THE REMOVAL OF BLOOD.
=The Removal of Blood.=—In November 1882, Prof. J. H. Clarke and Dr.
C. M. Lukens, while instructing a class in Philadelphia, in taking up
the carotid artery, the internal jugular vein was injured and a flow of
blood followed much to their dismay. This however turned out to be one
of the greatest events that ever happened for the embalming profession,
as it marked the beginning of the practice of the removal of blood from
the body.
There are some very important reasons why blood should be removed from
the body.
(1) There may be discolorations on the body, especially the face.
This discoloration may be due to the presence of blood in the minute
capillary system and other vessels which are near the surface skin.
This discoloration may be due to the presence of the bile pigments
in the blood, which would tend to give the body a yellowish hue. This
discoloration may be due to the breaking up or disintegration of the
blood corpuscles after death, which would tend to give the tissues of
the body a light, pale, yellow color. Or this discoloration may be due
to the presence of chromogenic bacteria, or color producing bacteria,
in the blood, which might give to the tissues a characteristic green
color.
(2) There may be blood in the arterial system after death, which
certainly will have to be removed or else it may be pushed into the
tissues of the face during the injection of the fluid and cause a
discoloration. Besides if the arteries are congested with blood, this
will have to be removed to make room for the embalming fluid, so that
it will reach the capillaries and the tissues of the body.
(3) There may be the formation of tissue gas, and there is no doubt but
that the removal of blood will greatly facilitate in the treatment, for
without the blood, the fluid will have more chance to act on the parts
containing the gas. This gas may be in the blood vessel itself, and
the removal of that blood then will relieve the gas and the pressure
exerted by the gas, which will aid in the injection of the fluid.
(4) To prevent a hasty decomposition. It may be that our subject is
very heavy and fleshy which will mean that there is more tissue to be
preserved and necessarily more fluid will have to be used. To make room
for this increased amount of fluid, blood should be removed.
It may be that the body is in a hydropic condition. The tissues and
the blood vessels will be filled with water. This will mean a hasty
decomposition. The watery blood should be drawn from the blood vessels
in order to make room for more fluid than ordinarily.
It may be that the body has died of a fever, which will also mean a
hasty decomposition. This will mean that the blood will soon coagulate
after death, and therefore the sooner it is removed, the better for the
general cosmetic effect.
We do not however believe that blood should be removed from every
subject, in order to get good cosmetic effect. Rather there are times
when blood should not be removed, the conditions which are as follows:
(1) In the thin emaciated subject where there is no discoloration. An
example of this condition would be in the tubercular subject, where
before death the body has become very thin and emaciated. We would not
remove blood when the subject is in this condition, for as a rule the
body will take plenty of fluid, the arteries are as a rule empty after
death, and besides we desire to leave the blood in the body, in order
to give the skin of the face a more filled out healthy cosmetic effect.
(2) In the pale, marble-like, anemic subject. We would not remove blood
in this case, first because it is not necessary, for there is a lack of
blood in the surface capillaries showing that the arterial system is
completely empty, and there is no congestion of the veins; secondly,
experience teaches us that in these cases, you probably would not get
any blood if you did try to remove it, and thirdly what little blood
is in the surface capillaries is needed to build up a more healthy
cosmetic effect.
There are times when blood should be removed from the subject after
death which are as follows:
(1) Whenever blood is found in the arterial system. An example of
this might be found in those cases of sudden death, such as drowning,
suffocation, electric shock, or general heart failure. Whenever there
has been a case of sudden death, the operator may expect to find blood
in the arterial system. The last contraction of the heart normally
would drive all the blood out of the arteries and arterial capillaries
into the venous capillaries and veins, but this is not accomplished in
the cases of sudden death. Whenever, on incising an artery, you find
blood in the artery, and it runs freely, it indicates that there is a
considerable quantity of blood in the arterial system. This blood then
should be removed, because, were fluid to be injected into the artery,
when it is full of blood and in this congested condition, all of this
blood would be pushed ahead of the fluid toward the center of pressure,
and from there large quantities would be pushed back into the tissues
of the face, which would result in a greatly discolored face and a very
poor cosmetic effect. DO NOT FORGET. Always remove blood when you find
it in the arteries. The regular blood drainage tube should be placed
in the artery, and all the blood removed that is possible, before
attempting to inject. If this blood is not removed, the operator need
not be surprised if he causes a decided blood discoloration of the face
and a bad cosmetic effect. In these cases blood should be removed from
the veins too, for that procedure will help to make room for what blood
does remain in the arteries and capillaries, so that it can be pushed
by the fluid into the veins rather than the tissues of the face.
(2) When the venous blood vessels are congested with blood and gas. An
example of this might be found in almost any case. When the operator
makes the incision to disclose the vessels and finds the venous
channels congested, or when over the body the surface veins show signs
of congestion and distention with gases, then blood should be removed.
(3) In dropsical cases. Often in these cases the tissues throughout
the body are in a hydropic condition (filled with water), the arteries
as well as the veins are filled with a watery, bloody colored fluid.
It will be best for the operator to remove all this watery blood from
the arteries, veins, and the tissues also, in order to get the greatest
amount of preservative action from his fluid.
(4) In heavy, fleshy subjects. Experience teaches us that these bodies
are as a rule difficult to handle from a cosmetic, as well as from
a preservative standpoint. It seems advisable to draw blood from
these subjects whenever possible, and by so doing bring about a clear
non-discolored cosmetic effect; also the removal of blood will give
more room for a greater supply of fluid, and thus the tissues will be
better preserved.
(5) When the face is discolored. Whenever the operator takes charge of
a body and finds the face discolored, no matter what the cause of the
discoloration may be, it is a good indication to remove blood from that
body.
By removing blood from the larger venous channels, the operator will
make room for the blood to leave the face, and in this way better
cosmetic effect is assured. Massage the face toward the internal
jugular vein, and push the discoloring blood from the tissues of the
face, out into the larger channels, that have been emptied by the
removal of blood.
(6) In fever. Whenever a body dies in a high state of fever, it
indicates a hasty coagulation of the blood, and a tendency to a
discoloration of the face. Whenever the operator knows that the subject
has died of a fever, or when there has been considerable fever on the
body before death, then blood should be removed.
(7) To make room for fluid. The average embalmer only injects a gallon
to a gallon and a half of fluid into a body. There are times when the
operator desires to use more fluid. It may be that the body will have
to be shipped a long distance, perhaps to another country or a distant
state. After a certain amount of fluid has been injected the vessels
become filled up and there is a great resistance established. If the
operator disregards this pressure, and forces still more fluid into the
arterial system, the fine capillary network will be broken, especially
in the lung where the result will be a leakage of fluid through the
mouth and nose from the ruptured air cells in the lung, or in the
tissues of the skin, where the result will be a leakage into a certain
area of tissue later causing a condition known as leathery skin. To
have prevented this the operator should not have forced the fluid
beyond a certain maximum resistance. He could, though, have reduced
this resistance by removing the blood from the venous system, and then
succeeded in the further injection of fluid.
There are times when blood ought to be removed from a subject after
death, but for some reason it seems impossible to remove any. The
reasons may be stated briefly as follows:
(1) The blood may already be in a coagulated condition, owing to the
fact that the body has died in a state of high fever.
(2) The blood may be in a coagulated condition owing to the fact, that
the bacteria of decomposition and putrefaction, have so altered the
blood as to make its removal impossible.
(3) Certain drugs may have been previously given, or taken during life
which would cause a hasty coagulation of the blood.
(4) The body may still be in a condition of rigor, and although the
operator may have released the rigor in the joints, still all the
tissues are in that condition, a condition which might prevent the
blood from draining from the veins no matter what method was used.
Arterial blood is removed from the aorta indirectly, and from the
arteries, only when the arterial system contains blood after death.
Venous blood is removed from the right side of the heart directly or
indirectly, and the veins, only when it is deemed necessary by the
operator.
There are two methods of removing this arterial or venous blood from
the body. These two methods are aspiration and drainage. Besides these
two methods some modified methods or combinations of the two, are
given.
Aspiration consists in actually pumping the blood from the heart,
arteries or veins. In this method, if blood is to be taken from the
heart directly, the trocar is used; if the blood is to be taken from
the heart indirectly or from the arteries or the veins one of the
drainage tubes is used. Either the trocar or the drainage tube is
connected by rubber tubing, to the goose neck on the blood bottle,
which in turn is connected by rubber tubing to the aspirator side of
the aspirator and injector pump. When the air is drawn from the blood
bottle, there is a vacuum formed, which will aspirate or draw the blood
from the heart directly or indirectly from the arteries or veins. The
one great disadvantage of this method is that if the vacuum is made too
great, the artery or vein will collapse ahead of the drainage tube and
thus prevent the successful aspiration of the blood.
