and these knobs present through the
capsule a yellowish appearance. The granulations vary in size from a
pinhead to a pea. As a rule there is a little jaundice, as there is
a decrease in the production of bile, instead the skin takes on an
earthy, sallow tint. There is generally ascites, swelling of the feet
and legs, which increases until the abdomen and the lower extremities
become of an enormous size. The nutrition of the body suffers, the
skin is dry and harsh. The blood is altered in quantity, and coagulates
quickly. Ecchymotic spots appear on the skin, about the face and nose.

_Treatment._—There are probably not many other cases of death, which
need greater skill and intelligence in their treatment than does
cirrhosis. The condition that presents itself is a distended abdomen
with gas and liquid. The limbs are also distended and the upper part of
the body is wasted away and is greatly discolored as death was caused
by asphyxia.

Place the body on the board, open the femoral vein, and insert your
drainage tube. It is better to use this vein as it is larger, and there
is more control of the removal of blood, and we would advise in this
case the use of the flexible rubber drainage tube, which can be pushed
up in the vein till it reaches the right auricle of the heart if you
wish. Drain all the blood possible. Use the trocar method, see page
255, or the direct incision, see page 257, to remove the gases and
ascitic fluid from the abdomen. Use the bandage method, see page 339 to
remove the water from the tissue of the extremities.

Raise the femoral artery and inject slowly a diluted fluid and massage
the face gently toward the jugular vein, using some recognized face
bleacher. Then follow with an injection of fluid of full strength until
you are sure the fluid has permeated every tissue of the body. Do not
be afraid to use plenty of fluid. Inject the cavities.

For transportation, govern yourself according to the transportation
rules.


=Carcinoma of the Liver.=—_Definition._—A cancerous growth in the liver.

_Pathology._—Jaundice is present in most cases and where the portal
circulation is seriously compressed, ascites developes. The liver is
greatly enlarged, and the surface is nodular.

_Treatment._—As in all chronic affections of the liver, where the skin
takes on a yellowish or bronze hue, due to pigmentation, it is almost
impossible to bring about the desired cosmetic effects. The pigment is
not only in the blood vessel but also in the tissues of the skin.

We would advise the washing out of the tissues, by the use of the
oxalic or borax solution, injecting the axillary artery and draining
from the femoral artery or raising both the carotid arteries, injecting
upward on one side and draining from the other.

For transportation, govern yourself according to the transportation
rules.


=Appendicitis.=—An inflammation, acute or chronic, of the appendix.

_Pathology._—The pathology will depend to a great extent upon the
degree of the inflammation. Ulceration may take place or there may be
perforation.

_Treatment._—If, after an operation, reopen the incision made by
the surgeon, relieve the gas pressure on the intestines by incising
them; surround the intestines with hardening compound; then inject an
artery, using half strength fluid for the first 64 oz., followed by
enough normal fluid to secure preservation. Drain the blood during the
injection by one of the drainage processes.

If no operation has been made, insert a trocar into the caecum to
relieve the gas pressure, then inject normal fluid into the same place,
using sufficient fluid to neutralize the process of putrefactive
fermentation. The trocar can be first inserted in the usual place
passing it to the caecum, or through the abdominal wall directly over
the caecum. The arterial injection and drainage should be made as is
mentioned above. For transportation, govern yourself according to the
transportation rules.


=Peritonitis.=—An acute or chronic inflammation of the peritoneum
either local or general.

_Pathology._—There is nearly always present more or less fluid in the
abdominal cavity.

_Treatment._—Drain blood from a large vein, and inject half strength
fluid for the first part of the injection, following this with enough
normal fluid to preserve the tissues of the body. After the arterial
injection and drainage have been completed, pierce the abdominal cavity
in the usual place and draw off all the fluid that you can reach,
paying especial attention to the lower part of the cavity. Then inject
normal or supernormal fluid into the cavity to neutralize the process
of putrefactive fermentation. Pierce the colons and inject fluid into
them as well. If fermentation resists this treatment, make a small
incision along the median line and above the umbilicus, examine the
stomach and intestines, incising them if they contain the gas. After
eliminating the gas, inject fluid directly into them, or, surround the
organs of the cavity with good hardening compound; sew up the incision
and the body should not deteriorate in any way. For transportation,
govern yourself according to the transportation rules.


=Dropsy.=—_Definition._—Dropsy is the accumulation of serous fluid in
a cavity or in the tissues.

Dropsy of the abdomen is called ascites.

Dropsy of the chest is called hydrothorax.

Dropsy of the peritoneum is called hydroperitoneum or ascites. General
dropsy of the cellular tissues is called anasarca.


=Ascites.=—_Synonyms._—Dropsy of the Peritoneum; Abdominal Dropsy.

_Definition._—An accumulation of serous fluid in the peritoneal cavity.

_Etiology._—Any obstruction of the portal circulation is a possible
cause of ascites, the most frequent being cirrhosis of the liver.
Pressure from tumors or neighboring organs may also give rise to it.
Peritonitis and valvular diseases of the heart are also responsible
for ascites, and chronic pulmonary affections may impair the portal
circulation to the extent of producing it.

_Pathology._—The quality and character of the fluid show great
variation, from a few pints to several gallons, and from a straw or
lemon tint to a brownish or greenish hue. It may be blood stained, and
occasionally clean and transparent. It is usually watery in character.

_Treatment._—Use the trocar method. Insert the trocar through the
umbilicus and draw off all the ascitic fluid from the abdomen, then
surround the organs with a quantity of fluid sufficient to preserve
them. Or if you desire, use the direct incision and after the ascitic
fluid has been drawn off, surround the organs with a hardening
compound.

The body in general should be preserved through an arterial injection
of normal fluid for the first 64 ounces, then one and one-quarter
strength for all subsequent bottles. This, if attended by copious
drainage from a large vein, will preserve all portions of the body
excepting possibly the epidermis of the posterior abdominal wall,
which, by gravitation of the ascitic fluid, will become separated from
the derma, producing skin slip, and causing the formation of blisters.

