=Cardiac Thrombosis.=—_Definition._—Cardiac thrombosis is the formation
of blood clots in the cavities of the heart.
_Pathology._—The blood clots are found most frequently in the right
side of the heart. They vary in size, from that of a pin head to that
of a hen's egg. When degeneration takes place, softening follows, and
sometimes particles become dislodged and float off to set up thrombi in
other viscera.
_Treatment._—Remove the maximum amount of blood by drainage along with
the injection of fluid. The fluid in this case should be not more than
half strength for the first part of the injection, to be followed by
enough normal fluid to secure preservation. If thrombi have lodged
in any of the larger arteries, the circulation to the part reached
by the branches of the artery will be affected. This can be overcome
by injecting an artery close to the part which is not receiving the
fluid. Massage the face downward to assist capillary circulation.
Give a complete cavity injection. For transportation, govern yourself
according to the provisions of the transportation rules.
=Hypertrophy of the Heart.=—_Definition._—Hypertrophy of the heart is
an enlargement of the organ, due to an increase in the volume of its
muscular fibers, and usually also to dilatation of its cavities.
_Treatment._—Secure full drainage from the veins. Drainage will be
stimulated by an injection of half strength fluid for the first part
of the injection and a massage of the face. Follow the first part of
the injection with enough normal fluid to secure preservation. Give
a complete cavity injection. For transportation, govern yourself
according to the provisions of the transportation rules.
=Cardiac Dilatation.=—_Definition._—Cardiac dilatation is an increase
in the size of the cavities of the heart, due either to thickening or
thinning of the walls.
_Treatment._—Treat the same as for hypertrophy of the heart.
=Cardiac Atrophy.=—_Definition._—Cardiac atrophy is a decrease in the
size, strength, weight, and activity of the heart.
_Treatment._—Remove blood by drainage, and inject half strength fluid
for the first part of the injection. The amount of fluid need not be as
great as in the acute disease of the heart. Massage the face downward.
Give cavity injection. For transportation, govern yourself according to
the provisions of the transportation rules.
=Arterio-Sclerosis.=—_Synonyms._—Endarteritis; Atheroma; Arterial
Sclerosis.
_Definition._—Arterio-sclerosis is an inflammatory and degenerative
condition of the arterial system, primarily of the intima, although
later degenerative changes may involve the whole structure. Calcarine
deposits are quite common.
_Pathology._—As a result of proliferation, infiltrated areas begin
in the middle and outer coats. These nodules vary in size from that
of a small shot to that of a large coin. As they increase in size,
the intima loses its smoothness and becomes thickened and rough.
As these changes progress, the middle and outer coats are weakened.
Calcification may also occur in the wall.
In the diffuse form the change in the coats of the vessels extends
throughout the greater part of the arterial system, and in some cases
invades the capillaries and veins.
In the senile arterio-sclerosis calcareous deposits occur, which render
the vessels rigid. Where these tissue-changes involve the capillaries,
there may be complete obliteration of their lumen in some places.
_Treatment._—In some cases the artery appears to be closed at a point
ahead of the tube and will resist the injection of fluid. Usually,
however, the injection can be made without resistance. Blood should be
drained from these cases so as to allow as full capillary penetration
as possible. When no arterial injection can be made, open the internal
jugular and several other large veins, drain blood from them and then
inject fluid while the tube is within the vessel. If necessary add a
complete hypodermic injection to all parts of the body excepting the
face. Give the cavities full treatment. For transportation, govern
yourself according to the transportation rules.
=Fatty Degeneration of the Arteries.=—In the fatty degeneration of
arteries the process consists in the gradual replacement of certain
parts of the muscular cells by fat droplets. The fat makes its
appearance as minute droplets or granules in the cells. These granules,
which are characterized by their dark color, gradually increase
in number and ultimately the whole of that part of the cell may be
transformed. During the process the granules coalesce, and in this
manner form distinct drops of fat. As the process proceeds the cell is
increased in size and becomes more globular in shape. The cell wall is
destroyed and the cell may thus be converted into a mass of granular
fat. Ultimately the matter between the granules of fat liquify. The
corpuscles break up and the fat becomes distributed in the surrounding
tissues. The immediate effect of this fatty degeneration is to produce
more or less softening of the fatty part, which will impair or destroy
its function. In the case of the artery, the internal, middle and
external coats may be affected, but the external is the one usually
first attacked. The inner layer or endothelium, and the connective
tissue cells in the deeper layers of the inner coat may become affected
in various parts of the vessel. The process may involve a great
portion of the inner coat, even the whole thickness of the intima may
be destroyed. The walls of the artery may be entirely solidified, the
canal being closed completely with a soft, yellowish substance as a
result of the disease. The artery might appear to be a solid mass when
the dissecting knife is passed through. We have seen the anterior and
posterior tibial, the popliteal, radial, ulnar, the aorta arteries, and
especially the arch of the aorta thus affected. Calcification may be
present at many places. These cases are frequently met with in old age.
A body of this kind, where there is fatty degeneration of the arteries,
is sometimes hard to embalm. The walls of the artery will be very
much weakened, and too much pressure must not be made on them while
injecting fluid. Inject the fluid so that it will take several hours
to fill the tissues. The pressure should be gentle and regular when
the aspirator and injector pump is used. If this precaution is taken
often the whole body can be embalmed without a rupture of the arterial
system, the fluid reaching all the extremities by means of collateral
circulation.
If the embalmer should be so unfortunate as to rupture the circulation
then he will have to resort to cavity embalming, and the subcutaneous
tissues will have to be embalmed by the hollow needle trocar.
=Aneurism.=—_Definition._—An aneurism is a circumscribed dilatation
of an artery, formed by the giving away of one or more of its coats. A
false aneurism is where there is a rupture of the coats, and the blood
is found in the adjacent tissues.
_Treatment._—Drain blood from a large vein. Inject half strength
fluid for the first part of the injection, followed by enough normal
fluid to secure preservation. The aneurism itself, will not affect the
circulation of fluid to any great extent. Massage the face downward.
Give a complete cavity injection. For transportation, govern yourself
according to the transportation rules.
CHAPTER XXII.
TREATMENT OF SPECIAL DISEASES.—Continued.
DISEASES OF THE DIGESTIVE SYSTEM.
=Jaundice.=—_Synonym._—Icterus.
_Definition._—Jaundice is a symptom rather than a disease, and is
found in the various affections of the liver. It is characterized by a
deposit of bilirubin in the various structures and fluids of the body,
which gives them a yellow or jaundiced hue.
_Etiology._—Most pathologists agree that all the forms of jaundice can
only come from obstruction. The obstruction is due to inflammation
tumefaction of the duodenum or bile-ducts; to foreign bodies, such
as gall stones or parasites, within the ducts; tumors within the duct
or by pressure from without, such as tumors, gravid uterus, or fecal
matter; or to stricture or obliteration of the duct.