Drainage or gravity consists in opening one of the principle arteries
or veins of the body, inserting a blood drainage tube into the artery
or vein as far as it seems practical, and then connecting the blood
drainage tube to the blood bottle by means of rubber tubing. The blood
bottle should be placed considerably lower than the body in order to
have the blood drain successfully. If the femoral artery or vein is
used, the body ought to be on a considerable incline, the head at least
one foot higher than the feet in order to get the maximum amount of
blood.
If the axillary, brachial, or carotid, or their corresponding veins
are used, the body ought to be on a level or turned to the side of the
opening veins.
Simple drainage in itself is not a very successful method of getting
the maximum amount of blood from the body.
The process can be modified in three ways which are as follows:
(1) By placing the blood drainage tube in the vein and the arterial
tube in the corresponding artery. Inject fluid into the arteries
which will tend to push the blood in turn from the capillaries into
the veins, and out into the drainage tube into the blood bottle. This
modified method has been called by Robbins “Displacement.” This is a
good name and one which should be generally adopted.
(2) By placing the blood drainage tube in the artery or vein,
preferably the femoral, and connect it by means of rubber tubing to
the blood bottle. The operator now stands at the head of the subject,
he reaches over, takes hold of each hand of the subject, raises the
arms of the subject to right angles with the subject, then crosses the
arms and with a steady gentle pressure bears down on the chest of the
subject over the heart region.
If the axillary is used the operator is able to manipulate but one arm,
the one opposite. Raise this arm to right angles with the body then
fold down on the chest, exerting an even steady pressure. By raising
the arms the blood will leave the hands, and each time pressure is
exerted on the chest blood begins to flow from the artery or the vein,
and will continue to flow as long as the even pressure is exerted.
(3) By the combination of number one and two. The operator opens the
artery, preferably the femoral, inserts the arterial tube, and injects
a pint of fluid to exert a pressure on the venous system. He then opens
the vein, inserts the blood drainage tube which is connected with the
blood bottle. With the pump in his right hand (granting that he is
using the aspirator and injector pump), he stands at the head of the
subject and slowly injects the fluid. If at any time the blood ceases
to flow, by taking hold of the hands, raising both arms at right angles
to the subject, crossing, and while in this position injecting a few
ounces of fluid, then bear down gently on the chest with a steady
pressure. If the blood will not flow by this method and the operator
is using either the axillary or the femoral, there is hardly any use of
trying any other method. The operator will be able to draw the maximum
amount of blood with this method, if it is at all possible to draw
blood.
Often when the blood stops flowing, there is a blood clot formation
ahead of the drainage tube. By injecting just a few ounces of fluid or
salt water through the tube into the vein, the clot may be pushed to
one side, and the blood will continue to flow.
=Removal of Blood from the Right Auricle of the Heart. Direct
Method.=—Insert the trocar in the third intercostal space, just to
the right edge of the sternum or the breastbone. The trocar should be
inserted obliquely, the point of the trocar is to pass in the general
direction of the left hip joint, while the open end of the trocar is to
point in the general direction of the right ear. A general knowledge of
the anatomy as far as the location of the heart is absolutely necessary
to master this procedure. The object is to have the point of the trocar
pierce the right auricle of the heart. When the trocar has pierced the
right auricle, which the operator will have to judge through practice,
attach rubber tubing to the gooseneck of the blood bottle and by the
use of the aspirator pump, draw the blood from the heart into the blood
bottle. This is removal of blood by aspiration.
=Removal of Blood from the Right Ventricle of the Heart. Direct
Method.=—Insert the long thin twelve or fourteen inch trocar two inches
above and two inches to the left of the navel and pierce the abdominal
wall, pass the trocar keeping the point close to the abdominal wall,
in the general direction of the right shoulder as far as the lower
border of the third intercostal space, without fear of breaking any
circulation. The right ventricle will thus be reached from which blood
can be aspirated as in the previous method. Here again a general
knowledge of the anatomy as far as the location of all the organs
in the upper abdominal and thoracic cavity is necessary to perform a
successful operation. This is removal of blood by aspiration.
=Removal of Blood from the Right Auricle of the Heart. Indirect
Method.=—Make the incision for the femoral artery and vein.
Raise the artery and inject about a pint of fluid in order to cause a
pressure on the venous system. Open the vein and insert the flexible
rubber drainage tube, known on the market as the Red Seal drainage tube
or the Worsham drainage tube. Push this tube up through the femoral,
external iliac, the ascending vena cava, through the eustachian valve,
and into the right auricle of the heart.
In order to determine when the tube is inside the right auricle, the
operator should have laid the tube on the external surface of the
body from the point of entrance to the point where the right auricle
normally should be, allowing for the bend of the vein in its course.
Mark the tube, then when it has been pushed into the vein to that point
the operator is reasonably sure that the end is in the right auricle.
In order to make the tube slip easily it should be greased with a
liquid solution of vaseline.
After the tube has reached the right auricle the blood may be allowed
to drain, or it may be aspirated.
Either femoral may be used, but the left femoral is preferable owing to
the fact that, the angle at the bifurcation of the ascending vena cava
is more obtuse.
If the operator desires to remove blood from the heart, we believe that
the indirect method is the better way. By the use of the direct method
to draw blood from the right auricle by means of the trocar there is
always danger of rupturing the circulation. The aorta may be accidently
pierced. When the trocar is inserted from below to reach the right
ventricle the stomach may be punctured and the liver and diaphragm will
have to be pierced which, too, may mean an injured circulation. If any
accidental damage has been done, it can not be remedied. The direct
method is a blind procedure and is always uncertain. On the other hand
if the flexible rubber drainage tube is inserted into the vein it must
follow the channel of that vein. It is more certain than the trocar
method and there is no danger of rupturing the circulation.
The basilic or axillary vein may be used to remove blood from the heart
instead of the femoral. These veins should be used on the left side
of the body owing to the fact that the angle at the junction of the
subclavian and internal jugular veins is not so acute as on the right
side.
=Removal of Blood by the Use of the Femoral Vein.=—The use of the
femoral vein is considered by some operators a very good method. The
femoral should be employed in the upper third. Make the incision in
the center of Scarpa's triangle, just below Poupart's ligament. The
incision should be about two inches in length, the length of the
incision usually depends upon the size and thickness of the thigh and
the depth of the vein in the tissue. Expose the artery and the vein.
The vein at this point will lie to the inside of and a little below
the femoral artery. Open the artery and inject about a pint of fluid to
cause a pressure on the venous system.
Have all the blood drainage outfit in readiness then open the vein
and quickly insert the drainage tube. Any of the drainage tubes now
commonly sold on the market are good. For the femoral, though, the
flexible rubber drainage tube seems to be the best, because the femoral
vein dips deep down into the posterior part of the abdomen after
it leaves the Poupart's ligament. The flexible rubber drainage tube
will follow this bend and can be pushed as far as is desired by the
operator, in contrast the steel drainage tube could only be pushed into
the vein for a few inches.
Blood ought to drain out into the blood bottle, if it does not, inject
a little more fluid to cause more pressure on the venous system, and if
it will not flow by the drainage method or any of its modifications try
the aspirator. If blood still will not flow, it may mean that there is
a clot ahead of the drainage tube. Pump some fluid through the drainage
tube into the vein, to see if the tube is open, then let the fluid
drain out which usually will bring some blood. After you have tried all
the methods, if blood still does not flow, it will indicate that the
blood is either in a coagulated condition, or there is not very much
blood in that particular vein, which in this case is the femoral. The
blood may be more in the dependent parts of the body.
=Removal of Blood from the Axillary Vein.=—The axillary vein is of
large size, and is formed by the junction of the venae comites or
deep brachial veins with the basilic. The axillary vein begins at the
lower part of the axillary space, increases in size as it ascends by
receiving tributaries corresponding in name with the branches of the
axillary artery and terminates immediately beneath the clavicle at the
outer margin of the first rib where it becomes the subclavian vein. To
remove blood from the axillary vein, raise the vein to the surface,
and insert the drainage tube. The Eckels-Genung steel drainage tube
will perhaps be the best tube to use. Insert the drain tube high up in
the arm pit, pass through the subclavian, to beyond the valve located
in the subclavian vein outside the point at which the internal jugular
vein unites with the subclavian to form the innominate. There being no
more valves the blood should pass out freely. If the blood does not
flow, raise the axillary artery, begin the injection of fluid which
will tend to cause a pressure through the capillaries on the venous
system pressing the blood back to the right auricle of the heart as
in life, and as there is no obstructed passage the blood should flow
freely from the tube. The vein tube is of metal having a plunger rod
within, and a Y attachment at the upper end. The blood runs from the
Y shaped attachment into a rubber tube which is connected with the
blood bottle. A flexible arterial tube should be used in the artery,
which will measure eight to ten inches in length and constructed with
a shut-off valve. The tube will reach the innominate artery close to
the arch of the aorta. With these arterial and drainage tubes the arms
can be folded and placed in position, with the hands over the abdomen
and the tubes will extend out over the upper border of the arm. This
method will enable the operator to inject the body and have the arms in
their natural position. If a short circuit through the internal mammary
vessels occurs, and this will be evidenced by the premature flow of
thin blood, close the vein tube now and then during the operation,
continuing the injection until the proper results are obtained.
