DISCOLORATIONS.
=Discolorations.=—Discolorations should be treated as a separate
and independent subject because they are causes of great annoyance
and embarrassment to the operator, and their treatment is of utmost
importance. Just think of the possibility of having a body properly
injected, and the preservation complete, and something along the line
of a discoloration coming to the front and ruin the results of the
work. If there is any condition possible in the dead body that can
cause more trouble to the embalmer than discolorations in general,
it has not as yet been discovered. You have only to realize what the
appearance of a body would be in the casket, if any discolorations were
present on an exposed surface, to know that too much can not be said on
the subject.
Discolorations may not occur in conjunction with tissue changes, so
when they do occur we should look for the cause of the same before
deciding just what the name of the discoloration is, or what treatment
should be given to eradicate it.
For convenience in study, and for the proper classification of
the various conditions, the subject has been divided into those
discolorations occurring before death, and those discolorations which
may occur in the body after death.
=Discolorations Occurring before Death.=—Those discolorations occurring
before death and which would remain on the body after death would be:
(a) Yellow jaundice,
(b) Pigmentary atrophy,
(c) Cancerous spots,
(d) Gangrene,
(e) Ecchymosis or ante-mortem staining,
(f) Wounds, fractures, scars and tattoo marks.
(a) =Yellow Jaundice.=—In the study of the liver you have heard that
the liver secretes a digestive juice called the bile.
Bile acts as the natural antiseptic of the intestines in life, and aids
with the digestion of fatty food substances along with other actions.
The principal coloring matter of the bile is a yellow substance called
bili-rubin. Biliverdin, green, is precipitated by alkalies.
The course of this bile in life is from the liver to the gall bladder,
which acts as the reservoir, into the cystic duct and then into the
common bile duct and into the cavity of the duodenum (first section
of the small intestines). It sometimes happens that there may be an
obstruction of the bile ducts with the result that the bile is backed
up into the gall bladder, and from there into the liver again, throwing
it into the blood vessels of the liver and out into the tissues of
the body along with the blood. As the blood traverses the entire area
of the body, and as the yellow coloring matter of the bile acts as a
stain, it is only a matter of course that the tissues will be stained
the characteristic color of the bile.
This stain will be found all over the body from the outer layer of
the skin to the membrane covering the bone (the periosteum) and will
adhere very closely to the tissues, rendering the removal practically
impossible.
Ordinary arterial injection of a body of this character will have
absolutely no effect, no matter what preservative fluid may be used and
regardless of whatever any one may say, as it stands to reason that
when the discoloration is not located in the blood vessels, that the
removal of same can not be accomplished by flushing the blood vessels
alone.
Of course, the washing of the blood vessels with a solution will
aid the removal of the discoloration, but it is necessary to employ
a strong bleaching solution on the outer surface of the exposed
parts in order to better the conditions so that the body may be made
presentable.
In addition to this treatment, it would be advisable to color the
lights in the room in which the body is to be shown, so as to make
every thing in the room about the same color of the body, including the
persons viewing the remains. This will have the effect of lessening the
apparent bad color of the body, and will add to your reputation as an
embalmer.
(b) =Pigmentary Atrophy.=—Here is another instance of the work of bile
pigments or coloring matters, in which not only the yellow, but the
green colors are deposited in the tissue cells. In addition to this,
the cells all over the body atrophy (contract or reduce in size). The
contraction of the cells may be due to imperfect nutrition or perhaps
anemia or some other action causing great emaciation of the body.
You will see very readily that the main point of difference between
yellow jaundice and pigmentary atrophy is in the color, and also in the
fact that the cells in yellow jaundice are in their normal state and in
pigmentary atrophy are in a contracted condition. The treatment given
for yellow jaundice as follows: injecting and washing the blood vessels
with a mild solution and the application to the affected parts of a
strong bleaching solution, should be given for pigmentary atrophy.
The suggestions as regarding the lights to show the body under, should
also be noted and used in these cases.
(c) =Cancerous Spots.=—What is intended for this particular
discoloration, is not the ordinary cancer that has eaten through the
skin, but that form sometimes noted in aged persons where the cancer is
just about to come through the skin. In other words, a yellowish brown
color showing in any of the exposed parts of the skin before death.
As cancer is in fact a rottening or mortification of the tissues, the
injection with a hypodermic outfit of a strong hardening and bleaching
solution will harden and bleach out the color of the cancer to a great
extent, and thus improve the appearance greatly, the ordinary cosmetic
powders will finish the preparation.
For the hypodermic injection we would suggest the following:
R Alum, 10 gr.
Corrosive sublimate, 5 gr.
Zinc chloride, 5 gr.
Grain alcohol, 4 fluid oz.
Formaldehyde, 2 fluid oz.