=Catarrhal Jaundice.=—_Definition._—Catarrhal inflammation of the
lining membrane of the biliary ducts, and the duodenum, and attended
with discoloration of the skin and tissues from the consequent
retention and absorption of the bile.
_Pathology._—That portion of the duct lying in the intestines is more
frequently and seriously affected, though the inflammation may extend
to the cystic and even the hepatic duct. The membrane lining the ducts
is swollen and inflamed. The liver is usually congested, slightly
enlarged, and of a deep yellow color. The gall bladder is usually
distended with bile. The ducts are occluded by the swollen mucosa and
plugs of inspissated mucous.
Discoloration of the skin and conjunctiva occurs. The yellow tinge
begins in the eyes, forehead, and neck, gradually extending over
the body, the color being the deepest in the wrinkles and folds of
the skin. The color is generally of a lemon hue, becoming darker and
assuming a bronze or greenish tint as the hepatic lesion assumes a
graver character.
=Infantile Jaundice.=—_Etiology._—It is not known positively what
causes give rise to temporary jaundice in the new-born. Some say it
is due to a reduction of blood pressure in the hepatic capillaries,
while others say it is due to a stasis in the smaller bile ducts,
which are compressed by the distended radicles of the portal vein. The
severe form may be due to congenital closure or absence of the common
or hepatic duct, to hepatic syphilis of congenital form, or to septic
infection due to phlebitis of the umbilical vein.
In the child the skin becomes a yellowish hue of various shades. In the
severe form the hue increases in intensity, the skin assuming a bronze
or yellowish-green color. The abdomen becomes full and tumid, owing to
the congestion of the liver and spleen. When due to syphilis, there is
usually skin eruption.
=Malignant Jaundice.=—_Synonyms._—Acute Yellow Atrophy of the Liver.
_Definition._—A grave form of jaundice characterized by neurosis of the
hepatic cells and atrophy of the liver.
_Pathology._—The liver shows marked atrophy, being not more than
two-thirds or one-half of the normal size, is thin, flabby. On making a
section a yellow or a reddish yellow surface is presented. The hepatic
cells are found in every stage of necrosis. Most of the organs are bile
stained, as well as the skin, and hemorrhages are frequent.
_Treatment for Jaundice._—Since the conditions are similar and since
the conditions after death are identical in reference to pigmentation,
we will consider the treatment of infantile, malignant, and catarrhal
jaundice under one head.
The pigmentation of the skin, no matter how small, is the condition
which presents itself most forcefully, and is the most annoying to the
embalmer. Much study has been given to the subject, but with little
success. It is claimed by some that certain fluids will bleach and
bring out the natural color.
A small amount of bile is sufficient to tint the surface of the body.
Bile is composed of salts, fats, organic matter, acids, and also
coloring matter, called the bile pigments. Bilirubin is the principal
coloring matter, and when dissolved in alkali, forms, when coming in
contact with the air and also in the dead body, a green precipitate
known as biliverdin. The bile pigments in the blood are carried with
the serum from the capillaries to the tissues, being deposited in the
internal coat or deep layer of the epidermis as well as the papillary
of the dermis. The amount deposited regulates the extent of the
pigmentation.
One of the most beneficial things to do, where pigmentation is present
is to wash out the arterial system, draw blood from the veins, massage
the exposed parts. Inject a diluted fluid at first, follow with a fluid
of full strength, until complete disinfection and permeation of the
tissues has taken place. Keep up constant massaging during the whole
course of injection. This may bring fair results, with the addition of
face tints and showing the body under artificial light.
Strong solutions of formaldehyde when used at first are deleterious,
causing the skin to become green. This greenness is more pronounced
when chemicals such as methylene blue have been administered by the
attending physician before death. Bilirubin is a red yellow color, and
alkalies precipitate the bilirubin and form biliverdin. Biliverdin is
a greenish color.
All fluids contain alkalies, and are mostly alkali in reaction, and
this may account for the greenish color of the skin after the injection
of fluid. Acids do not precipitate the biliverdin and there is a
tendency to dissolve it and keep it in solution.
Moadinger suggests that a weak solution of some acid be injected into
the arterial system before the injection of embalming fluid. He prefers
a two per cent. solution of oxalic acid.
Dhonau prefers the use of a one or two per cent. solution of borax, to
be injected into the arterial system, followed by half strength fluid,
and this followed by full strength fluid. Dhonau also applies full
strength peroxide of hydrogen to the skin while massaging the face.
Eckels prefers the use of a fluid containing a peroxide.
If methylene blue has been administered by the attending physician and
you have learned this fact before hand, it is then not advisable to
use a formaldehyde fluid. There is a chemical action set up between
the methylene blue and the formaldehyde which will give to the tissues
a greenish color which is quite objectionable. In this case you would
inject some fluid which does not contain formaldehyde. A benzoate of
soda or borax, or peroxide solution would do.
A good formula to use, when you know methylene blue has been used by
the attending physician is:
Rx Carbolic acid 5 oz.
Borax 12 oz.
Glycerine 1 oz.
Water, qs. 1 gal.
For transportation, govern yourself according to the transportation
rules.
=Cirrhosis of the Liver.=—_Synonyms._—Interstitial Hepatitis; Sclerosis
of the Liver; Nutmeg Liver; Hobnailed Liver.
_Definition._—A chronic disease of the liver, characterized by an
increased connective tissue, a reduction in the size of the organ, and
a degeneration of the parenchymatous constituents.
_Etiology._—In a great majority of cases the disease is due to alcohol,
syphilis, highly spiced and very rich foods. Cirrhosis may result
from chronic obstruction of the bile ducts, due to gall stones, or
tuberculosis. Cirrhosis frequently occurs between the ages of thirty
and sixty years, though it may be found in the extremes of life. Men
are more liable to contract the disease, owing to greater dissipations.
_Pathology._—The liver is increased in size by the increase of
connective tissue, and hyperaemic. On the surface it exhibits a knobbed
appearance (hobnailed liver) and these knobs present through the
capsule a yellowish appearance. The granulations vary in size from a
pinhead to a pea. As a rule there is a little jaundice, as there is
a decrease in the production of bile, instead the skin takes on an
earthy, sallow tint. There is generally ascites, swelling of the feet
and legs, which increases until the abdomen and the lower extremities
become of an enormous size. The nutrition of the body suffers, the
skin is dry and harsh. The blood is altered in quantity, and coagulates
quickly. Ecchymotic spots appear on the skin, about the face and nose.
_Treatment._—There are probably not many other cases of death, which
need greater skill and intelligence in their treatment than does
cirrhosis. The condition that presents itself is a distended abdomen
with gas and liquid. The limbs are also distended and the upper part of
the body is wasted away and is greatly discolored as death was caused
by asphyxia.