=Removal of Blood from the Basilic Vein.=—To withdraw blood from
the basilic vein the left arm should be employed, because of a more
direct route to the right auricle. Make the incision in the middle
or the upper third of the arm. The basilic vein lies in the upper arm
and extends from the elbow to the shoulder, and can be found a short
distance from the brachial artery, either above or below, but generally
below and toward the body. Its position is not always the same, owing
to the many anomalies that might occur. As a rule the vein is quite
large and prominent and when secured, raise to the surface freeing it
from the surrounding tissues.
Prepare two ligatures, make the incision in the vein and pass gently
the basilic drainage tube upward toward the heart. Either a steel or
rubber tube may be used. If the flexible rubber tube is used, it will
find its way to the right auricle of the heart, its course is through
the basilic, axillary, sub-clavian, innominate, superior vena cava, to
the right auricle. Either the aspiration or the drainage methods may be
used. If these fail try the displacement method.
The use of the basilic for the removal of blood is fast disappearing
from general practice. Larger veins can be used, which will always
insure greater success.
=The Removal of Blood from the Internal Jugular Vein.=—The internal
jugular vein is the largest tributary vein in the body, and accompanies
the carotid artery. The operator will cut through the skin at a point
from one half inch above the clavicle or collar bone and in the valley
formed by the sterno-mastoid muscle to the outside and the muscles
of the wind pipe to the inside, cut upward making the perpendicular
incision. Raise both the artery and the vein according to the usual
method. It seems best to raise the artery and the vein together, and
by so doing this will tend to give added strength to the vein which is
very large but has quite thin walls.
Direct the hook around the vein first then around the artery toward
the wind pipe or trachea, raise both to the surface, place on the
bone separator, and remove the sheaths. Use any of the drainage tubes.
Insert the vein drainage tube and the arterial tube, the point of both
tubes being directed toward the heart. The injection should be made
slowly, which will cause the blood to flow from the vein through the
tube and into the blood bottle.
This vein is not as much used as the axillary or the femoral for the
removal of blood.
It is true that it is very close to the center of circulation and a
gateway for the blood from the face. The chief disadvantage is that the
vein lies quite deep, is very large and has such thin walls, that it is
almost impossible to raise it without a rupture.
About one-thirteenth of the body's weight is calculated to be blood.
Granting for the sake of argument that the average body that we
would desire to draw blood from would weigh 208 pounds, then that
average body would contain 16 pounds of blood. One pound of blood is
practically equal to one pint, making the average body to contain about
16 pints of blood.
After death about one-fourth of the blood of the body is found in the
portal system. The portal system has capillaries at both ends so that
it is impossible to draw this blood.
After death about one-fourth of the blood of the body is found in the
tiny capillaries and tissues, blood which by the ordinary methods used
today the embalmer is unable to draw.
After death about one-fourth of the blood of the body is found in the
azygos system, and points dependent in the body, which blood, too, it
is impossible to draw.
This leaves about one-fourth of the blood of the body, which we are
able to draw. One-fourth of 16 pints, is 4 pints which is the maximum
we can draw from the average body.
The point of this argument is that if from the average body you have
taken from two to four pints of pure undiluted blood, then you should
be satisfied. If the majority of this blood has been taken from the
face you will get the desired cosmetic effect. The claims by some that
they are able to draw a gallon or more of blood is in our judgment
erroneous, as we feel the blood has been greatly diluted. We have
tested this out many times with the aid of control solutions and have
found that what the embalmer would ordinarily call thin blood was
composed of from 10 to 30% blood and from 70 to 90% fluid.
PART IV.
TREATMENTS
Infectious Diseases
CHAPTER XIX.
TREATMENT OF SPECIAL DISEASES.
=Anthrax.=—_Synonyms._—Malignant Pustule; Splenic Fever, Wool-sorter's
Disease; Carbuncle; Charbons.
_Definition._—An acute infectious, non-contagious disease, caused by
the bacillus anthracis, and characterized by the formation of a boil
with a circumscribed, infiltrated base and dark center, and a systemic
infection of a severe type, the toxemia being of the gravest character.
_Pathology._—The blood is dark, thick, diffluent, and rich in the
spores of this disease.
_Treatment._—Wash the body with 1 : 500 bichloride of mercury or 5%
carbolic acid. Inject the arteries, using 64 ounces of half strength
fluid followed by enough normal fluid to secure preservation. Inject
the cavities with normal fluid. Drain blood from the veins, and
disinfect the blood before disposing of it. Close the openings of the
body. For transportation, govern yourself according to the provisions
of the transportation rules.
=Cerebro-spinal Fever.=—_Synonyms._—Spotted fever; Cerebro-spinal
meningitis; Typhus syncopalis; Malignant purpuric fever.
_Definition._—An acute, infectious non-contagious disease, occurs
sporadically, epidemically and endemically characterized by hyperemia
of the brain and spinal cord, and sometimes attended by a petechial
eruption.
_Cause._—The meningococcus intracellularis of Weichselbaum.
_Pathology._—In those cases that speedily prove fatal, there are
little, if any, changes in the blood or tissues after death. Where
the disease has continued for several days, however, we find the
characteristic suppurative exudation. The sinuses of the brain contain
blood clots. Sometimes pus is found in the internal ear, and the
chamber of the eye. The liver, spleen and kidneys are usually slightly
engorged and somewhat softened. There occurs in quite a number of cases
a petechial eruption; the purpuric spots may be quite profuse, or but
one or two may be seen.
_Treatment._—As the means of ingress and egress of the infectious
material is not known, it is best that we give these cases a thorough
treatment; which should include a full arterial injection, drainage
from the vein, injection of the cavities, and full care of the exposed
portions of the body by washing same with a 1 : 500 solution of
bichloride of mercury. The ears should be treated by packing them with
absorbent cotton saturated with the fluid or with bichloride of mercury
solution. The eyes should be carefully cleansed with a soft cloth or
with cotton saturated with bichloride of mercury solution. The arterial
injection should consume an amount of fluid equal to 10 per cent. of
the body weight. Give full cavity injection. Govern yourself by the
regulations of your district for transportation of these cases.
=Erysipelas.=—_Synonym._—St. Anthony's fire.
_Definition._—An infectious, non-contagious disease, characterized
by an acute and specific inflammation of the skin and subcutaneous
tissues, attended by a shining redness, which spreads rapidly, marked
swelling and pain, and which finally terminates in desquamation.
_Cause._—This disease is supposed to be caused by the streptococcus
erysipelatis.
_Pathology._—The blood vessels are dilated and distended with
blood, the cell infiltration may extend into the deeper tissues with
suppuration. The cocci are found in the lymph spaces of the affected
area, also in the lymph vessels. There is a true dermatitis, involving
the skin, subcutaneous, and mucous surfaces.
_Treatment._—Operator should wear rubber gloves. Wash the body
externally with 1 : 500 solution of bichloride of mercury using
absorbent cotton in the process. If crusts have formed bathe the spots
with sweet oil, which will soften them and which will allow you to
remove them; destroying them by burning would be the best means of
disposal. If the face be the part affected, treat as above and then
apply the following solution to the part with lintine (Moadinger) or by
simple saturation: boric acid, one drachm; glycerine, one ounce; water,
three ounces.
Inject the first 64 ounces of fluid at half the normal strength,
gradually strengthening the fluid until the tissues become firm. Drain
blood freely from a large vein and disinfect the drawn blood before
disposing of it. Allow the softening solution mentioned above to remain
on the face until you are ready to place the body in the casket, when
the face can be dried and the usual cosmetic powders applied. Should
the peritoneum or the pleura be affected, inject the proper cavities
with very strong fluid. For transportation, govern yourself according
to the provisions of your district rules.
=Glanders.=—_Synonyms._—Farcy.
_Definition._—A specific, infectious, non-contagious disease of the
horse, communicable to man by inoculation, and characterized by the
formation of nodules in the mucous membrane of the nose-glanders; and
also beneath the skin and lymph structures—farcy.
_Cause._—In 1882, Loeffler and Schütz discovered the bacillus mallei
which is the exciting cause of this disease. The infectious material
is transmitted directly from horse to men, usually through an abraded
surface, and occurs most frequently among hostlers, veterinarians,
farmers, and those who come in contact with horses. It has been
communicated from man to man, but this is rare.