Previously to placing the body on the embalming board for treatment,
a rubber cover should be placed over the board so that drippings of
all kinds can be made to flow into a bucket at the lower end of the
embalming board. When the above mentioned blisters are cut and their
contents disposed of by gravitation into the bucket, a strong solution
of formaldehyde should be applied to the affected skin to harden it and
to prevent any further progress toward decomposition.

In ascitic cases the casket should be lined with rubber or oil cloth
to a point three or four inches above the bottom. In addition to this
precaution, the use of sawdust is favored so that any unlooked for
breaking of blisters may not be attended by a flow of the ascitic
liquid from the casket. Many embalmers do not protect themselves
against contingencies of this kind and are frequently criticized by the
friends and family of the deceased.


=Anasarca.=—_Definition._—Anasarca is a general dropsy of the cellular
tissues.

_Treatment._—_Bandage Method._—Bandage the extremities of the body,
commencing at the toes and finger tips, bandaging upward to the hip and
shoulder, using a rubber bandage. Relieve the water as you go along,
then rebandage, and by the third application you will have removed most
of the water from the extremities. Do not leave the bandage on while
injecting.

_Bandage Method._—Bandage the lower limbs, commencing with the thighs.
Bandage as tight as possible down to the toes and make an incision in
the heel, from which drainage of the serous fluid can be secured. In
this method no laps are left between the bandaging so that the serous
fluid can be forced toward the opening at the heel. (This method is
said to be reliable, although we have had but little experience with
it.)

Any accumulation of ascitic fluid in the cavities should be removed by
aspiration with the trocar, as described in the treatment of ascites
and hydrothorax. The rubber cover for the embalming board as described
in the treatment for ascites, should not be omitted.

After the water has been eliminated as far as possible, the arterial
injection should be made, using 64 ounces of normal strength fluid,
followed by enough one-fourth strength fluid to secure preservation.
Copious drainage will help to clear the blood vessels and allow a
better distribution of the fluid, thereby assuring good preservation of
all parts excepting the epidermis, which is practically closed off to
the fluid by the accumulation of water in the subcutaneous tissue.

In these cases the skin should receive a good application of strong
formaldehyde fluid before and after the principle operation, so as to
strengthen it against the putrefactive tendencies of the rete mucosum.

These cases should be watched closely between the time of embalming and
the funeral, as the most thorough preparation is sometimes unequal to
the task of preserving the entire body in such a way as to prevent the
formation of blisters.

For transportation of all dropsical conditions, govern yourself
according to the provisions of the transportation rules.



CHAPTER XXIII.

TREATMENT OF ACCIDENT CASES.


Under this head are treated those deaths which are the result of
accident.


=Specific Treatment of Accidents.=—_Broken Neck_, _Hanging_,
_Strangulation._—The mode of death may possibly cause a separation
or dividing of the blood vessels of the neck. If this is the case
there will remain in the head and face a large amount of blood, which
would soon become coagulated, causing a dark bluish turning black
discoloration. The treatment then must be to get this blood from the
face, so would recommend the common carotid for injection of fluid and
the internal jugular vein for the removal of blood.

Raise both the artery and the vein to the surface, and insert the
arterial tube in the artery toward the face, and inject a small
quantity of fluid in order to cause a pressure on the venous system,
then open the vein, insert the drainage tube and begin to remove the
blood, and as the blood drains from the drainage tube inject slowly
into the artery. This will help to push the blood out of the capillary
system and into the blood bottle and thus clear up the face of its
discoloration.

In these cases the raising of only one common carotid would hardly
suffice, and it would be far better to operate on both carotids to get
the best results. For this reason then the circular incision would
be the best operation, and perhaps the use of the Y shaped drainage
tube. With the Y shaped drainage tube both sides of the face could be
injected at the same time, and the blood could be removed from both
internal jugular veins, and the operator could not help but get good
results. The removal of blood from the internal jugulars in this direct
way will relieve the pressure in the capillaries and smaller veins and
induce a better circulation to all the immediate tissues.


=Body Severed.=—For these cases one should have a very good idea of the
general arterial and venous circulations of the body, for many of the
smaller as well as the larger vessels will be cut, necessitating one to
tie them off.

If the body is severed below the diaphragm remove and cleanse all the
loose and injured organs and tissues, place them in a bucket or pan
and cover with fluid. Ligate all the injured arteries and veins in the
upper and lower parts.

Inject the lower extremities from inside the abdominal cavity using the
common iliac artery, observing the presence of the remaining united
arteries and veins, which you can now see, for fluid will leak from
them. The lock forceps will enable you to pick them up and with the
aneurism needle dissect around the end of the vessel and tie each one
tight.

Treat the upper extremity in the same way injecting either from the
inside or the outside, according as the severity of the accident may
lead you to decide. Inject from the inside upward through the aorta,
or from the outside either through the radial, brachial, axillary or
carotid.

The trunk may now be sewed together, beginning at the middle of the
back. Sew each side up leaving the top open to receive the organs and
the tissues which were removed. After these are placed more or less in
position sprinkle hardening compound throughout the cavity. Now sew up
the front and then place a strong bandage around the body.


=The Arm Severed.=—Clean off the parts, and inject the severed
part through the radial towards the hand and by means of collateral
circulation through palmar arch, the upper part will be embalmed and
the arteries that have been severed disclosed, when they can be tied
off. If there is a great leakage through the stub end, and all the
arteries can not be tied off, plaster of paris may be put on the stub
and then a strong and tight bandage drawn around.

The remaining body can then be injected through the opposite carotid,
brachial or femoral, and when the leakages begin to occur at the stub
end of the arm they can be found and tied off or if the leakage is too
great plaster of paris may be used and a tight bandage placed about the
stub end.

After both the arm and the body have been injected the arm can now be
sewed on in its natural position, plaster of paris put around and a
strong bandage placed around or a splint may be used on both sides.