Place the body on the board, open the femoral vein, and insert your
drainage tube. It is better to use this vein as it is larger, and there
is more control of the removal of blood, and we would advise in this
case the use of the flexible rubber drainage tube, which can be pushed
up in the vein till it reaches the right auricle of the heart if you
wish. Drain all the blood possible. Use the trocar method, see page
255, or the direct incision, see page 257, to remove the gases and
ascitic fluid from the abdomen. Use the bandage method, see page 339 to
remove the water from the tissue of the extremities.
Raise the femoral artery and inject slowly a diluted fluid and massage
the face gently toward the jugular vein, using some recognized face
bleacher. Then follow with an injection of fluid of full strength until
you are sure the fluid has permeated every tissue of the body. Do not
be afraid to use plenty of fluid. Inject the cavities.
For transportation, govern yourself according to the transportation
rules.
=Carcinoma of the Liver.=—_Definition._—A cancerous growth in the liver.
_Pathology._—Jaundice is present in most cases and where the portal
circulation is seriously compressed, ascites developes. The liver is
greatly enlarged, and the surface is nodular.
_Treatment._—As in all chronic affections of the liver, where the skin
takes on a yellowish or bronze hue, due to pigmentation, it is almost
impossible to bring about the desired cosmetic effects. The pigment is
not only in the blood vessel but also in the tissues of the skin.
We would advise the washing out of the tissues, by the use of the
oxalic or borax solution, injecting the axillary artery and draining
from the femoral artery or raising both the carotid arteries, injecting
upward on one side and draining from the other.
For transportation, govern yourself according to the transportation
rules.
=Appendicitis.=—An inflammation, acute or chronic, of the appendix.
_Pathology._—The pathology will depend to a great extent upon the
degree of the inflammation. Ulceration may take place or there may be
perforation.
_Treatment._—If, after an operation, reopen the incision made by
the surgeon, relieve the gas pressure on the intestines by incising
them; surround the intestines with hardening compound; then inject an
artery, using half strength fluid for the first 64 oz., followed by
enough normal fluid to secure preservation. Drain the blood during the
injection by one of the drainage processes.
If no operation has been made, insert a trocar into the caecum to
relieve the gas pressure, then inject normal fluid into the same place,
using sufficient fluid to neutralize the process of putrefactive
fermentation. The trocar can be first inserted in the usual place
passing it to the caecum, or through the abdominal wall directly over
the caecum. The arterial injection and drainage should be made as is
mentioned above. For transportation, govern yourself according to the
transportation rules.
=Peritonitis.=—An acute or chronic inflammation of the peritoneum
either local or general.
_Pathology._—There is nearly always present more or less fluid in the
abdominal cavity.
_Treatment._—Drain blood from a large vein, and inject half strength
fluid for the first part of the injection, following this with enough
normal fluid to preserve the tissues of the body. After the arterial
injection and drainage have been completed, pierce the abdominal cavity
in the usual place and draw off all the fluid that you can reach,
paying especial attention to the lower part of the cavity. Then inject
normal or supernormal fluid into the cavity to neutralize the process
of putrefactive fermentation. Pierce the colons and inject fluid into
them as well. If fermentation resists this treatment, make a small
incision along the median line and above the umbilicus, examine the
stomach and intestines, incising them if they contain the gas. After
eliminating the gas, inject fluid directly into them, or, surround the
organs of the cavity with good hardening compound; sew up the incision
and the body should not deteriorate in any way. For transportation,
govern yourself according to the transportation rules.
=Dropsy.=—_Definition._—Dropsy is the accumulation of serous fluid in
a cavity or in the tissues.
Dropsy of the abdomen is called ascites.
Dropsy of the chest is called hydrothorax.
Dropsy of the peritoneum is called hydroperitoneum or ascites. General
dropsy of the cellular tissues is called anasarca.
=Ascites.=—_Synonyms._—Dropsy of the Peritoneum; Abdominal Dropsy.
_Definition._—An accumulation of serous fluid in the peritoneal cavity.
_Etiology._—Any obstruction of the portal circulation is a possible
cause of ascites, the most frequent being cirrhosis of the liver.
Pressure from tumors or neighboring organs may also give rise to it.
Peritonitis and valvular diseases of the heart are also responsible
for ascites, and chronic pulmonary affections may impair the portal
circulation to the extent of producing it.
_Pathology._—The quality and character of the fluid show great
variation, from a few pints to several gallons, and from a straw or
lemon tint to a brownish or greenish hue. It may be blood stained, and
occasionally clean and transparent. It is usually watery in character.
_Treatment._—Use the trocar method. Insert the trocar through the
umbilicus and draw off all the ascitic fluid from the abdomen, then
surround the organs with a quantity of fluid sufficient to preserve
them. Or if you desire, use the direct incision and after the ascitic
fluid has been drawn off, surround the organs with a hardening
compound.
The body in general should be preserved through an arterial injection
of normal fluid for the first 64 ounces, then one and one-quarter
strength for all subsequent bottles. This, if attended by copious
drainage from a large vein, will preserve all portions of the body
excepting possibly the epidermis of the posterior abdominal wall,
which, by gravitation of the ascitic fluid, will become separated from
the derma, producing skin slip, and causing the formation of blisters.
Previously to placing the body on the embalming board for treatment,
a rubber cover should be placed over the board so that drippings of
all kinds can be made to flow into a bucket at the lower end of the
embalming board. When the above mentioned blisters are cut and their
contents disposed of by gravitation into the bucket, a strong solution
of formaldehyde should be applied to the affected skin to harden it and
to prevent any further progress toward decomposition.
In ascitic cases the casket should be lined with rubber or oil cloth
to a point three or four inches above the bottom. In addition to this
precaution, the use of sawdust is favored so that any unlooked for
breaking of blisters may not be attended by a flow of the ascitic
liquid from the casket. Many embalmers do not protect themselves
against contingencies of this kind and are frequently criticized by the
friends and family of the deceased.
=Anasarca.=—_Definition._—Anasarca is a general dropsy of the cellular
tissues.
_Treatment._—_Bandage Method._—Bandage the extremities of the body,
commencing at the toes and finger tips, bandaging upward to the hip and
shoulder, using a rubber bandage. Relieve the water as you go along,
then rebandage, and by the third application you will have removed most
of the water from the extremities. Do not leave the bandage on while
injecting.
_Bandage Method._—Bandage the lower limbs, commencing with the thighs.
Bandage as tight as possible down to the toes and make an incision in
the heel, from which drainage of the serous fluid can be secured. In
this method no laps are left between the bandaging so that the serous
fluid can be forced toward the opening at the heel. (This method is
said to be reliable, although we have had but little experience with
it.)
Any accumulation of ascitic fluid in the cavities should be removed by
aspiration with the trocar, as described in the treatment of ascites
and hydrothorax. The rubber cover for the embalming board as described
in the treatment for ascites, should not be omitted.