_Pathology._—There are found nodules located in the nose, in which case
the disease is called glanders; or beneath the skin, in which case it
is called farcy. These nodular masses discharge a yellow pus, which
will infect any abraded surface.
_Treatment._—Disinfect the oral and nasal openings, and wash the body
with a good germicide. Give a thorough arterial injection, using half
strength fluid in the first bottle and normal thereafter. Drain blood
from a large vein, disinfecting the blood before disposing of it. Give
a complete cavity injection. Close openings. For transportation, govern
yourself according to the provisions of the transportation rules.
=Hydrophobia.=—_Synonyms._—Rabies.
_Definition._—A specific infectious, non-contagious disease peculiar
to animals, especially the dog, and communicable to man by inoculation,
generally by a bite. It is characterized in many by melancholia; great
fear of water; violent spasms of the pharynx and larynx, rendering
deglutition and respiration very difficult; great prostration, a stage
of paralysis, which generally terminates in death.
_Cause._—The specific cause has not been determined, though
bacteriologists agree that it is of microbic origin.
_Pathology._—The blood vessels of the cerebrospinal system are
congested.
_Treatment._—Wash the body with 1 : 500 solution of bichloride of
mercury, or 5% carbolic acid. Inject half strength fluid into a large
artery for the first part, followed by enough normal fluid to secure
preservation. Drain blood from the veins and disinfect the blood
before disposing of it. If circulation to face and head is impaired
through the cerebral congestion, open the common carotids and inject
upward, draining from the internal jugular vein. Give thorough cavity
injection. Close all openings of the body. For transportation, govern
yourself according to the transportation rules.
=Relapsing Fever.=—_Synonyms._—Typhus recurrens; Bilious fever; Famine
fever; Hunger pest; Spirillum fever.
_Definition._—An acute, infectious and non-contagious disease,
characterized by a series of exacerbations and remissions, each lasting
from five to seven days, and prevailing epidemically.
_Cause._—The spirillum of Obermeier.
_Pathology._—There is no characteristic change in the solids of the
body. There is sometimes icteric discoloration during the disease and
the tissues are stained after death. The liver, kidneys and spleen are
somewhat enlarged. The heart becomes soft. The body retains its heat a
long time after death and the blood coagulates slowly if at all.
_Treatment._—Arterial injection with half strength fluid, followed, in
the second and third parts, with normal fluid. Drainage of blood. Spray
fluid over abdominal viscera, through the usual puncture.
For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.
=Syphilis.=—_Synonyms._—Pox; mal-venereal; lues venereal.
_Definition._—A specific infectious, non-contagious disease, weeks
or months are occupied in its development; contracted by inoculation
which is known as acquired syphilis, or hereditary, which is congenital
syphilis, and is characterized by three distinct stages; primary,
secondary, tertiary.
_History._—”In all probability syphilis is as old as the human race;
for we can readily believe that illicit intercourse was practiced in
the cities of the ancient world when the morals of the people were more
lax than those of today. Our knowledge of the disease, however, dates
from the fifteenth century. Breaking out among the troops of Charles
VIII, King of France, it rapidly spread over Europe. From then to
the present day our knowledge of the disease has grown, till today we
are able to classify and separate the various lesions resulting from
illicit and promiscuous intercourse. All forms of venereal disease were
included under the name of syphilis till Ricord, in 1831, demonstrated
that gonorrhea and syphilis were two distinct diseases.”
_Etiology._—Predisposing causes are injuries or abrasions of the mucous
surfaces of exposed parts, for the disease can originate in only one
way, by inoculation.
_Modes of Infection._—There are three modes of infection; illicit
intercourse, heredity and accidental. Of these the embalmer need only
consider the accidental form of infection.
_Pathology._—The initial lesion is the chancre, the secondary lesions
are ulceration of the mucous surfaces and cutaneous eruptions, and the
tertiary lesions are inflammatory products known as gummata, and are
found upon the bones and periosteum, or in the skin, muscles, liver,
kidneys, lung, heart, brain; in fact in any of the viscera of the body.
_Treatment._—Wash body thoroughly with 5% carbolic acid or 1 : 500
solution of bichloride of mercury. Work with rubber gloves. Inject half
strength fluid for the first 64 ounces of fluid and follow that with
normal fluid until disinfection and preservation are assured. Give the
body a complete cavity injection with normal fluid. Drain blood from
a large vein, and disinfect the blood before disposing of it. Close
all openings of the body with absorbent cotton saturated with normal
fluid. Bandage any large sores and saturate the bandage with normal
fluid. When purpura (characterized by a blue spot on the face) exists,
the discoloration cannot be removed. If anything is to be done at all
for the discoloration, it must be of the nature of a covering for the
spot, such as paint or other cosmetics. For transportation of the body,
govern yourself according to the transportation rules.
=Tetanus.=—_Synonyms._—Lockjaw; Trismus.
_Definition._—An acute infectious, non-contagious disease,
characterized by painful spasmodic contraction of the voluntary
muscles, most frequently those of the jaw, face, and neck; less
frequently those of the trunk, the extensors of the spine and limbs.
_Cause._—The cause is recognized as the bacillus tetanus.
_Pathology._—The infection usually enters by way of a wound, especially
of the hands and feet, and a punctured wound rather than an incised
one. The post-mortem lesions are not constant.
_Treatment._—The body should receive a complete arterial injection
using half strength fluid for the first part of the injection, followed
by sufficient normal fluid to secure preservation and disinfection.
Blood should be drained from the veins and should be disinfected before
being disposed of. Wash the wound with 1 : 500 solution of bichloride
of mercury and bandage it to avoid infection from it. Inject the
cavities of the body. Close the openings. For transportation, govern
yourself according to the provisions of the transportation rules.
=Actinomycosis.=—_Synonyms._—Big Jaw; Lumpy Jaw.
_Definition._—A specific infectious, non-contagious disease of domestic
animals, particularly cattle, communicable to man, and caused by the
ray-fungus.
_Pathology._—Infection takes place, as a rule, through the mouth,
through a cut or abrasion of the skin and rarely through the
respiratory tract. The fungus produces a tumor, with a rapid
proliferation of the neighboring connective tissue. The disease is not
limited to any organ as the name lumpy jaw would imply; we may have
actinomycosis of the lung, digestive tract, and of the skin.
_Treatment._—Disinfect the outside of the body by washing with a good
germicide. Care should be exercised against inoculation through an
abrasion of the skin. Give the body a thorough arterial injection,
draining blood, and disinfecting the blood before disposing of it.
Close all openings. For transportation, govern yourself according to
the provisions of the transportation laws.
=Dengue.=—_Synonyms._—Break-bone fever; dandy fever; broken-wing fever.
_Definition._—An acute, specific, infectious, non-contagious fever,
occurring epidemically in tropical and subtropical climates and
characterized by two severe paroxysms of fever, separated by an
intermission, great muscular pain, and usually attended by an eruption.
_Cause._—The nature of the infection or contagion is not known. That it
is infectious is shown by the rapidity with which it spreads when once
it invades a section. In 1885, within a few weeks, sixteen thousand,
in Austin, Texas, were stricken. Neither age, sex, race, nor position
exert an influence in staying the disease.
_Pathology._—As few cases prove fatal, but little opportunity has ever
been given to study its pathological character. There has been found
infiltration of the tissues about the joints. It is rare for a case to
end fatally, only few succumbing to its influence. For this reason the
embalmer will not have many of these cases to treat.
_Treatment._—As this rarely comes excepting in the epidemic form,
that form will be treated on. The body should be washed with a good
germicide, and all openings should be closed with absorbent cotton. The
body should then receive a very heavy arterial injection, with drainage
of blood, and cavity injection. As is the case in epidemics, the body
should be buried as soon as possible. While the mortality is light, yet
the most strenuous treatment should be given to assist in the campaign
of the health authorities against the disease and its spread. When more
is known about the characteristics of the disease, it is likely that a
more definite treatment can be advised.
=Malarial Fever.=—_Synonyms._—Ague; Chills and fever; Intermittent
fever; Swamp fever; Marsh fever; Paludal fever.
_Definition._—A specific, infectious, although non-contagious disease,
caused by the hematozoa of Lavaran, and consisting of two distinct
parts; first, a succession of exacerbations and intermissions, or a
series of short fevers separated by short intervals of health; second,
a continued fever made up of exacerbations and remissions, there being
but one cold stage.
_Cause._—The hematozoa of Lavaran.
_Pathology._—There is a destruction of the red blood corpuscles, due
to the action of the parasite. There is an increase of pigment, in the
spleen, liver, kidneys, bone marrow, skin, and in fact, in all the
tissues, due to the conversion of hemoglobin into pigment granules.