=The Leg Severed.=—Clean off the parts, and inject the severed part
through the large dorsal toward the foot and by means of collateral
circulation through the plantar arch, the upper part will be embalmed
and the arteries that have been severed disclosed, when they can be
tied off. If there is a great leakage through the stub end, and all the
arteries can not be tied off, plaster of paris may be put on the stub
and then a strong and tight bandage drawn around.

The remaining body can then be injected through the carotid, brachial,
axillary, or the opposite femoral and when the leakages begin at the
stub end of the leg they can be found and tied off, or if the leakage
is too great plaster of paris may be used and a tight bandage placed
about the stub end.

After both the leg and the body have been injected, the leg can be
sewed on in its natural position, plaster of paris put around and a
strong bandage placed around, or a splint may be used on both sides.


=The Head Severed.=—Clean off the parts, and inject the head through
the stub end of the carotid artery, and by means of collateral
circulation through the circle of Willis, the fluid will leak through
the other severed vessels and disclose them, so that they can be tied
off. If one side of the face should take more fluid than the other side
by this method the other carotid can be injected so as to equalize. It
would perhaps be impossible to tie off all the tiny vessels that are
severed so plaster of paris may be used to cover the stub end.

To inject the body, the four principle arteries to be tied are the
two common carotids and the two vertebrals, besides numerous veins
and small vessels. If it is impossible to tie all the severed vessels
plaster of paris may be used, and then by injecting either through the
brachial, axillary or femoral a thorough injection may be obtained. The
stub end of the carotid might also be used for injection, but would
not advise it as in most cases we find that it would be hard to get
especially if the head were cut off close to the shoulders.

When both the head and the body have been injected, bring the two
parts together by using a splint in the vertebral column, and having
plastered well together sew the skin. Demi-surgery can be practiced to
the fullest extent in this case, with great cosmetic effect.


=The Head Crushed.=—Remove all the coagulated blood and the injured
parts of the brain. Cleanse the cavity thoroughly and remould with
plaster of paris. Inject the best you can through one or both of the
carotid arteries, and complete the injection hypodermically. Inject
the rest of the body in the regular way, through one of the carotids
raised for the injection of the head. With the practice and use
of demi-surgery, all the bruised and torn fragments may be blended
together, and the cosmetic effect made almost perfect.


=The Foot Crushed.=—Remove all the coagulated blood by washing, and
place all the parts together as nearly natural as possible. Now inject
any of the principle arteries used in embalming, watching carefully the
flow of fluid and blood. As soon as you see a leakage stop injecting
long enough to tie it up, and when all the visible leakages have
been thus treated, wrap the whole of the injured part with a bandage
saturated with a plaster of paris solution. After this becomes dry and
set complete the injection.


=The Chest Crushed.=—Open up the cavity and remove all the injured
organs and tissues, which you will place in a vessel containing
formaldehyde fluid. With a soft sponge remove all the coagulated blood
from the cavity. Now tie up all the visible arteries and start the
injection from the inside, using first the innominate to inject the
right arm and the right side of the face then the left common carotid
to inject the left side of the face and the left subclavian to inject
the left arm. It must be remembered though that while one artery
is being injected the others should be tied off lest by collateral
circulation you would get leakages. The thoracic aorta might be used
but it will be found more difficult because of the leakages which
would occur through the intercostal arteries. These leakages would not
occur nearly as much by the raising of the branches off the arch of
the aorta, namely the innominate, the left common carotid and the left
subclavian. Any leakage can be stopped by means of the lock forceps and
then tied.

The lower part of the body, if it is not injured, can be injected now
through the abdominal aorta, but if there has been any damage done
below the diaphragm, it would probably be best to further open up the
cavity and inject each lower extremity through the common iliacs.

Now replace all the organs and surround them with hardening compound,
and sew up the cavity incisions, with great care and neatness. It would
be well to practice demi-surgery here, so that you would become more
proficient in the art, and thus be able to do more efficient work on
the exposed parts, should the occasion ever demand it.


=Gun-shot in the Abdomen.=—When death occurs it is generally due to
severing or dividing of an artery or decomposition resulting from the
injury done the intestines. The operator should open the body cavity,
from the end of the sternum bone to the pubic bone, and cleanse the
cavity of all the coagulated blood and other putrid matter. Locate and
tie up the injured vessels. The injection can then be started from one
of the principle arteries which will aid in locating the other injured
vessels. Puncture the stomach and inject inside, so as to prevent the
formation of gas, and after the body has been injected place hardening
compound inside the body cavity and sew up carefully and neatly.


=Burns and Scalds.=—A burn is an injury to the body produced by
the application of a flame or of a substance heated above a certain
temperature.

A scald is an injury produced by the application of a liquid heated
above a certain temperature.

Injuries resulting from corrosive liquids such as sulphuric acid,
nitric acid, caustic potash, carbolic acid, etc., are properly termed
burns. A heated solid such as iron may produce a burn of great
intensity from the blistering of the skin to the charring of the
underlying tissues. Metals heated above 212 degrees Fahrenheit will
produce redness, vesication and coagulation of the blood. Molten metals
cause burns or scalds very similar to those produced by heated solids.
Boiling oil produces severe burns. If a part is severely scalded with
boiling water, the skin may appear sodden, blistered, and of an ash
grey color, but never produces blackening or charring of the cuticle.
Phosphorous burns are usually very severe and of great depth, while
the area of skin destroyed is usually small. Gunpowder burns caused by
explosions are often of great superficial extent, extensive scorching
and numerous carbon particles are commonly found imbedded in the true
skin. Petroleum burns are generally severe, as usually all or nearly
all the body is scorched and blackened. Burns from flame, extensive
scorching with burnt hair is a usual feature in a flame burn. Burns
from explosions of fire damp in coal mines are frequently of great
extent and present the appearance of great scorching, and very often a
quantity of coal dust will be found imbedded in the true skin. There
are six degrees of burns as follows: (a) Simple hyperemia of the
skin, (b) dermatitis, with vesicles or bullae, (c) necrosis of the
superficial layer of the skin, (d) complete necrosis of the skin, (e)
necrosis of the skin, superficial fascia and muscles, and (f) complete
carbonization of the part.