After the water has been eliminated as far as possible, the arterial
injection should be made, using 64 ounces of normal strength fluid,
followed by enough one-fourth strength fluid to secure preservation.
Copious drainage will help to clear the blood vessels and allow a
better distribution of the fluid, thereby assuring good preservation of
all parts excepting the epidermis, which is practically closed off to
the fluid by the accumulation of water in the subcutaneous tissue.
In these cases the skin should receive a good application of strong
formaldehyde fluid before and after the principle operation, so as to
strengthen it against the putrefactive tendencies of the rete mucosum.
These cases should be watched closely between the time of embalming and
the funeral, as the most thorough preparation is sometimes unequal to
the task of preserving the entire body in such a way as to prevent the
formation of blisters.
For transportation of all dropsical conditions, govern yourself
according to the provisions of the transportation rules.
CHAPTER XXIII.
TREATMENT OF ACCIDENT CASES.
Under this head are treated those deaths which are the result of
accident.
=Specific Treatment of Accidents.=—_Broken Neck_, _Hanging_,
_Strangulation._—The mode of death may possibly cause a separation
or dividing of the blood vessels of the neck. If this is the case
there will remain in the head and face a large amount of blood, which
would soon become coagulated, causing a dark bluish turning black
discoloration. The treatment then must be to get this blood from the
face, so would recommend the common carotid for injection of fluid and
the internal jugular vein for the removal of blood.
Raise both the artery and the vein to the surface, and insert the
arterial tube in the artery toward the face, and inject a small
quantity of fluid in order to cause a pressure on the venous system,
then open the vein, insert the drainage tube and begin to remove the
blood, and as the blood drains from the drainage tube inject slowly
into the artery. This will help to push the blood out of the capillary
system and into the blood bottle and thus clear up the face of its
discoloration.
In these cases the raising of only one common carotid would hardly
suffice, and it would be far better to operate on both carotids to get
the best results. For this reason then the circular incision would
be the best operation, and perhaps the use of the Y shaped drainage
tube. With the Y shaped drainage tube both sides of the face could be
injected at the same time, and the blood could be removed from both
internal jugular veins, and the operator could not help but get good
results. The removal of blood from the internal jugulars in this direct
way will relieve the pressure in the capillaries and smaller veins and
induce a better circulation to all the immediate tissues.
=Body Severed.=—For these cases one should have a very good idea of the
general arterial and venous circulations of the body, for many of the
smaller as well as the larger vessels will be cut, necessitating one to
tie them off.
If the body is severed below the diaphragm remove and cleanse all the
loose and injured organs and tissues, place them in a bucket or pan
and cover with fluid. Ligate all the injured arteries and veins in the
upper and lower parts.
Inject the lower extremities from inside the abdominal cavity using the
common iliac artery, observing the presence of the remaining united
arteries and veins, which you can now see, for fluid will leak from
them. The lock forceps will enable you to pick them up and with the
aneurism needle dissect around the end of the vessel and tie each one
tight.
Treat the upper extremity in the same way injecting either from the
inside or the outside, according as the severity of the accident may
lead you to decide. Inject from the inside upward through the aorta,
or from the outside either through the radial, brachial, axillary or
carotid.
The trunk may now be sewed together, beginning at the middle of the
back. Sew each side up leaving the top open to receive the organs and
the tissues which were removed. After these are placed more or less in
position sprinkle hardening compound throughout the cavity. Now sew up
the front and then place a strong bandage around the body.
=The Arm Severed.=—Clean off the parts, and inject the severed
part through the radial towards the hand and by means of collateral
circulation through palmar arch, the upper part will be embalmed and
the arteries that have been severed disclosed, when they can be tied
off. If there is a great leakage through the stub end, and all the
arteries can not be tied off, plaster of paris may be put on the stub
and then a strong and tight bandage drawn around.
The remaining body can then be injected through the opposite carotid,
brachial or femoral, and when the leakages begin to occur at the stub
end of the arm they can be found and tied off or if the leakage is too
great plaster of paris may be used and a tight bandage placed about the
stub end.
After both the arm and the body have been injected the arm can now be
sewed on in its natural position, plaster of paris put around and a
strong bandage placed around or a splint may be used on both sides.
=The Leg Severed.=—Clean off the parts, and inject the severed part
through the large dorsal toward the foot and by means of collateral
circulation through the plantar arch, the upper part will be embalmed
and the arteries that have been severed disclosed, when they can be
tied off. If there is a great leakage through the stub end, and all the
arteries can not be tied off, plaster of paris may be put on the stub
and then a strong and tight bandage drawn around.
The remaining body can then be injected through the carotid, brachial,
axillary, or the opposite femoral and when the leakages begin at the
stub end of the leg they can be found and tied off, or if the leakage
is too great plaster of paris may be used and a tight bandage placed
about the stub end.
After both the leg and the body have been injected, the leg can be
sewed on in its natural position, plaster of paris put around and a
strong bandage placed around, or a splint may be used on both sides.
=The Head Severed.=—Clean off the parts, and inject the head through
the stub end of the carotid artery, and by means of collateral
circulation through the circle of Willis, the fluid will leak through
the other severed vessels and disclose them, so that they can be tied
off. If one side of the face should take more fluid than the other side
by this method the other carotid can be injected so as to equalize. It
would perhaps be impossible to tie off all the tiny vessels that are
severed so plaster of paris may be used to cover the stub end.
To inject the body, the four principle arteries to be tied are the
two common carotids and the two vertebrals, besides numerous veins
and small vessels. If it is impossible to tie all the severed vessels
plaster of paris may be used, and then by injecting either through the
brachial, axillary or femoral a thorough injection may be obtained. The
stub end of the carotid might also be used for injection, but would
not advise it as in most cases we find that it would be hard to get
especially if the head were cut off close to the shoulders.
When both the head and the body have been injected, bring the two
parts together by using a splint in the vertebral column, and having
plastered well together sew the skin. Demi-surgery can be practiced to
the fullest extent in this case, with great cosmetic effect.
=The Head Crushed.=—Remove all the coagulated blood and the injured
parts of the brain. Cleanse the cavity thoroughly and remould with
plaster of paris. Inject the best you can through one or both of the
carotid arteries, and complete the injection hypodermically. Inject
the rest of the body in the regular way, through one of the carotids
raised for the injection of the head. With the practice and use
of demi-surgery, all the bruised and torn fragments may be blended
together, and the cosmetic effect made almost perfect.
=The Foot Crushed.=—Remove all the coagulated blood by washing, and
place all the parts together as nearly natural as possible. Now inject
any of the principle arteries used in embalming, watching carefully the
flow of fluid and blood. As soon as you see a leakage stop injecting
long enough to tie it up, and when all the visible leakages have
been thus treated, wrap the whole of the injured part with a bandage
saturated with a plaster of paris solution. After this becomes dry and
set complete the injection.