The spleen is enlarged as are also the liver and the kidneys. The skin
presents a jaundiced appearance in chronic malarial fever.
_Treatment._—Arterial injection of 64 oz. 1% solution of borax or
oxalic acid followed by 64 oz. of half strength fluid and then a
sufficient quantity of normal fluid to complete preservation. Drainage
of blood and solution to wash stain from capillaries. Application of
full strength peroxide hydrogen to face, and massage during injection.
For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.
=Yellow Fever.=—_Synonyms._—Typhus ichteroides; Febris flava; Black
vomit; Yellow jack.
_Definition._—An acute, infectious, though non-contagious disease of
the tropics or sub-tropics, characterized by a high grade of fever,
lasting from two to seven days, tenderness over the epigastrium
(stomach), vomiting of black, broken down blood, and yellow
discoloration of the skin.
_Cause._—Not known, although it is definitely known that the infection
is spread through the bite of a species of mosquito, the stegomyia
fasciata.
_Pathology._—The skin and the mucous membranes show a varying degree
of jaundice, from a light yellow to a dark brownish or orange color;
the color deepening over the course of the blood vessels. The stomach
contains more or less of broken down blood, the so-called black vomit.
The blood is dark and broken down.
_Treatment._—Arterial injection of 64 oz., of half strength fluid
followed by sufficient normal fluid to assure disinfection and
preservation. Drainage of contents from vein and massage of face with
full strength hydrogen peroxide in an attempt to clear the complexion.
Full abdominal cavity treatment, and close orifices of the body.
For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.
=Diphtheria.=—_Synonyms._—Diphtheritis; angina maligna; membranous
croup.
_Definition._—An acute infectious, contagious disease characterized by
a grayish-white, fibrinous exudate, usually located on the tonsils or
the neighboring tissues.
_Cause._—This is the bacillus diphtheriae, although some still hold
that the specific cause has not as yet been determined.
_Pathology._—In the severe forms the deeper connective tissues are
involved, and there may be extensive destruction of tissue, including
the blood-vessels. There is more or less discoloration of the tissues
from extravasation of the coloring matter. The kidneys and spleen
may be enlarged. The blood is more or less broken down, the fibrin is
deficient.
_Treatment._—Disinfect the oral and nasal cavities with the embalming
fluid. Wash the body externally with 1 : 500 solution of bichloride
of mercury. Inject an amount of fluid equaling 10% of the body weight
into the arteries, and give cavity injection. Drain blood and inject
additional fluid to make up for that which will be lost in drainage.
In young persons the strength of the fluid for the first 64 ounces of
the injection should be cut to half of the normal strength. Close all
openings of the body with absorbent cotton. Dress the body and then
place it in the casket, drawing the glass slide and closing it, after
which, it should not be re-opened. Abide by the regulations of your
district concerning the amount of time to elapse between the time of
death and of burial in these cases. For transportation govern yourself
according to the provisions of your district rules.
=Tuberculosis.=—_Definition._—An infectious, slightly contagious
disease, characterized by the formation of small nodules, tubercles,
varying from the size of a millet-seed to that of a mustard-seed or
even larger.
_Cause._—Tubercle bacillus of Koch.
_Pathology._—Any organ of the body may be the seat of the disease. In
the adult the lungs are the most frequently affected, while in children
the lymph glands, joints, and intestines are favorable seats for the
disease. Probably the only form that will give the embalmer any trouble
is tuberculosis of the lungs. Here either from the poison, developed by
the bacilli, or from some other source, necrosis of the cells occurs,
forming a cheesy condition known as caseation. At a later period
this breaks down, forming an abscess, the cavity being filled with a
purulent material. At other times there is a calcareous deposit, and
the tubercular mass is said to undergo calcification.
_Treatment._—In pulmonary tuberculosis, give the body a complete
arterial injection using half strength fluid for the first part of
the injection, followed by three-fourths strength for the latter part.
Hohenschuh prefers to drain blood from all cases; the authors prefer
to drain blood in tuberculosis, only when it is necessary as a means of
preventing discolorations, and that would be in case the blood vessels
contained much blood. Massage the face carefully with one of the
commercial solutions, or, with water which of course has no bleaching
action. For transportation, govern yourself according to the provisions
of the transportation rules.
=Typhoid Fever.=—_Synonyms._—Typhus abdominalis; Typhus nervosus;
Ileo-typhus and Autumnal fever, are the most common terms, although
Murchison's list includes forty others.
_Definition._—An acute, infectious and slightly contagious disease,
derived from a specific cause and characterized by inflammation and
generally sloughing of Peyer's glands, swelling of the mesentery,
engorgement of the spleen and a rose colored eruption.
_Cause._—A specific germ called the bacillus of Eberth or the bacillus
typhosus.
_Pathology._—The lesions resulting from this disease may be divided
into two parts. First, the lesions of the intestinal canal, Peyer's
patches, the solitary glands of the ileum and caecum, and more rarely
of the colon and the rectum, and changes in the spleen. Secondly,
those lesions resulting from sepsis occurring during the long period
of fever, and affecting the tissues and organs at large. The first
effect of the poison or bacilli is to cause hyperemia (swelling) of
the lymphatics, the capillaries become engorged and cell infiltration
takes place in the solitary glands of the intestines. Frequently the
infiltration is so excessive that the capillaries become engorged and
entirely choked with the infiltration. Ulcers form, which are shallow
or deep, according to the amount of necrosis (sloughing), and when very
deep, perforation of the bowel may follow, although this condition is
rare. The spleen is nearly always involved, congestion takes place,
followed by softening. The liver becomes hyperemic, swollen and soft,
and often shows abscess formation. There is granular degeneration in
the kidney, ulceration of the larynx and sometimes congestion of the
lung. The heart muscles too often become weakened the result of the
poison.
_Treatment._—If death occurs early in the disease, the body will not
be greatly emaciated, and the following treatment may be followed in
detail:
If intense abdominal fermentation exists, relieve the accumulated gas
with trocar, aspirate as much serous matter as possible from the pelvic
cavity, introduce a strong fluid into the cavity, taking care to have
as much of this fluid reach the cavities of the intestines as possible.
Open one of the arteries commonly used in one of the drainage processes
and inject 64 ounces of half strength fluid, draining blood from
the vein simultaneously with the injection. Then inject a sufficient
quantity of normal fluid to complete preservation. Close all openings
of the body with absorbent cotton. Massage the face with water or a
commercial solution during the injection.
If death occurs late in the disease, the abdomen may require a stronger
treatment such as we would give in acute peritonitis. The trocar may
not prove efficient in reaching the affected parts and in such a case
we would make a 4 inch incision along the median line and between the
umbilicus and the pubic arch, exposing the ileum and caecum, which
should be incised, their contents removed, and then all replaced in
the cavity thoroughly surrounded with hardening compound. After this
the wound should be closed with stitches. After preservation has been
completed in either this form of the disease or the one mentioned
above, dust on a good quality of face powder to remove the moist
appearance from the skin. When a body dead of this disease is to
be transported, consult the state or local transportation rules in
addition to these treatments.
=Leprosy.=—_Definition._—A chronic, infectious, contagious disease,
which usually terminates fatally.
_Cause._—The bacillus leprae. There are tuberculous growths in the
skin, which push outward, form nodular masses, between which are seen
areas of ulceration and cicatrization, which in the face, distort the
features. These tubercular masses discharge a thick purulent material.
The destruction of tissue proceeds gradually, years being occupied in
destroying a patient. The deep, ulcerative process may amputate fingers
and toes in its progressive march.
_Treatment._—The body is rarely presentable for sometime before death,
and this should not be a consideration in our treatment. If an arterial
injection is possible, give it, using normal fluid for the injection.
Work with rubber gloves. Give a complete cavity injection. Wrap the
body in absorbent cotton and then in a sheet. For transportation,
govern yourself according to the provisions of the transportation
rules.
=Influenza.=—_Synonyms._—Epidemic catarrhal fever; la grippe.
_Definition._—An acute, infectious disease, the contagion of which is
questionable occurring pandemically.
_Cause._—The bacillus influenza.
_Pathology._—There is no characteristic lesion in the uncomplicated
case. When death occurs it is usually from complication.
_Treatment._—Disinfect the oral and nasal cavities with embalming
fluid. Inject as much fluid as you can into the arteries and cavities.
The usual 10% of the body weight must be given for transportation.
If blood vessels are filled with blood, drain from a large vein, and
add more fluid to your injection, to make up for the loss of blood
to the blood bottle. Close all openings with absorbent cotton. For
transportation, govern yourself according to the provisions of your
district rules.