_Treatment._—The embalmer does not treat these cases according to the
cause as much as to what is left of the part after burning has been
accomplished. After observing the part to note whether the condition
can be bettered by a replacement of tissue by artificial means and
finding such to be the case, I would use a form of paste commonly used
for filling in cuts and restoring the features and with this paste
thoroughly cover the burned part. If the affected part covers the
entire face or most of it, an entire new surface will have to be built
up with the paste. If the burning of the skin has left particles of
epidermis adhering to the derma, I would use sweet oil and bath the
entire face with it, thus softening the skin and allowing the removal
of the small particles. Any small desiccated spots should be covered
with the paste. After carefully blending the paste with the skin so
as to produce a smooth even complexion, which can best be done by the
use of a brush to smooth it with, apply a good quality of face powder
(flesh color) to the part. If the color is too striking, or too white,
destroy the contrast with carmine rouge. This form of operation is
commonly known as demi-surgery. We find that the face powder is best
applied with a pad made of surgical gauze especially when applied
with a patting movement. This gives a good imitation of the pores of
the skin, and if any further smoothing is necessary the brush can be
used again. The principal result wanted is a good imitation of the
natural parts. If the operator will use the utmost care to give the
parts gentle, fine touches here and there, a most artistic effect will
be produced. If the eye brows have been destroyed, imitate them with
charcoal, carbon, or dark theatrical paint. A good make-up outfit is
indispensable for an embalmer handling many railroad cases during the
year, and as such can be had at any dealer in theatrical supplies, we
advise the securing of a few varieties of pastes, and some good face
powder together with carmine rouge.

If the face is damp or moist, the theatrical paste above mentioned will
not adhere properly, and in that case alcohol applied to the skin will
cause it to dry. One of the most important considerations in these
cases, is the placing of the body in the casket. The body should be
placed as low as possible, the silk slide should be closed and a view
of the body only secured through it, the light in the room should be
tempered so that no striking rays of light serve to distort any portion
of the features. Wonderful work has been accomplished by the authors
and by others in rescuing cases of this kind from non-presentability
to presentability, but in all cases, the ingenuity of the operator
is taxed to the utmost, and the case never looks just right until the
last touch is applied. With the above information, you have only the
rudiments of the work. Your success or failure will depend upon how
hard you try to make good in each individual case, and your success in
matching colors, which can only be acquired with much patience.

Give burned bodies a very thorough arterial injection, using half
strength fluid for the first part of the injection. The cavities
should also receive a good injection of normal fluid. The peculiar
odor present about a burned body can be lessened by the use of false
deodorizers such as flowers, perfume, etc.



CHAPTER XXIV.

TREATMENT OF POSTED CASES.


=Cranial Evisceration.=—By this term is meant the complete removal of
the brain. To do so the scalp is cut from ear to ear, the front part
is pulled forward over the nose and the back part over the occipital
bone. A skull clamp is placed in position and with a saw take away the
calvarium. When the calvarium or skull cap has been removed the brain
is in full view and can be easily removed by cutting the arteries at
the circle of Willis and the ligaments at the base of the skull.


=Thoracic Autopsy.=—By this term is meant the complete removal of all
the organs of the thoracic or chest cavity. To do so the skin is cut on
either side from the sterno-clavicular junction to a point where the
ninth rib joins to its costal cartilage. The ribs are cut on either
side at the costochondral articulation, which will permit the entire
front chest wall to be taken away. The heart and lungs are now in full
view and can be easily removed.


=Abdominal Post.=—By this term is meant the complete removal of all
the organs of the abdominal cavity. To do so the skin and muscles
are cut on either side from a point where the ninth rib joins its
costal cartilage vertically downward to about an inch above Poupart's
ligament and from there to the top of the pubic bone. When the anterior
abdominal wall has been removed all the organs will be in full view and
can easily be removed.


=Posted Cases.=—By this term is meant those cases on which an autopsy
has been held and all the internal organs of the body have been
removed. Here all the internal circulation has been destroyed.

_Treatment._—Place the body on the cooling board and undo all the
stitches made by the physician in sewing up the body after the
post-mortem. Remove all the organs, that have been previously removed
by the physician, and place same in a bucket or other container. Clean
out thoroughly all the blood from the cranial, thoracic and abdominal
cavities. Now try to tie off the arteries in the cranial cavity which
will be the vertebrals or the basilar and the common carotids. If these
have been cut too short to be tied, then mix up some plaster of paris
and cover them securely so that there will be no leakage. While the
plaster of paris is setting raise the common iliac artery, which you
will find at the back of the abdomen just over the ilio-psoas muscle,
represented by a line drawn from the body of the fourth dorsal vertebra
to the center of Poupart's ligament. Inject the right and left common
iliac arteries downward which will take care of the lower extremities.
Here the only artery you need to tie off is the deep epigastric artery
which is a branch of the external iliac just a short distance above
Poupart's ligament and which takes a course upward over the abdominal
muscles finally to anastomose with the deep mammary artery.

By the time you have injected the lower extremities, the plaster of
paris will be set. Work from the inside of the thoracic cavity, and
tie off the innominate, left common carotid and the left subclavian
arteries, and when this has been accomplished inject each one
separately. Here the only leakage you will have will be through the
mammary or intercostal arteries which you will tie off as the leakage
occurs.

Now turn the body over and hypodermic the back, then turn body over
again. Fill the cranial cavity with sawdust, place the skull cap in
position and sew up the scalp. Wash all the organs and place them back
in the cavities in their proper positions or as nearly so as possible
and as you do so fill in with hardening compound. Sew up the abdomen
and wash the body with a disinfecting solution and apply outward
cosmetics.



CHAPTER XXV.

TREATMENT OF MISCELLANEOUS CASES.


=Alcoholism.=—_Definition._—An intoxication, acute or chronic, due to
the injection of a sufficient quantity of alcohol to produce muscular
inco-ordination, mental disturbances, and finally narcosis.