=The Chest Crushed.=—Open up the cavity and remove all the injured
organs and tissues, which you will place in a vessel containing
formaldehyde fluid. With a soft sponge remove all the coagulated blood
from the cavity. Now tie up all the visible arteries and start the
injection from the inside, using first the innominate to inject the
right arm and the right side of the face then the left common carotid
to inject the left side of the face and the left subclavian to inject
the left arm. It must be remembered though that while one artery
is being injected the others should be tied off lest by collateral
circulation you would get leakages. The thoracic aorta might be used
but it will be found more difficult because of the leakages which
would occur through the intercostal arteries. These leakages would not
occur nearly as much by the raising of the branches off the arch of
the aorta, namely the innominate, the left common carotid and the left
subclavian. Any leakage can be stopped by means of the lock forceps and
then tied.
The lower part of the body, if it is not injured, can be injected now
through the abdominal aorta, but if there has been any damage done
below the diaphragm, it would probably be best to further open up the
cavity and inject each lower extremity through the common iliacs.
Now replace all the organs and surround them with hardening compound,
and sew up the cavity incisions, with great care and neatness. It would
be well to practice demi-surgery here, so that you would become more
proficient in the art, and thus be able to do more efficient work on
the exposed parts, should the occasion ever demand it.
=Gun-shot in the Abdomen.=—When death occurs it is generally due to
severing or dividing of an artery or decomposition resulting from the
injury done the intestines. The operator should open the body cavity,
from the end of the sternum bone to the pubic bone, and cleanse the
cavity of all the coagulated blood and other putrid matter. Locate and
tie up the injured vessels. The injection can then be started from one
of the principle arteries which will aid in locating the other injured
vessels. Puncture the stomach and inject inside, so as to prevent the
formation of gas, and after the body has been injected place hardening
compound inside the body cavity and sew up carefully and neatly.
=Burns and Scalds.=—A burn is an injury to the body produced by
the application of a flame or of a substance heated above a certain
temperature.
A scald is an injury produced by the application of a liquid heated
above a certain temperature.
Injuries resulting from corrosive liquids such as sulphuric acid,
nitric acid, caustic potash, carbolic acid, etc., are properly termed
burns. A heated solid such as iron may produce a burn of great
intensity from the blistering of the skin to the charring of the
underlying tissues. Metals heated above 212 degrees Fahrenheit will
produce redness, vesication and coagulation of the blood. Molten metals
cause burns or scalds very similar to those produced by heated solids.
Boiling oil produces severe burns. If a part is severely scalded with
boiling water, the skin may appear sodden, blistered, and of an ash
grey color, but never produces blackening or charring of the cuticle.
Phosphorous burns are usually very severe and of great depth, while
the area of skin destroyed is usually small. Gunpowder burns caused by
explosions are often of great superficial extent, extensive scorching
and numerous carbon particles are commonly found imbedded in the true
skin. Petroleum burns are generally severe, as usually all or nearly
all the body is scorched and blackened. Burns from flame, extensive
scorching with burnt hair is a usual feature in a flame burn. Burns
from explosions of fire damp in coal mines are frequently of great
extent and present the appearance of great scorching, and very often a
quantity of coal dust will be found imbedded in the true skin. There
are six degrees of burns as follows: (a) Simple hyperemia of the
skin, (b) dermatitis, with vesicles or bullae, (c) necrosis of the
superficial layer of the skin, (d) complete necrosis of the skin, (e)
necrosis of the skin, superficial fascia and muscles, and (f) complete
carbonization of the part.
_Treatment._—The embalmer does not treat these cases according to the
cause as much as to what is left of the part after burning has been
accomplished. After observing the part to note whether the condition
can be bettered by a replacement of tissue by artificial means and
finding such to be the case, I would use a form of paste commonly used
for filling in cuts and restoring the features and with this paste
thoroughly cover the burned part. If the affected part covers the
entire face or most of it, an entire new surface will have to be built
up with the paste. If the burning of the skin has left particles of
epidermis adhering to the derma, I would use sweet oil and bath the
entire face with it, thus softening the skin and allowing the removal
of the small particles. Any small desiccated spots should be covered
with the paste. After carefully blending the paste with the skin so
as to produce a smooth even complexion, which can best be done by the
use of a brush to smooth it with, apply a good quality of face powder
(flesh color) to the part. If the color is too striking, or too white,
destroy the contrast with carmine rouge. This form of operation is
commonly known as demi-surgery. We find that the face powder is best
applied with a pad made of surgical gauze especially when applied
with a patting movement. This gives a good imitation of the pores of
the skin, and if any further smoothing is necessary the brush can be
used again. The principal result wanted is a good imitation of the
natural parts. If the operator will use the utmost care to give the
parts gentle, fine touches here and there, a most artistic effect will
be produced. If the eye brows have been destroyed, imitate them with
charcoal, carbon, or dark theatrical paint. A good make-up outfit is
indispensable for an embalmer handling many railroad cases during the
year, and as such can be had at any dealer in theatrical supplies, we
advise the securing of a few varieties of pastes, and some good face
powder together with carmine rouge.
If the face is damp or moist, the theatrical paste above mentioned will
not adhere properly, and in that case alcohol applied to the skin will
cause it to dry. One of the most important considerations in these
cases, is the placing of the body in the casket. The body should be
placed as low as possible, the silk slide should be closed and a view
of the body only secured through it, the light in the room should be
tempered so that no striking rays of light serve to distort any portion
of the features. Wonderful work has been accomplished by the authors
and by others in rescuing cases of this kind from non-presentability
to presentability, but in all cases, the ingenuity of the operator
is taxed to the utmost, and the case never looks just right until the
last touch is applied. With the above information, you have only the
rudiments of the work. Your success or failure will depend upon how
hard you try to make good in each individual case, and your success in
matching colors, which can only be acquired with much patience.
Give burned bodies a very thorough arterial injection, using half
strength fluid for the first part of the injection. The cavities
should also receive a good injection of normal fluid. The peculiar
odor present about a burned body can be lessened by the use of false
deodorizers such as flowers, perfume, etc.
CHAPTER XXIV.
TREATMENT OF POSTED CASES.
=Cranial Evisceration.=—By this term is meant the complete removal of
the brain. To do so the scalp is cut from ear to ear, the front part
is pulled forward over the nose and the back part over the occipital
bone. A skull clamp is placed in position and with a saw take away the
calvarium. When the calvarium or skull cap has been removed the brain
is in full view and can be easily removed by cutting the arteries at
the circle of Willis and the ligaments at the base of the skull.
=Thoracic Autopsy.=—By this term is meant the complete removal of all
the organs of the thoracic or chest cavity. To do so the skin is cut on
either side from the sterno-clavicular junction to a point where the
ninth rib joins to its costal cartilage. The ribs are cut on either
side at the costochondral articulation, which will permit the entire
front chest wall to be taken away. The heart and lungs are now in full
view and can be easily removed.