=Cholera.=—_Synonyms._—Cholera Algida; Cholera Asiatica; Cholera
maligna.
_Definition._—Cholera is an acute, specific, infectious slightly
contagious disease, occurring epidemically and endemically, and
characterized by severe vomiting and copious watery stools, violent
cramping of the muscles and collapse.
_Cause._—The exciting cause is now generally recognized as the comma
bacillus of Koch, or spirillum cholerae.
_Pathology._—The tissues after death are shrunken and drawn, and
the extremities are inclined to be mottled; in some cases there is
a postmortem rise of temperature. Rigor mortis sets in very early.
Spasmodic contractions sometimes occur for some moments after death;
hence the eyes and jaws have been seen to move after life was extinct.
Owing to this marked contraction, the limbs have been distorted and
the partial turning of the body is thus accounted for, and is not, as
many have supposed, the result of being buried alive. The tissues are
dry, having been drained of these fluids before death, hence some time
elapses before decomposition begins after death. The chief visceral
lesion is that of the intestinal canal. The intestines contain a more
or less quantity of rice-water, fluid rich in the comma bacillus. The
blood is very dark, but slightly coagulable and robbed of its salts and
fluids.
_Treatment._—Arterial and cavity embalming, closing all orifices of the
body. Any discharges from the bowels should be disinfected before being
disposed of. In epidemics, cosmetic effect is a non-essential and in
that case the most thorough treatment must be given without regard to
appearances.
For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.
=Bubonic Plague.=—_Synonyms._—The Pest; Black Death; Plague of Egypt.
_Definition._—A specific, infectious, contagious disease, running
a rapid course, and characterized by inflammation of the glands
(buboes), carbuncles, ecchymoses, and petechiae upon the surface. It is
endemic on the eastern coast of the Mediterranean Sea and the Oriental
countries adjacent. Epidemics occur when it spreads to other parts
of the world, traveling along the great thoroughfares of travel and
commerce.
_Cause._—To Kitasato belongs the honor of discovering the specific
cause, the bacillus pestis. On entering the body, either by inoculation
or by way of the digestive or respiratory tracts, it multiplies with
great rapidity. It is found in the blood, in the internal organs, in
the intestinal canal, lymphatic glands and in great numbers in the
suppurating buboes.
_Pathology._—Rigor mortis occurs early, and often there is elevation
of temperature immediately after death. Petechiae, ecchymoses, and
carbuncles are generally found upon the skin. The lymphatic system is
generally affected, the lymph glands of the groin and axilla showing
evidence of inflammation.
_Treatment._—Wash the body thoroughly with a good germicide, close all
openings, first however, disinfect the oral and nasal openings. Nothing
should be done for the ecchymotic spots, the cosmetic effect in these
cases being secondary to disinfection. The arteries should receive a
heavy injection of normal fluid, blood being drained from the veins.
The blood should be disinfected before being disposed of. The cavities
should receive a heavy injection of normal fluid. For transportation
of these cases, govern yourself according to the provisions of the
transportation rules.
=Scarlet Fever.=—_Synonyms._—Scarlatina; scarlet rash.
_Definition._—An acute, contagious disease, characterized by a bright
scarlet colored eruption, diffused over the entire body, terminating by
desquamation of the skin.
_Cause._—Not definitely known, although thought by Klein and Gordon to
be the streptococcus scarlatinae.
_Pathology._—The blood is dark, diffluent, and does not coagulate
readily, owing to a defect in the fibrin. The eruption disappears after
death, except in those malignant cases where the eruption failed to
appear during life, and appears upon the death of the patient.
_Treatment._—First protect yourself by wearing a bandage of surgical
gauze over your mouth and nose, then enter the room of death and
wash the body thoroughly with a 1 : 500 solution of bichloride of
mercury. Inject an amount of fluid equaling 10% of the body weight
into the arteries and inject into the cavities. Drain blood through
one of the drainage processes, and add an amount of fluid to the
arterial injection equal to that which is lost to the blood bottle.
Close all openings with absorbent cotton, dress the body, and then
place it in the casket, drawing the glass slide and closing it, after
which, it should not be reopened. Abide by the regulations of your
district concerning the amount of time to elapse between the time of
death and of burial in these cases. For intra-state and inter-state
transportation, govern yourself according to the provisions of your
district rules.
=Variola.=—_Synonyms._—Small-pox; German Blattern; French, La Petite
Verole.
_Definition._—A specific, infectious, highly contagious febrile
disease, characterized by a dermatitis, in which the eruption passes
from the papule to vesicle, and this in turn into pustule, finally
dessicating.
_Cause._—The true nature of the virus is not known, and although
certain microorganisms have been described which are found in the pock,
there is no proof that they are responsible for producing the poison.
All that is positively known is, that it is developed in the system and
reproduced in the pustule.
_Pathology._—The most marked change occurs in the skin, where an
eruption takes place, finally with the formation of scabs or crusts.
The blood does not reveal any microscopic changes, although darkened in
color.
_Treatment._—No one but an immune should handle these cases, and he
should first wash the body with a 1 : 500 solution of bichloride of
mercury. After this has been done, inject an amount of fluid equal
to 10 per cent. of the body weight, distributing same by arterial
injection. If blood is drained, and it is proper to do so, add fluid
to the injection to make up the loss into the blood bottle. Give full
cavity injection. Bodies dead of this disease should be buried within a
reasonably short length of time, so that the apartments may be rendered
safe by fumigation, and under no circumstances should a public funeral
be held. After the body has been placed in the casket, the slide,
preferably of glass, should be closed and should not be reopened under
any circumstances. Govern yourself by the regulations of your district
for transportation of these cases.
=Measles.=—_Synonyms._—Morbilli; rubeola.
_Definition._—An acute, infectious, contagious fever, characterized by
a general papular eruption.
_Cause._—The efforts to isolate a specific germ which will produce the
disease has thus far failed, though many organisms have been found in
the secretions.
_Pathology._—There is a lack of coagulability of the blood, which is
dark in color. The internal organs are congested and softened. The
lesion of the skin consists of an acute hyperemia with exudation in the
vascular papillae of the corium, the sebaceous and sweat glands.
_Treatment._—Bodies rarely die from this cause; the usual immediate
cause of death is exhaustion. An injection of half strength fluid
for the first part of the injection followed by normal fluid for the
balance of the injection, with full cavity injection, closing the
orifices is all that is necessary. For transportation, govern yourself
according to the provisions of the transportation rules.
=Parotitis.=—_Synonyms._—Mumps, epidemic parotitis.
_Definition._—An acute, infectious, and contagious disease,
characterized by an inflammation of one or both of the parotid glands.
_Cause._—The specific cause is a contagion generated during the course
of the disease, the exact nature of which is not known, although
thought by some to be the tetrad of mumps.
_Pathology._—The parotid glands become swollen and hard. Death very
seldom occurs from this disease.
_Treatment._—Disinfect the oral cavity with embalming fluid. The
swelling cannot be reduced, so that the next concern to the embalmer
will be to preserve the body. This should be done by injecting 64
ounces of half strength fluid, followed by enough normal fluid to
secure preservation. If blood vessels contain much blood, drain from a
large vein, and then inject additional fluid to make up for that lost
by drainage. Close all openings with absorbent cotton. Abide by the
regulations of your state governing the transportation of these cases.
=Pertussis.=—_Synonyms._—Whooping-cough; tussis convulsiva.
_Definition._—A specific infectious, contagious disease occurring
epidemically, and characterized by a peculiar, spasmodic cough, ending
in a whoop.
_Cause._—The cause of whooping-cough has always been a matter of
conjecture.
_Pathology._—In the uncomplicated form there is no lesion which can be
said to be characteristic. There might in complications be hemorrhage
from the lung.
_Treatment._—Disinfect the oral and nasal cavities with embalming
fluid. Inject 64 ounces of half strength fluid followed by enough
normal fluid to secure preservation. If blood vessels contain much
blood, drain from a large vein, and then inject additional fluid to
make up for that lost by drainage. Close all openings with absorbent
cotton. Discourage public funerals in these cases. For intra-state or
inter-state transportation of these cases, govern yourself according to
the provisions of your district rules.
=Typhus Fever.=—_Synonyms._—Famine fever; Ship fever; Jail fever;
Hospital fever; and Putrid fever.
_Definition._—An acute, infectious, very contagious, endemic, and also
epidemic disease, characterized by a high grade of fever and a peculiar
rash.
_Cause._—Not known.
_Pathology._—The blood is dark and diffluent the result of the
intense fever and rapid work of the poison. The liver is somewhat
enlarged and softened, as are also the kidneys and spleen. There is
an extravasation into the pericardium which gives it an ecchymotic
appearance. There is also a slight engorgement and infiltration of the
capillaries. The muscular tissues are of a dark red color. The skin
shows a characteristic rash and ecchymotic spots are found on the more
dependent parts of the body after death.