_Pathology._—Where death is the result of acute alcoholism, the mucous
membrane of the gastro-intestinal canal is engorged, injected, and
dark red in color, and covered with a sticky, mucoid exudate. The
brain and the kidneys show the same characteristic changes. In chronic
alcoholism, changes of a more permanent character take place, depending
somewhat upon the quantity, quality and kind of alcoholics consumed,
and the length of time used. While all the bodily tissues are more or
less impaired, the brain, kidneys, and digestive system suffer most.
There may be connective tissue changes, fatty degeneration, sclerosed
kidneys, liver or arteries, and a more or less dilatation of the
stomach.

_Treatment._—In acute alcoholism, the blood should be drained from
a large vein, while fluid is being injected into a large artery.
After draining a sufficient amount of blood from the body, the vein
tube should be shut off and the arterial injection should continue
until the capillaries have been filled to their utmost capacity. This
strong treatment is advised on account of the early tendencies toward
putrefaction, which is sometimes in an advanced state shortly after
death. The cavities should receive a thorough treatment with normal or
supernormal fluid. Myers advises the re-injection of the cavity in 6 or
8 hours after removing the fluid remaining in the cavity from the first
injection. As a preventive treatment, this last is a wise precaution.
While the cavity treatment is being given the stomach should be entered
by the trocar, relieved of its contents and injected, thus preventing
post-operative purging.

In chronic alcoholism, the greatest circulation difficulties will
be encountered. The capillaries will not receive the fluid, the
putrefactive processes causing the formation of tissue gas early
in the case, which, when coupled to many natural impediments to the
circulation in cases of this kind, virtually nullifies the circulation
for fluid distribution. Inject as many arteries as possible, and if
necessary the veins also. Use the hollow needle or trocar and give
the unexposed portions of the body a heavy hypodermic injection. The
fluid used in this case should be not less than normal in strength and
in most cases should be at least ¼ over normal. Give the cavities a
very heavy injection, paying special attention to the food passages.
This is one of the cases coming to the attention of the embalmer where
every emphasis must be laid upon the injection of a sufficient amount
of fluid, through as many channels as possible. Do not count the cost
of the fluid in this case, if you value the securing of satisfactory
results. Cosmetic effect will be enhanced by injection of the carotids
upward with drainage from the internal jugular veins. Finish the case
with the use of good face powder, unless a discoloration is present,
when this should be obliterated with one of the improved methods
mentioned in the chapter on discolorations.


=Morphinism.=—_Definition._—A chronic intoxication due to the habitual
use of opium, or some of its alkaloids, especially morphine.

_Pathology._—There are no characteristic tissue changes, other than
that due to indigestion and malnutrition. At death the patient is
anemic, the skin dry, sallow and inelastic, the heart and blood vessels
show the effects of poor nutrition, and the tissues generally present
a starved appearance. The blood disintegrates, causing a discoloration
of a brownish color, one or two days after death.

_Treatment._—Drain blood from these cases using half strength fluid
for the first part of the injection. The more blood obtained, the less
the danger of discoloration will be. Give the body a thorough cavity
injection in addition to the arterial injection. If your treatment does
not eliminate the blood as a factor, the discoloration will occur and
then it cannot possibly be removed. In this case the use of cosmetics,
if in the hands of a patient operator, will overcome the color.


=Plumbism.=—_Synonyms._—Lead-poisoning.

_Definition._—A chronic intoxication due to absorption of lead.

_Pathology._—The muscles are atrophied and pale in color.
Arteriosclerosis of the cerebral blood vessels is found. There may be
softening of the brain and hemorrhage.

_Treatment._—Drain blood from the veins while injecting fluid in the
arteries. The fluid should be used half strength for the first bottle
of the injection. Massage the face downward to help eliminate any
discoloration of blood origin from cerebral hemorrhage. Give the body
a thorough injection both as to arteries and cavities. If the face is
unduly pale from this treatment, carmine rouge, judiciously applied
will lessen the paleness.


=Arsenicism.=—_Definition._—A chronic intoxication caused by the
continued absorption of arsenic.

_Treatment._—Same as for plumbism.


=Mercurialism.=—_Definition._—A chronic mercurial poisoning, caused,
either by ingestion of the drug, or by inhalation and absorption of the
mineral in the industrial pursuits.

_Pathology._—There is an acute inflammation of the mouth, stomach, and
intestines. The kidneys are inflamed and the liver is degenerated.

_Treatment._—Drain blood from a large vein while the injection is
going on. The first bottle of fluid for the injection should be half
strength. The cavities should be injected, as intense inflammation
takes place in the alimentary tract.


=Heat-Stroke.=—_Synonyms._—Sunstroke.

_Definition._—Heat-stroke is the result of exposure to intense heat,
either from the direct rays of the sun, or the radiation of blasts or
furnaces, or to an overheated atmosphere.

_Pathology._—Owing to the excessive heat of the body, putrefactive
changes occur very early. If a post-mortem examination is made very
soon after death, the left heart will be found contracted, while the
right heart will be engorged, and the venous trunks filled with dark
semi-fluid blood. There is also venous engorgement of the brain, spinal
cord, and lungs. Ecchymoses and extravasations of blood are found in
the skin and mucous membranes.

_Treatment._—Drain blood from a large vein during the injection. The
first two bottles of the injection should be of half strength fluid.
The face should be massaged to assist in the securing of capillary
circulation and in the elimination of the blood discoloration. The body
should be treated as soon as possible after death, as putrefaction
begins early. The cavities should have a very thorough treatment,
eliminating the gases and injecting normal fluid therein. Should
ecchymosis occur, obliterate the color by an application of cosmetics.


=Obesity.=—_Definition._—An excessive accumulation of fat, impairing
the bodily functions, or rendering one uncomfortable.

_Treatment._—Drain blood from these cases, injecting the first bottle
of fluid half strength followed by normal fluid for the balance of
the injection. Massage the face downward during the injection. Inject
the cavities, with special attention to the stomach and intestines.
For transportation of these cases, govern yourself according to the
provisions of the transportation laws.