=Abdominal Post.=—By this term is meant the complete removal of all
the organs of the abdominal cavity. To do so the skin and muscles
are cut on either side from a point where the ninth rib joins its
costal cartilage vertically downward to about an inch above Poupart's
ligament and from there to the top of the pubic bone. When the anterior
abdominal wall has been removed all the organs will be in full view and
can easily be removed.
=Posted Cases.=—By this term is meant those cases on which an autopsy
has been held and all the internal organs of the body have been
removed. Here all the internal circulation has been destroyed.
_Treatment._—Place the body on the cooling board and undo all the
stitches made by the physician in sewing up the body after the
post-mortem. Remove all the organs, that have been previously removed
by the physician, and place same in a bucket or other container. Clean
out thoroughly all the blood from the cranial, thoracic and abdominal
cavities. Now try to tie off the arteries in the cranial cavity which
will be the vertebrals or the basilar and the common carotids. If these
have been cut too short to be tied, then mix up some plaster of paris
and cover them securely so that there will be no leakage. While the
plaster of paris is setting raise the common iliac artery, which you
will find at the back of the abdomen just over the ilio-psoas muscle,
represented by a line drawn from the body of the fourth dorsal vertebra
to the center of Poupart's ligament. Inject the right and left common
iliac arteries downward which will take care of the lower extremities.
Here the only artery you need to tie off is the deep epigastric artery
which is a branch of the external iliac just a short distance above
Poupart's ligament and which takes a course upward over the abdominal
muscles finally to anastomose with the deep mammary artery.
By the time you have injected the lower extremities, the plaster of
paris will be set. Work from the inside of the thoracic cavity, and
tie off the innominate, left common carotid and the left subclavian
arteries, and when this has been accomplished inject each one
separately. Here the only leakage you will have will be through the
mammary or intercostal arteries which you will tie off as the leakage
occurs.
Now turn the body over and hypodermic the back, then turn body over
again. Fill the cranial cavity with sawdust, place the skull cap in
position and sew up the scalp. Wash all the organs and place them back
in the cavities in their proper positions or as nearly so as possible
and as you do so fill in with hardening compound. Sew up the abdomen
and wash the body with a disinfecting solution and apply outward
cosmetics.
CHAPTER XXV.
TREATMENT OF MISCELLANEOUS CASES.
=Alcoholism.=—_Definition._—An intoxication, acute or chronic, due to
the injection of a sufficient quantity of alcohol to produce muscular
inco-ordination, mental disturbances, and finally narcosis.
_Pathology._—Where death is the result of acute alcoholism, the mucous
membrane of the gastro-intestinal canal is engorged, injected, and
dark red in color, and covered with a sticky, mucoid exudate. The
brain and the kidneys show the same characteristic changes. In chronic
alcoholism, changes of a more permanent character take place, depending
somewhat upon the quantity, quality and kind of alcoholics consumed,
and the length of time used. While all the bodily tissues are more or
less impaired, the brain, kidneys, and digestive system suffer most.
There may be connective tissue changes, fatty degeneration, sclerosed
kidneys, liver or arteries, and a more or less dilatation of the
stomach.
_Treatment._—In acute alcoholism, the blood should be drained from
a large vein, while fluid is being injected into a large artery.
After draining a sufficient amount of blood from the body, the vein
tube should be shut off and the arterial injection should continue
until the capillaries have been filled to their utmost capacity. This
strong treatment is advised on account of the early tendencies toward
putrefaction, which is sometimes in an advanced state shortly after
death. The cavities should receive a thorough treatment with normal or
supernormal fluid. Myers advises the re-injection of the cavity in 6 or
8 hours after removing the fluid remaining in the cavity from the first
injection. As a preventive treatment, this last is a wise precaution.
While the cavity treatment is being given the stomach should be entered
by the trocar, relieved of its contents and injected, thus preventing
post-operative purging.
In chronic alcoholism, the greatest circulation difficulties will
be encountered. The capillaries will not receive the fluid, the
putrefactive processes causing the formation of tissue gas early
in the case, which, when coupled to many natural impediments to the
circulation in cases of this kind, virtually nullifies the circulation
for fluid distribution. Inject as many arteries as possible, and if
necessary the veins also. Use the hollow needle or trocar and give
the unexposed portions of the body a heavy hypodermic injection. The
fluid used in this case should be not less than normal in strength and
in most cases should be at least ¼ over normal. Give the cavities a
very heavy injection, paying special attention to the food passages.
This is one of the cases coming to the attention of the embalmer where
every emphasis must be laid upon the injection of a sufficient amount
of fluid, through as many channels as possible. Do not count the cost
of the fluid in this case, if you value the securing of satisfactory
results. Cosmetic effect will be enhanced by injection of the carotids
upward with drainage from the internal jugular veins. Finish the case
with the use of good face powder, unless a discoloration is present,
when this should be obliterated with one of the improved methods
mentioned in the chapter on discolorations.
=Morphinism.=—_Definition._—A chronic intoxication due to the habitual
use of opium, or some of its alkaloids, especially morphine.
_Pathology._—There are no characteristic tissue changes, other than
that due to indigestion and malnutrition. At death the patient is
anemic, the skin dry, sallow and inelastic, the heart and blood vessels
show the effects of poor nutrition, and the tissues generally present
a starved appearance. The blood disintegrates, causing a discoloration
of a brownish color, one or two days after death.
_Treatment._—Drain blood from these cases using half strength fluid
for the first part of the injection. The more blood obtained, the less
the danger of discoloration will be. Give the body a thorough cavity
injection in addition to the arterial injection. If your treatment does
not eliminate the blood as a factor, the discoloration will occur and
then it cannot possibly be removed. In this case the use of cosmetics,
if in the hands of a patient operator, will overcome the color.
=Plumbism.=—_Synonyms._—Lead-poisoning.
_Definition._—A chronic intoxication due to absorption of lead.
_Pathology._—The muscles are atrophied and pale in color.
Arteriosclerosis of the cerebral blood vessels is found. There may be
softening of the brain and hemorrhage.
_Treatment._—Drain blood from the veins while injecting fluid in the
arteries. The fluid should be used half strength for the first bottle
of the injection. Massage the face downward to help eliminate any
discoloration of blood origin from cerebral hemorrhage. Give the body
a thorough injection both as to arteries and cavities. If the face is
unduly pale from this treatment, carmine rouge, judiciously applied
will lessen the paleness.
=Arsenicism.=—_Definition._—A chronic intoxication caused by the
continued absorption of arsenic.
_Treatment._—Same as for plumbism.
=Mercurialism.=—_Definition._—A chronic mercurial poisoning, caused,
either by ingestion of the drug, or by inhalation and absorption of the
mineral in the industrial pursuits.
_Pathology._—There is an acute inflammation of the mouth, stomach, and
intestines. The kidneys are inflamed and the liver is degenerated.