_Treatment._—Slow arterial injection and drainage of blood. On account
of rash, apply bichloride of mercury 1 : 500. In the presence of
fermentation, give the abdomen a special treatment.
For transportation of bodies dead of this disease, govern yourself
according to the provisions of the transportation rules.
=Varicella.=—_Synonym._—Chicken-pox.
_Definition._—An acute, specific, and infectious disease, characterized
by an eruption that rapidly passes through the stage of papule,
vesicle, and pustule, and terminates by dessication.
_Cause._—This is not known. All attempts to isolate the microorganisms
or the contagium, whatever that may be, have failed.
_Pathology._—The only pathological lesion is the eruption that appears
on the skin.
_Treatment._—These cases should be thoroughly washed with 1 : 500
solution of bichloride of mercury, after which a thorough arterial and
cavity injection should be given, consuming for this purpose an amount
of fluid equal to 10 per cent. of the body weight in the arteries.
Blood should be drained from the veins, and an amount of fluid equal to
what is lost to the blood bottle should be injected in addition to the
10 per cent. mentioned above. After the body is placed in the casket,
close the slide which should be of glass, and do not reopen again.
Public funerals of these cases should be discouraged, to avoid the
indiscriminate transfer of the disease.
=Septicemia.=—_Definition._—A morbid process commonly known as blood
poisoning, in which there is an invasion of the blood by bacteria or
their toxins.
_Cause._—Any bacteria or its toxin.
_Pathology._—The blood is found to be dark, diffluent, and rich in
bacteria. The liver and spleen are soft, dark in color, and show
swelling. The lymphatics are also swollen.
_Treatment._—The operator should approach these cases with unbroken
skin on his hands, or if that be impossible, with rubber gloves,
as the disease is disseminated through abrasions. Take up a large
artery and vein, inject half strength fluid for the first bottle and
normal fluid thereafter in the arteries, and drain from the veins.
Disinfect the blood obtained from the vein before disposing of
it. Give the body a complete cavity injection. Massage the face to
stimulate capillary circulation while the arterial injection is being
made. For transportation, govern yourself according to your district
transportation rules.
=Pyemia.=—_Definition._—An infectious disease due to the absorption
of animal poisons, principally pyogenic organisms, and characterized
by the formation, in the various tissues and organs, of multiple
metastatic abscesses.
_Cause._—One of the forms or a combination of pyogenic micrococci are
held to be responsible, for this condition. The streptococcus and the
staphylococcus are the forms most common, though it is not uncommon
to find the micrococcus lanciolatus, the gonococcus, the bacillus coli
communis, bacillus typhosis, bacillus pyocyaneus, and many others.
_Pathology._—The body does not undergo putrefaction as rapidly as in
septicemia. The first effects of the morbid changes are found in the
veins, which result in thrombi. These thrombi are found in the various
organs and tissues of the body.
_Treatment._—Use the precautions observed in the treatment for
septicemia. Give the body a complete arterial injection using half
strength fluid for the first bottle of the injection. Drain as much
blood from the veins as possible. Thrombi may complicate the drainage,
and if none can be obtained from several of the larger veins, tap the
heart as a last resort. Disinfect the blood before disposing of it.
Streptococcus infection of the embalmer from abrasions of the skin is
very dangerous and every possible precaution should be carefully taken.
Give the body a complete cavity injection. For transportation, govern
yourself according to the provisions of the transportation rules.
CHAPTER XX.
TREATMENT OF SPECIAL DISEASES.—Continued.
DISEASES OF THE RESPIRATORY SYSTEM.
=Gangrene of the Lung.=—_Definition._—A putrefactive necrosis of the
lung.
_Cause._—Many putrefactive bacteria thrive in the necrotic soil, but
whether they are the cause or the result is not known.
_Pathology._—When the gangrene is due to the plugging of one of the
large branches of the pulmonary artery, a large part of the lung
becomes dark, greenish brown, or a black fetid mass, softening rapidly
in the center, forming an irregular cavity, containing a foul-smelling
disgusting, greenish fluid.
_Treatment._—Give complete arterial injection. Inject the pleural sac
on the affected side through the first intercostal space or through
the apex of the cavity. Spray fluid into the mouth and nose and close
them with absorbent cotton. For shipment of these cases govern yourself
according to the transportation rules.
=Pulmonary Hemorrhage.=—_Synonyms._—Hemoptysis; Broncho-pulmonary
hemorrhage; Bronchorrhagia; Pneumorrhagia.
_Definition._—An expectoration of blood, due to hemorrhage from the
mucous membrane of the bronchi, trachea, or larynx and from erosion or
rupture of capillaries in lung cavities.
_Cause._—The hemorrhage may result from congestion of the lungs,
due either to pulmonary lesions or from cardiac derangements. It may
accompany malignant affections, infectious fevers, scurvy, cancer of
the lung, gangrene, and abscess of the lung.
_Pathology._—There is, in most cases rupture of the capillaries of
the bronchial mucous membranes. If tubercular cavities are formed, a
ruptured aneurism is sometimes seen, or large blood vessel eroded by
ulceration. If pulmonary apoplexy has existed, the parenchyma may be
lacerated.
_Treatment._—Some operators wait until fluid passes from the mouth
before taking steps to stop the hemorrhage due to the injection of
fluid. We prefer to use plaster of paris and cotton, making a paste
of them and forcing the paste down upon the epiglottis to prevent the
waste of fluid from that source. When the cause of death is known, this
operation must be done before the injection is begun or the throat will
have to be dried out before the plaster of paris will set properly.
Another treatment to prevent the leakage of fluid would be to tie off
the trachea just above the upper border of the sternum.
The body is usually emaciated and should be injected arterially with
comparatively mild fluid, in order to avoid drying or dessication of
the features. Whenever fermentation exists in the abdomen, the cavity
should be injected; otherwise it is not usually necessary. The amount
of fluid for the injection should be based on the amount that will
be taken by the vessels of a body the size of the one being injected.
For transportation of these cases the provisions of the transportation
rules should be your guide.
=Pulmonary Abscess.=—_Synonyms._—Abscess of the lungs; Suppurative
pneumonitis.
_Definition._—A collection of pus in the lung, accompanied by
degeneration of tissue.
_Pathology._—The abscess may involve one or more lobules, or engage
almost the entire lobe, or the abscesses may be scattered throughout
the whole lung.
_Treatment._—Should hemorrhage occur, treat this case the same as for
pulmonary hemorrhage. If no hemorrhage occurs, give the body a complete
injection with a mild fluid and inject the pleural sacs from the first
intercostal space or the apex of the cavity. For transportation, govern
yourself according to the provisions of the transportation laws.
=Pneumonia.=—This disease is divided into different subdivisions as
follows: Lobar Pneumonia, broncho-pneumonia, and chronic interstitial
pneumonia.
(A) _Lobar Pneumonia._—_Synonyms._—Croupous or Fibrinous Pneumonia;
Pneumonitis; Inflammation of the lungs; and Winter fever.
_Definition._—This is an acute infectious disease characterized by an
inflammation of the lung tissue in which there is, first, congestion
and engorgement, second, exudation or consolidation; and third,
resolution or suppuration.
_Pathology._—The right lung is more frequently affected than the left,
and one lobe, or one entire lung, rather than both lungs at the same
time.
_Treatment._—Should suppuration occur, turn the body on its side, press
on the sternum and cause the suppurative matter to leave the windpipe
by purging it into the folds of a towel which should be placed at the
mouth. Spray the mouth with fluid and close the oral and nasal cavities
with absorbent cotton.
Give the body a thorough arterial and cavity injection, paying especial
attention to the pleural sacs, which should be injected independently
from the first intercostal space on each side or from the apex of the
cavity. Drain blood and disinfect the contents of the blood bottle
before disposing of same. For transportation, govern yourself according
to the provisions of the transportation laws.
(B) _Broncho-Pneumonia_—_Synonyms._—Capillary Bronchitis; Lobular
Pneumonia; Catarrhal Pneumonia.
_Definition._—An inflammation of the terminal bronchi, air vesicles,
and interstitial tissue of a few or many of the lobules.
_Pathology._—The interstitial tissue between the air cells and the
capillaries are greatly weakened. In most cases the lung will float
when placed in water, though the small mahogany-colored nodules found
distributed throughout the lung when excised sink in water.
_Treatment._—The nature of the disease is such that preservation is
comparatively simple, the disease affecting the extremities of the
respiratory system. Arterial injection together with special attention
to the pleural sacs will suffice for the cases. For transportation,
govern yourself according to the provisions of the transportation
rules.
(C) _Chronic Interstitial Pneumonia._—_Synonyms._—Cirrhosis of the
lungs; Fibroid Pneumonia.