=Elephantiasis.=—_Definition._—A chronic disease caused by inflammation
and obstruction of lymphatics and marked by great thickening of the
skin.

_Treatment._—Drain blood from these cases and inject normal fluid
sufficient enough in quantity to secure preservation. For long time
preservation, supplement the foregoing treatment by a special injection
into the thickened extremity, either through an artery leading directly
to the part or by trocar or hollow needle inserted under the skin. Give
the body a thorough cavity treatment, using normal fluid throughout.
For transportation, govern yourself according to the provisions of the
transportation laws.


=Drowned Cases.=—_Treatment._—Inject fluid into the lungs by inserting
a child's trocar into the windpipe at the upper border of the sternum,
making the injection sufficient in strength and amount to fill the
lungs. If this is not done, a bloody purging will take place several
hours after death. Tap the stomach through the epigastric region,
aspirate the contents and inject strong fluid before removing the
instrument. Drain blood from the body during the injection, which
should be quite heavy and of normal fluid. The last bottle should be
made 1¼ strength or ¼ over normal.


=Floater.=—_Definition._—A body that has been floating on the water.

_Treatment._—The body is distended with gases in the cavities, tissues
and capillaries, putrefaction is in an advanced state, and a vile
odor will be present. If body is to be shipped, aspirate all the gas
possible from the tissues with the hollow needle, injecting strong
fluid in the same openings. Open the body from the base of the neck
to the pubic bone, relieve the gases in the alimentary tract and
lungs, and fill cavity thoroughly with hardening compound, after
which it should be sewed up. Inject as many arteries as possible with
very strong fluid. Dress the body and place it in a metallic casket.
Pour the contents of two pound bottles of Platt's chlorides on the
underclothing to assist in deodorizing the body. Do not open the casket
after it is once sealed.

If the body is not to be shipped, it will be advisable to deodorize it
as much as possible and bury it without delay.


=Mother and Unborn Child.=—_Mother and Foetus in Utero._
—_Treatment._—Before pregnancy has reached the three months
stage, the child will receive fluid directly from the circulation
connected with the mother.

After the three months stage, the circulation, by direct flow, is
stopped and fluid could only reach the foetus by absorption from the
placenta. This is naturally insufficient to preserve the child, which
by this time is immersed in the liquor amnii (water of the womb) and
which is subject to early putrefaction in that situation. The trocar
should be directed to the uterus or womb from a point on the median
line, half way from the umbilicus to the pubic arch, care being taken
to reach the water which surrounds the foetus. Withdraw the water,
and inject as much strong fluid as possible so that the foetus will
be surrounded with fluid, and in that way preserved. If the trocar
enters the body of the child, this will not occur, so the instrument
should be carefully manipulated to reach the space between the child
and the uterine wall. The mother should receive a very heavy arterial
and cavity injection, with full drainage of blood. The vulva should be
closed with absorbent cotton. The face should be massaged thoroughly
toward the heart.


=Senility.=—_Synonyms._—Old age.

_Definition._—A state of decline in an aged person characterized by
progressive atrophy of all the tissues and organs.

_Pathology._—Excessive shrinking and obliteration takes place among
the capillaries. The skin becomes diminished in thickness. When this
occurs, it is easily seen why in old age there will follow, after the
injection of fluid into the arterial system, greenish, brownish, and
soft spots, in the different parts of the body, especially notable in
the face, neck and hands. The products of degeneration may accumulate
in the tissues and cause them to be thicker than they are in health,
as is seen in the vessels, the walls of which are much thicker than
normal. The blood contains fewer corpuscles and solid constituents, is
more watery, and coagulates more readily; also the total quantity is
less. The pericardium, endocardium, and the capsules of the liver and
spleen are opaque and toughened. Degeneration of the cardiac substance
may lead to a state of asthenia, which generally produces death.
Dilatation of the orifices of the heart may be the prominent lesion,
or they may be contracted by atheroma, or by thickening of the vales
or rings. The lungs are changed more or less, increasing the bronchial
secretions, which during life have been attended by severe paroxysms of
coughing.

_Treatment._—Inject half strength fluid for the first bottle, following
that with ¾ strength for the second and normal for the third and all
thereafter if more be necessary. Blood may be drained from the vein if
the operator thinks it advisable. The commercial face solution or water
should be used on the face while massaging in order that the skin may
be kept moist and to prevent dessication from the action of the fluid.
The cavity should be injected as a matter of precaution.


=Gangrene.=—_Synonyms._—Senile gangrene; mortification.

_Definition._—Putrefactive fermentation of dead tissue, from various
causes.

_Treatment._—The extremities are affected in senile gangrene. They
should be wrapped with absorbent cotton which should then be saturated
with fluid. The body itself should receive the same treatment accorded
in the paragraph on senility.



INDEX


(References are to pages.)

  A.

  Abdomen, 101, 254
  Abdominal cavity, 101, 254
  Abdominal fermentation, 182
  Abdominal post, 351
  Absence of normal moisture in skin, 200
  Alimentary canal, 96
  Anatomical guides, 225
  Anatomy, 33
  Angiology, 34
  Antemortem staining, 191
  Anus, 112
  Apnea, 157
  Aponeuroses, 55
  Appendix, 109
  Arterial system, 125
  Arteries, structure of, 58
  Artery, differentiated from nerve, 215
  Artery, differentiated from vein, 215
  Artery, how to cut for injection, 216
  Artery, how to raise, 214
  Artery, selection of, 211
  Ascending color, 111
  Asphyxia, 157
  Axillary artery, location, 231
  Aztecs embalming, 19
  Azygos system, 125


  B.

  Babylonian embalming, 17
  Bandage test, 159
  Belgian embalming, 18
  Bladder, urinary, 118
  Blood, 61
  Blood coagulation, 65
  Blood corpuscles, 63, 64
  Blood plasma, 62
  Blood, removal of, 264
  Blood vascular system, 123
  Bones, 48, 69
  Bones of face, 74
  Bones of lower extremity, 77
  Bones of pelvic girdle, 78
  Bones of thorax, 76
  Bones of upper extremity, 77
  Boudet, 22
  Brachial artery, location, 234
  Britain embalming, 18
  Bronchus, 87


  C.