_Treatment._—Drain blood from a large vein while the injection is
going on. The first bottle of fluid for the injection should be half
strength. The cavities should be injected, as intense inflammation
takes place in the alimentary tract.
=Heat-Stroke.=—_Synonyms._—Sunstroke.
_Definition._—Heat-stroke is the result of exposure to intense heat,
either from the direct rays of the sun, or the radiation of blasts or
furnaces, or to an overheated atmosphere.
_Pathology._—Owing to the excessive heat of the body, putrefactive
changes occur very early. If a post-mortem examination is made very
soon after death, the left heart will be found contracted, while the
right heart will be engorged, and the venous trunks filled with dark
semi-fluid blood. There is also venous engorgement of the brain, spinal
cord, and lungs. Ecchymoses and extravasations of blood are found in
the skin and mucous membranes.
_Treatment._—Drain blood from a large vein during the injection. The
first two bottles of the injection should be of half strength fluid.
The face should be massaged to assist in the securing of capillary
circulation and in the elimination of the blood discoloration. The body
should be treated as soon as possible after death, as putrefaction
begins early. The cavities should have a very thorough treatment,
eliminating the gases and injecting normal fluid therein. Should
ecchymosis occur, obliterate the color by an application of cosmetics.
=Obesity.=—_Definition._—An excessive accumulation of fat, impairing
the bodily functions, or rendering one uncomfortable.
_Treatment._—Drain blood from these cases, injecting the first bottle
of fluid half strength followed by normal fluid for the balance of
the injection. Massage the face downward during the injection. Inject
the cavities, with special attention to the stomach and intestines.
For transportation of these cases, govern yourself according to the
provisions of the transportation laws.
=Elephantiasis.=—_Definition._—A chronic disease caused by inflammation
and obstruction of lymphatics and marked by great thickening of the
skin.
_Treatment._—Drain blood from these cases and inject normal fluid
sufficient enough in quantity to secure preservation. For long time
preservation, supplement the foregoing treatment by a special injection
into the thickened extremity, either through an artery leading directly
to the part or by trocar or hollow needle inserted under the skin. Give
the body a thorough cavity treatment, using normal fluid throughout.
For transportation, govern yourself according to the provisions of the
transportation laws.
=Drowned Cases.=—_Treatment._—Inject fluid into the lungs by inserting
a child's trocar into the windpipe at the upper border of the sternum,
making the injection sufficient in strength and amount to fill the
lungs. If this is not done, a bloody purging will take place several
hours after death. Tap the stomach through the epigastric region,
aspirate the contents and inject strong fluid before removing the
instrument. Drain blood from the body during the injection, which
should be quite heavy and of normal fluid. The last bottle should be
made 1¼ strength or ¼ over normal.
=Floater.=—_Definition._—A body that has been floating on the water.
_Treatment._—The body is distended with gases in the cavities, tissues
and capillaries, putrefaction is in an advanced state, and a vile
odor will be present. If body is to be shipped, aspirate all the gas
possible from the tissues with the hollow needle, injecting strong
fluid in the same openings. Open the body from the base of the neck
to the pubic bone, relieve the gases in the alimentary tract and
lungs, and fill cavity thoroughly with hardening compound, after
which it should be sewed up. Inject as many arteries as possible with
very strong fluid. Dress the body and place it in a metallic casket.
Pour the contents of two pound bottles of Platt's chlorides on the
underclothing to assist in deodorizing the body. Do not open the casket
after it is once sealed.
If the body is not to be shipped, it will be advisable to deodorize it
as much as possible and bury it without delay.
=Mother and Unborn Child.=—_Mother and Foetus in Utero._
—_Treatment._—Before pregnancy has reached the three months
stage, the child will receive fluid directly from the circulation
connected with the mother.
After the three months stage, the circulation, by direct flow, is
stopped and fluid could only reach the foetus by absorption from the
placenta. This is naturally insufficient to preserve the child, which
by this time is immersed in the liquor amnii (water of the womb) and
which is subject to early putrefaction in that situation. The trocar
should be directed to the uterus or womb from a point on the median
line, half way from the umbilicus to the pubic arch, care being taken
to reach the water which surrounds the foetus. Withdraw the water,
and inject as much strong fluid as possible so that the foetus will
be surrounded with fluid, and in that way preserved. If the trocar
enters the body of the child, this will not occur, so the instrument
should be carefully manipulated to reach the space between the child
and the uterine wall. The mother should receive a very heavy arterial
and cavity injection, with full drainage of blood. The vulva should be
closed with absorbent cotton. The face should be massaged thoroughly
toward the heart.
=Senility.=—_Synonyms._—Old age.
_Definition._—A state of decline in an aged person characterized by
progressive atrophy of all the tissues and organs.
_Pathology._—Excessive shrinking and obliteration takes place among
the capillaries. The skin becomes diminished in thickness. When this
occurs, it is easily seen why in old age there will follow, after the
injection of fluid into the arterial system, greenish, brownish, and
soft spots, in the different parts of the body, especially notable in
the face, neck and hands. The products of degeneration may accumulate
in the tissues and cause them to be thicker than they are in health,
as is seen in the vessels, the walls of which are much thicker than
normal. The blood contains fewer corpuscles and solid constituents, is
more watery, and coagulates more readily; also the total quantity is
less. The pericardium, endocardium, and the capsules of the liver and
spleen are opaque and toughened. Degeneration of the cardiac substance
may lead to a state of asthenia, which generally produces death.
Dilatation of the orifices of the heart may be the prominent lesion,
or they may be contracted by atheroma, or by thickening of the vales
or rings. The lungs are changed more or less, increasing the bronchial
secretions, which during life have been attended by severe paroxysms of
coughing.
_Treatment._—Inject half strength fluid for the first bottle, following
that with ¾ strength for the second and normal for the third and all
thereafter if more be necessary. Blood may be drained from the vein if
the operator thinks it advisable. The commercial face solution or water
should be used on the face while massaging in order that the skin may
be kept moist and to prevent dessication from the action of the fluid.
The cavity should be injected as a matter of precaution.
=Gangrene.=—_Synonyms._—Senile gangrene; mortification.
_Definition._—Putrefactive fermentation of dead tissue, from various
causes.
_Treatment._—The extremities are affected in senile gangrene. They
should be wrapped with absorbent cotton which should then be saturated
with fluid. The body itself should receive the same treatment accorded
in the paragraph on senility.
INDEX
(References are to pages.)
A.
Abdomen, 101, 254
Abdominal cavity, 101, 254
Abdominal fermentation, 182
Abdominal post, 351
Absence of normal moisture in skin, 200
Alimentary canal, 96
Anatomical guides, 225
Anatomy, 33
Angiology, 34
Antemortem staining, 191
Anus, 112
Apnea, 157
Aponeuroses, 55
Appendix, 109
Arterial system, 125
Arteries, structure of, 58
Artery, differentiated from nerve, 215
Artery, differentiated from vein, 215
Artery, how to cut for injection, 216
Artery, how to raise, 214
Artery, selection of, 211
Ascending color, 111
Asphyxia, 157
Axillary artery, location, 231
Aztecs embalming, 19
Azygos system, 125
B.