The cancerous spot should not be confounded with the color of
dessication which will resemble it somewhat. The main point of
difference would be that the cancer would be present before death,
and the dessication could not possibly occur until after the body
is embalmed. This caution is advised on account of the tendency the
solution to be injected hypodermically would have to make a dried spot
worse in color than better.
(d) =Gangrene.=—Gangrene can best be described as the death of certain
areas of tissue of the living body. The death of the tissue may be
brought about by very many causes; by vascular obstruction and arrest
of the blood supply to a part, or of the outflow from a part; by
enfeebled circulation; temporary stoppage of the circulation of a part
or organ; acute infection; and by burns.
Gangrene with its peculiar color, a dark green, is not often found on
the exposed surfaces of the body, but will more often be found on the
lower extremities and then only on the bodies of aged persons. For this
reason it will be unnecessary to treat it for the removal of color.
(e) =Ecchymosis, or Antemortem Staining.=—Ecchymosis is an
extravasation of blood into the areolar tissues, forming a bruised
place caused principally by a blow from a heavy instrument or missile.
This form of discoloration is mostly seen in accident cases, where
death was due to mechanical causes.
In ecchymosis the blood capillaries being ruptured, the blood permeates
the bruised tissues surrounding the ruptured vessels and thus gives the
characteristic color of venous blood. There seems to be no positive
treatment, but in some cases it can be remedied to some degree by a
hypodermic injection of a good bleacher, and then massaging the part
with a strong bleaching solution. Spots of this kind can sometimes be
covered with flesh tints.
It is often important to determine whether violence has been inflicted
on a body before death. In regard to this point, we must remember,
first, that blows and falls of sufficient violence to fracture bones
and rupture the viscera may leave no marks on the skin, even though
the person has survived for several days; and, second, that there are
postmortem appearances which simulate antemortem bruises. A severe
contusion during life may present, at first, no mark or only a general
redness. After a short time the injured part becomes swollen and of
a red color, this color may be succeeded by a dark blue, and this in
turn fade into a greenish yellow or yellow; these later appearances
are due to an escape of blood from the vessels and to a subsequent
decomposition of the hemoglobin. If, therefore, we cut into such an
ecchymosis after death, we find extravasated blood or the coloring
matter of the blood, in the form of pigment granules, free in the
tissues. Postmortem discolorations, on the other hand, although their
external appearance may resemble that of antemortem ecchymosis, are not
formed by an extravasation of blood, but by a circumscribed congestion
of the vessels or by an escape of blood stained serum. If you cut
into such discolorations, therefore, we find no blood outside the
vessels. Care should be taken not to mistake the lesions of hemorrhagic
infection for traumatic ecchymosis.
Blows on the skin of a body which has been dead for not more than two
hours may produce true ecchymosis with extravasation of blood, such
as can be distinguished with great difficulty or not at all from those
formed during life. If putrefactive changes be present, the difficulty
of distinguishing between antemortem and postmortem bruises is greatly
enhanced.
Hanging and strangulation are attended with the formation of marks
on the neck which are described in works on forensic medicine. These
marks must not be confounded with the natural creases of the skin of
the neck. Many adults during life have creases of the skin of the neck,
one or more in number, running downward from the ear under the chin or
encircling the neck. After death these creases may be much more evident
than during life, and may be rendered more decided by the position of
the head, or if the body be frozen. They usually persist until the skin
putrefies.
(f) =Wounds.=—The embalmer should notice the situation, extent and the
direction of a wound, the condition of the edges, and the surrounding
tissues. If it be a deep, penetrating wound, its course and extent
should be ascertained by careful dissection rather than by the use of
a probe.
If the edges of a wound be inflamed and suppurating, or beginning to
heal, it must have been inflicted some time before death. In a wound
inflicted a short time before death the edges are usually everted;
there may be more or less extravasation of blood into the surrounding
tissues, and the vessels contain coagulated blood; but sometimes
none of these changes occur. The chief characteristics of a wound
inflicted after death are absence of a considerable amount of bleeding,
non-retraction of edges, and the absence of extravasation of blood into
the tissues. But a wound inflicted within two hours after death may
resemble very closely one received during life. In general, unless a
wound is old enough for the edges to present inflammatory changes, the
embalmer must be very careful in asserting its antemortem or postmortem
character.
(g) =Fractures.=—It may be important to determine whether a bone was
fractured before or after death. This point can not always be decided.
Fractures inflicted during life are, as a rule, attended with more
extravasation of blood and evidences of reaction in the surrounding
tissues; but fractures produced within a few hours after death may
resemble these very closely. Usually a greater degree of force is
necessary to fracture bones in the dead than in the living body.
(h) =Scars and Tattoo Marks.=—The presence and character of these
should be noted. Scars produced by any considerable loss of substance
may become very much smaller and less conspicuous, but never entirely
disappear. Slight and superficial wounds, however, leave marks which
may not be permanent.
The discoloration produced by tattooing may, although it rarely does,
disappear during life. The embalmer should not try to remove it.