  Cadaveric lividity, 168
  Caecum, 109
  Cancerous spots, 190
  Capillary circulation, 132
  Capillary congestion, 204
  Cardia, 104
  Carotid artery, location, 225
  Cartilage, 48
  Cavities, 79
  Cavity embalming, 247
  Cell, 35
  Cerebro-spinal cavity, 79, 247
  Charge of embalming, 222
  Chemical action, 202
  Christian embalming, 20
  Circle of Willis, 127
  Clavicle bone, 77
  Coagulation of blood, 65
  Collateral circulation, 147
  Colon, 111
  Coma, 157
  Cooling of the body, 167
  Coronary circulation, 142
  Cranial cavity, 79, 247
  Cranial evisceration, 351
  Cranial nerves, 81
  Cranium, 94


  D.

  Descending colon, 112
  Descriptive anatomy, 33
  Diaphragm, 99
  Desiccation, 196
  Digestive fermentation, 180
  Direct incision, 257
  Discolorations, 187
  Discolorations after death, 196
  Discolorations before death, 188
  Disinfectants, 221
  Drying action of formaldehyde, 197
  Duodenum, 107


  E.

  Ecchymosis, 191
  Egyptian embalming, 5
  Embalming, 153
  Embalming, abdominal cavity, 254
  Embalming, Aztec, 19
  Embalming, Babylonian, 17
  Embalming, Belgian, 18
  Embalming, Britain, 18
  Embalming, cavity, 247
  Embalming, cerebral cavity, 247
  Embalming, charge, 222
  Embalming, chest cavity, 252
  Embalming, crania cavity, 247
  Embalming, early Christians, 20
  Embalming, Egyptian, 5
  Embalming, Ethiopian, 17
  Embalming, French, 18
  Embalming, Greek, 17
  Embalming, Guanch, 3
  Embalming, Hindoo, 18
  Embalming, Indian, 19
  Embalming, Jewish, 15
  Embalming, later European, 20
  Embalming, Norsemen, 18
  Embalming, Persian, 16
  Embalming, Peruvian, 19
  Embalming, Roman, 17
  Embalming, Scythian, 17
  Embalming, subcutaneous tissue, 260
  Embalming, thoracic cavity, 252
  Epigastric region, 103
  Esophagus, 99, 250
  Ethiopian embalming, 17
  Ethmoid bone, 74
  European embalming, 20


  F.

  Face bones, 74
  Falcony, 23
  Fascia, 43
  Fat, 56
  Feather test, 159
  Femur bone, 78
  Fermentation, 179
  Fermentation, abdominal, 182
  Fermentation, digestive, 180
  Fermentation, gastric, 184
  Fermentation, intestinal, 185
  Fermentation, metabolic, 181
  Fermentation, putrefactive, 181
  Fermentation, spirituous, 180
  Feverish condition, 199
  Fibula bone, 78
  First call, 205
  Fluid, injection of, 218
  Foetal circulation, 144
  Foramen of Winslow, 121
  Fractures, 194
  Franchini, 22
  Franciolli, 23
  Freezing of the skin, 199
  French embalming, 18
  Frontal bone, 74


  G.

  Gall bladder, 114
  Gangrene, 191
  Gannal, 23
  Gas formation, 179
  Gastric fermentation, 184
  Glands, 47
  Greek embalming, 17
  Greenish tinge of putrefaction, 200
  Guanch embalming, 3
  Guides, anatomical, 225
  Guides, linear, 225


  H.

  Hair, 41
  Heart, 92
  Heart sac, 92
  Hindoo embalming, 18
  Histology, 33, 35
  Holmes, 25
  Humerus bone, 77
  Hunter, 21
  Hyoid bone, 75
  Hypochondriac region, 103
  Hypogastric region, 103


  I.

  Ileum, 108
  Ilium bone, 78
  Indian embalming, 19
  Inferior maxillary bone, 74
  Inferior turbinate bone, 75
  Inguinal region, 103
  Injection of fluid, 218
  Intestinal fermentation, 185
  Intestines, large, 108
  Intestines, 106
  Ischium bone, 78


  J.

  Jejunum, 107
  Jewish embalming, 15


  K.

  Kidneys, 116


  L.

  Lachrymal bone, 75
  Large intestines, 108
  Larynx, 84
  Leucocytes, 64
  Ligaments, 55
  Linear guides, 225
  Liver, 112
  Lumbar region, 103
  Lungs, 88
  Lymphatic circulation, 123, 147
  Lymphatics, 44


  M.

  Malar bone, 75
  Mediastinum, 91
  Membranes, 57
  Mesentery, 122
  Metabolic, fermentation, 181
  Mirror test, 159
  Modes of death, 155, 156
  Mouth, 97
  Mucous membranes, 57
  Muscles, 54
  Myology, 33


  N.

  Nails, 40
  Natural evaporation, 196
  Nerves, 53, 81, 82
  Neurology, 33
  Norse embalming, 18
  North American Indian embalming, 19


  O.

  Omentum, 121
  Omohyoid muscle, 75
  Osteology, 33, 69


  P.

  Palate, 97
  Palate bone, 75
  Pancreas, 115
  Parietal bone, 74
  Patella, 78
  Pelvic cavity, 118
  Pericardium, 92
  Peritoneum, 120
  Persian embalming, 16
  Peruvian embalming, 19
  Pharynx, 98
  Pigmentary atrophy, 189
  Pleura, 87
  Plugging orifices, 262
  Portal circulation, 144
  Position of body on embalming board, 210
  Positive signs of death, 162
  Postmortem discoloration, 203
  Postmortem staining, 204
  Poupart's ligament, 55, 56
  Premature burial, 164
  Prostate, 119
  Protoplasm, 35
  Pubic bone, 78
  Pulmonary circulation, 134, 141
  Purging, 249
  Putrefactive changes, 160
  Putrefactive fermentation, 181
  Pyloris, 104


  R.

