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.