_Definition._—A chronic inflammation of the lungs, in which the normal
air cells are replaced by fibrous or connective tissue, followed by
induration and atrophy of the lung.
_Pathology._—The disease is nearly always confined to one lung, though,
in very rare cases, both lungs may be involved, while localized areas
are the rule. The affected lung becomes atrophied and in extreme cases,
may be no larger than the closed hand. As a result of the shrinkage of
the lung tissue, the heart undergoes hypertrophy. When tuberculosis
exists, cavities of varying size and number are found, and the
interstitial tissue between the capillaries and the air cells is very
much weakened.
_Treatment._—Should this disease be followed by a rupture of the
capillaries during the injection, thereby causing a hemorrhage
from the oral and nasal openings, treat it as you would a case of
pulmonary hemorrhage. Otherwise give the body a thorough arterial
and cavity injection with special attention to the pleural sacs. For
transportation, govern yourself according to the provisions of the
transportation laws.
=Hydrothorax.=—_Synonyms._—Thoracic dropsy; Dropsy of the chest; Dropsy
of the pleura.
_Definition._—A collection of serous fluid within the pleural cavity
without inflammation.
_Pathology._—Hydrothorax, unless due to cardiac affections, is usually
bilateral. The quantity of fluid varies, and is generally greater on
one side than on the other. The fluid is free, and of a low specific
gravity, alkaline in character, clear, and of an amber color.
_Treatment._—To prevent the formation of blisters on the posterior
surface of the thorax, aspirate the serous fluid from the pleural
sacs, introducing the trocar through the apex of the cavity, and
extending it into the cavity until it has almost reached the diaphragm.
This must be done with both the right and left sacs. Give the body a
complete injection, using normal fluid throughout the entire injection.
Inject the pleural sacs after the serous fluid has been withdrawn.
For prevention of post-operative dangers such as bursting blisters,
etc., line the casket with rubber for a distance of 3 inches above the
bottom. For transportation of these cases, govern yourself according to
the provisions of the transportation laws.
CHAPTER XXI.
TREATMENT OF SPECIAL DISEASES.—Continued.
DISEASES OF THE CIRCULATORY SYSTEM.
=Pericarditis.=—_Definition._—An acute inflammation of the pericardium
and the serous covering of the heart.
_Treatment._—Give the body a thorough injection of half strength fluid
followed by normal fluid. Drain from the veins. Inject the abdominal
cavity. For transportation of these cases, govern yourself according to
the provisions of the transportation rules.
=Hydropericardium.=—_Synonym._—Dropsy of the pericardium.
_Definition._—Hydropericardium is a non-inflammatory condition of the
pericardium, attended by an accumulation of sero-albuminous fluid.
_Pathology._—Hydropericardium is not a disease of itself, but it is
always secondary. The accumulated fluid is usually clear, of an amber
color, though it may become turbid by the presence of fibrin or red
blood corpuscles. The fluid is alkaline in reaction.
_Treatment._—As this disease is always secondary to another, the
treatment will also be secondary and all that can be said is that the
heart sac should be relieved of its accumulated serous fluid, after
the body has received the treatment necessary for the immediate cause
of death. Transportation will also be covered by the disease causing
death.
=Hemopericardium.=—_Definition._—Hemopericardium is an infiltration
of blood into the pericardium. It is the result of a rupture of an
aneurism of the aorta or coronary arteries, or in rare cases from
rupture of the heart. It may also arise from injuries such as bullet
wounds, fracture of the ribs, sternum, etc.
_Treatment._—This condition is usually secondary to another such as
gun shot wound, aneurism of the aorta, etc., so that the treatment
must be given under the heading of the immediate cause of death. For
transportation requirements also refer to the immediate cause of death
and the transportation rules.
=Pneumo-Pericardium.=—_Definition._—Pneumo-pericardium is an
accumulation of air in the pericardium. Although this is a rare
disease, it does occasionally occur, either through diseased processes,
such as cancerous or tubercular ulceration or through injuries; thus
a ruptured pulmonary cavity might result in this condition, or the
perforation of the esophagus, by malignant processes would give rise to
this lesion. Sometimes pus in the pericardium will generate gas.
_Treatment._—As the accumulation of air or gas is secondary to some
other process of disease, the immediate cause of death will carry with
it the proper treatment. The gas itself should be removed by piercing
the pericardium with a small needle or trocar, after which a small
quantity of fluid should be injected.
=Endocarditis.=—_Definition._—Endocarditis is an inflammation of the
lining membrane of the heart, and is generally confined to the valves,
though other parts may be affected.
_Pathology._—The morbid changes are, first, a reddened and injected
appearance of the endothelium, which soon becomes opaque and swollen
from congestion of the small blood vessels. This swelling or thickening
of the membrane furnishes a favorable resting place for deposits of
fibrin, and we have small, beady deposits from the size of a pin point
to that of a pea, or even larger. These small, beady excrescences may
become detached, and floating off in the general current, give rise to
embolism in distant parts.
_Treatment._—An embolism means the obstruction of a blood vessel
by some foreign material. If in the injection of fluid, there is an
obstruction in one of the blood vessels, leading to one of the organs,
you will never be any the wiser, but if the obstruction is in one of
the vessels supplying a certain area of skin, the condition will show
up sooner or later, when that certain part will have to be treated
hypodermically. Slow arterial injection with drainage of blood should
be given and when symptoms of fermentation are present, include special
attention to the abdominal cavity.
=Aortic Incompetency.=—_Synonyms._—Aortic Insufficiency; Aortic
Regurgitation.
_Definition._—Inability of the aortic valves to properly close an
abnormally large aortic opening, or a change in the segments whereby
they are shortened by curling of the leaflets, or by calcification.
_Treatment._—Bodies dead of this disease will be found with very
much blood, and the elimination of the blood by drainage should be
the first consideration along with the injection of fluid. The fluid
should be diluted one-half for the first part of the injection, and
sufficient fluid used to reach all parts of the circulatory system.
It will be well to add fluid equal to the amount of blood and fluid
taken from the vein to your normal injection in a body the size of the
one to be operated on. A complete cavity injection should be given.
For transportation, govern yourself according to the provisions of the
transportation rules.
=Aortic Stenosis.=—_Definition._—Aortic stenosis is an obstruction of
the aortic orifice, due to changes in the segments of the semilunar
valves, or arterio-sclerosis, or atheromatous deposits.
_Treatment._—Give same treatment advised for aortic incompetency, with
special care in the injection. Sclerotic conditions may complicate
the injection, and in that case as many arteries should be injected as
possible together with full blood drainage.
=Mitral Incompetency.=—_Synonyms._—Mitral Regurgitation; Mitral
Insufficiency.
_Definition._—This condition is an incomplete or imperfect closure of
the auriculo-ventricular opening, permitting the regurgitation of blood
during the contraction of the left ventricle, and due to an abnormal
condition of the leaflets or an enlarged opening.
_Treatment._—Give same treatment as advised for aortic incompetency,
with special care to remove as much blood as possible, which, with
massaging the face downward, should relieve any blood discolorations.
=Mitral Stenosis.=—_Definition._—Mitral stenosis is a constriction
of the left auriculo-ventricular orifice, usually due to valvular
endocarditis.
_Treatment._—Give this body the same treatment as advised for aortic
incompetency, with special care indicated in mitral incompetency.
=Tricuspid Incompetency.=—_Synonym._—Tricuspid Regurgitation.
_Definition._—This condition is an imperfect closure of the tricuspid
valves, due to dilation of the right ventricle or to disease of the
valves.
_Treatment._—Drain as much blood as possible from this case. Massage
the face downward, and inject the maximum amount of fluid; diluting
the first bottle to half strength. In obstinate cases of blood
discoloration, open the common carotid arteries and internal jugular
veins, inject upward in the arteries and drain from the veins, so as
to wash out the vessels of the face. For facial injection use nothing
stronger than half strength fluid. Give thorough cavity injection.
For transportation, govern yourself according to the provisions of the
transportation rules.
=Tricuspid Stenosis.=—_Definition._—Tricuspid stenosis is an
obstruction of the tricuspid opening, usually congenital, though it may
be acquired.
_Treatment._—Treat the same as for tricuspid incompetency.
=Pulmonary Incompetency.=—_Synonym._—Pulmonary Insufficiency.
_Definition._—Pulmonary incompetency is an imperfect closure of
the pulmonary orifice of the right ventricle due to changes in the
pulmonary valves.
_Treatment._—Treat the same as for tricuspid incompetency.
=Pulmonary Stenosis.=—_Definition._—Pulmonary stenosis is an
obstruction of the pulmonary opening of the right ventricle, due to
congenital defects or to endocarditis.