  Radial artery, location, 237
  Radius bone, 77
  Raising an artery, 214
  Receptaculum chylii, 46
  Rectum, 112
  Regional anatomy, 34
  Removal of blood, 264
  Removal of urine, 263
  Ribs, 76
  Rigor mortis, 177
  Roman embalming, 17
  Ruysch, 21


  S.

  Salivary glands, 98
  Sarcolemma, 54
  Scapula bone, 77
  Scars, 194
  Scythian embalming, 17
  Selection of artery, 211
  Serous membranes, 57
  Signs of death, 155, 157
  Sinuses, 136
  Skeleton, 69
  Skin, 37
  Skin slip, 175
  Skull, 72
  Small intestines, 106
  Sphenoid bone, 74
  Spinal cavity, 81
  Spinal nerves, 82
  Spine, 71
  Spirituous fermentation, 180
  Spleen, 116
  Stomach, 103
  Sucquet, 23
  Superior maxillary bone, 74
  Suprarenal capsule, 117
  Surgical anatomy, 34
  Syndesmology, 33
  Synovial membranes, 57
  Systemic circulation, 125
  Systemic system, 134


  T.

  Tattoo marks, 194
  Teeth, 52, 97
  Temporal bone, 74
  Tendons, 55
  Tests of death, 155, 158
  Thoracic autopsy, 351
  Thoracic cavity, 83, 252
  Thoracic duct, 45
  Tibia bone, 78
  Tissue, 37
  Trachea, 85, 250
  Transverse colon, 111
  Treatment of accidents, 341
    Arm severed, 343
    Body severed, 342
    Broken neck, 341
    Burns, 347
    Chest crushed, 346
    Foot crushed, 345
    Gun shot in abdomen, 347
    Hanging, 341
    Head crushed, 345
    Head severed, 344
    Leg severed, 344
    Scalds, 347
    Strangulation, 341
  Treatment of diseases, 285
    Actinomycosis, 293
    Ague, 295
    Alcoholism, 354
    Anasarca, 339
    Aneurism, 328
    Anthrax, 285
    Aortic incompetency, 321
    Aortic insufficiency, 321
    Aortic regurgitation, 321
    Aortic stenosis, 321
    Appendicitis, 336
    Arsenicism, 357
    Arterio sclerosis, 325
    Ascites, 337
    Black death, 303
    Black vomit, 296
    Bubonic plague, 303
    Carbuncle, 285
    Carcinoma of liver, 333
    Cardiac atrophy, 324
    Cardiac dilatation, 324
    Cardiac thrombosis, 323
    Cerebro spinal fever, 286
    Cerebro spinal meningitis, 286
    Charbons, 285
    Chicken-pox, 309
    Chills and fever, 295
    Cholera, 302
    Cirrhosis of liver, 333
    Dengue, 294
    Diphtheria, 297
    Dropsy, 337
    Elephantiasis, 359
    Drowned cases, 359
    Endoarteritis, 325
    Endocarditis, 320
    Erysipelas, 287
    Famine fever, 308
    Farcy, 288
    Fatty degeneration of arteries, 326
    Floater, 359
    Gangrene, 362
    Gangrene of lungs, 312
    Glanders, 288
    Heat stroke, 357
    Hemopericardium, 319
    Hospital fever, 308
    Hydropericardium, 318
    Hydrophobia, 289
    Hydrothorax, 317
    Hypertrophy of heart, 324
    Influenza, 301
    Jail fever, 308
    Jaundice, 329
    Leprosy, 301
    Lockjaw, 292
    Lumpy jaw, 293
    Malaria, 295
    Malignant pustule, 285
    Marsh fever, 295
    Measles, 306
    Mercurialism, 357
    Mitral incompetency, 321
    Mitral insufficiency, 321
    Mitral regurgitation, 321
    Mitral stenosis, 322
    Morphinism, 356
    Mother and unborn child, 360
    Mumps, 307
    Obesity, 358
    Parotitis, 307
    Pericarditis, 318
    Peritonitis, 336
    Pertussis, 308
    Plumbism, 356
    Pneumonia, 314
    Pneumopericardium, 319
    Pulmonary abscess, 314
    Pulmonary hemorrhage, 312
    Pulmonary incompetency, 323
    Pulmonary insufficiency, 323
    Pulmonary stenosis, 323
    Putrid fever, 308
    Pyemia, 311
    Rabies, 289
    Relapsing fever, 290
    Rubeola, 306
    St. Anthony's fire, 287
    Scarlatina, 304
    Scarlet fever, 304
    Scarlet rash, 304
    Senility, 361
    Septicemia, 310
    Ship fever, 308
    Small-pox, 305
    Splenic fever, 285
    Spotted fever, 286
    Swamp fever, 295
    Syphilis, 290
    Tetanus, 292
    Tricuspid incompetency, 322
    Tricuspid regurgitation, 322
    Tuberculosis, 298
    Typhoid fever, 299
    Typhus fever, 308
    Varicella, 309
    Variola, 305
    Whooping cough, 308
    Wool-sorter's disease, 285
    Yellow fever, 296
  Treatment of posted cases, 351
    Abdominal post, 351
    Cranial evisceration, 351
    Posted cases, 352
    Thoracic autopsy, 351
  Trocar method, 255


  U.

  Ulna bone, 77
  Ulnar artery, location, 240
  Umbilical region, 103
  Ureter, 117
  Urinary bladder, 118
  Urine, removal of, 263
  Uterus, 118


  V.

  Vasa-vasorum, 60
  Vascular system, 123
  Veins, structure of, 60, 61
  Venous circulation, 134
  Venous congestion, 204
  Vermiform appendix, 109
  Vertebral column, 71
  Vomer, 75


  W.

  Winslow, Foramen of, 121
  Wounds, 193


  Y.

  Yellow jaundice, 188



Transcriber's Note

Original spelling, hyphenation and punctuation, even where
inconsistent, have been preserved. Minor typographical errors have been
corrected without note.





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