Babylonian embalming, 17
Bandage test, 159
Belgian embalming, 18
Bladder, urinary, 118
Blood, 61
Blood coagulation, 65
Blood corpuscles, 63, 64
Blood plasma, 62
Blood, removal of, 264
Blood vascular system, 123
Bones, 48, 69
Bones of face, 74
Bones of lower extremity, 77
Bones of pelvic girdle, 78
Bones of thorax, 76
Bones of upper extremity, 77
Boudet, 22
Brachial artery, location, 234
Britain embalming, 18
Bronchus, 87
C.
Cadaveric lividity, 168
Caecum, 109
Cancerous spots, 190
Capillary circulation, 132
Capillary congestion, 204
Cardia, 104
Carotid artery, location, 225
Cartilage, 48
Cavities, 79
Cavity embalming, 247
Cell, 35
Cerebro-spinal cavity, 79, 247
Charge of embalming, 222
Chemical action, 202
Christian embalming, 20
Circle of Willis, 127
Clavicle bone, 77
Coagulation of blood, 65
Collateral circulation, 147
Colon, 111
Coma, 157
Cooling of the body, 167
Coronary circulation, 142
Cranial cavity, 79, 247
Cranial evisceration, 351
Cranial nerves, 81
Cranium, 94
D.
Descending colon, 112
Descriptive anatomy, 33
Diaphragm, 99
Desiccation, 196
Digestive fermentation, 180
Direct incision, 257
Discolorations, 187
Discolorations after death, 196
Discolorations before death, 188
Disinfectants, 221
Drying action of formaldehyde, 197
Duodenum, 107
E.
Ecchymosis, 191
Egyptian embalming, 5
Embalming, 153
Embalming, abdominal cavity, 254
Embalming, Aztec, 19
Embalming, Babylonian, 17
Embalming, Belgian, 18
Embalming, Britain, 18
Embalming, cavity, 247
Embalming, cerebral cavity, 247
Embalming, charge, 222
Embalming, chest cavity, 252
Embalming, crania cavity, 247
Embalming, early Christians, 20
Embalming, Egyptian, 5
Embalming, Ethiopian, 17
Embalming, French, 18
Embalming, Greek, 17
Embalming, Guanch, 3
Embalming, Hindoo, 18
Embalming, Indian, 19
Embalming, Jewish, 15
Embalming, later European, 20
Embalming, Norsemen, 18
Embalming, Persian, 16
Embalming, Peruvian, 19
Embalming, Roman, 17
Embalming, Scythian, 17
Embalming, subcutaneous tissue, 260
Embalming, thoracic cavity, 252
Epigastric region, 103
Esophagus, 99, 250
Ethiopian embalming, 17
Ethmoid bone, 74
European embalming, 20
F.
Face bones, 74
Falcony, 23
Fascia, 43
Fat, 56
Feather test, 159
Femur bone, 78
Fermentation, 179
Fermentation, abdominal, 182
Fermentation, digestive, 180
Fermentation, gastric, 184
Fermentation, intestinal, 185
Fermentation, metabolic, 181
Fermentation, putrefactive, 181
Fermentation, spirituous, 180
Feverish condition, 199
Fibula bone, 78
First call, 205
Fluid, injection of, 218
Foetal circulation, 144
Foramen of Winslow, 121
Fractures, 194
Franchini, 22
Franciolli, 23
Freezing of the skin, 199
French embalming, 18
Frontal bone, 74
G.
Gall bladder, 114
Gangrene, 191
Gannal, 23
Gas formation, 179
Gastric fermentation, 184
Glands, 47
Greek embalming, 17
Greenish tinge of putrefaction, 200
Guanch embalming, 3
Guides, anatomical, 225
Guides, linear, 225
H.
Hair, 41
Heart, 92
Heart sac, 92
Hindoo embalming, 18
Histology, 33, 35
Holmes, 25
Humerus bone, 77
Hunter, 21
Hyoid bone, 75
Hypochondriac region, 103
Hypogastric region, 103
I.
Ileum, 108
Ilium bone, 78
Indian embalming, 19
Inferior maxillary bone, 74
Inferior turbinate bone, 75
Inguinal region, 103
Injection of fluid, 218
Intestinal fermentation, 185
Intestines, large, 108
Intestines, 106
Ischium bone, 78
J.
Jejunum, 107
Jewish embalming, 15
K.
Kidneys, 116
L.
Lachrymal bone, 75
Large intestines, 108
Larynx, 84
Leucocytes, 64
Ligaments, 55
Linear guides, 225
Liver, 112
Lumbar region, 103
Lungs, 88
Lymphatic circulation, 123, 147
Lymphatics, 44
M.
Malar bone, 75
Mediastinum, 91
Membranes, 57
Mesentery, 122
Metabolic, fermentation, 181
Mirror test, 159
Modes of death, 155, 156
Mouth, 97
Mucous membranes, 57
Muscles, 54
Myology, 33
N.
Nails, 40
Natural evaporation, 196
Nerves, 53, 81, 82
Neurology, 33
Norse embalming, 18
North American Indian embalming, 19
O.
Omentum, 121
Omohyoid muscle, 75
Osteology, 33, 69
P.
Palate, 97
Palate bone, 75
Pancreas, 115
Parietal bone, 74
Patella, 78
Pelvic cavity, 118
Pericardium, 92
Peritoneum, 120
Persian embalming, 16
Peruvian embalming, 19
Pharynx, 98
Pigmentary atrophy, 189
Pleura, 87
Plugging orifices, 262
Portal circulation, 144
Position of body on embalming board, 210
Positive signs of death, 162
Postmortem discoloration, 203
Postmortem staining, 204
Poupart's ligament, 55, 56
Premature burial, 164
Prostate, 119
Protoplasm, 35
Pubic bone, 78
Pulmonary circulation, 134, 141
Purging, 249
Putrefactive changes, 160
Putrefactive fermentation, 181
Pyloris, 104
R.
Radial artery, location, 237
Radius bone, 77
Raising an artery, 214
Receptaculum chylii, 46
Rectum, 112
Regional anatomy, 34
Removal of blood, 264
Removal of urine, 263
Ribs, 76
Rigor mortis, 177
Roman embalming, 17
Ruysch, 21
S.
Salivary glands, 98
Sarcolemma, 54
Scapula bone, 77
Scars, 194
Scythian embalming, 17
Selection of artery, 211
Serous membranes, 57
Signs of death, 155, 157
Sinuses, 136
Skeleton, 69
Skin, 37
Skin slip, 175
Skull, 72
Small intestines, 106
Sphenoid bone, 74
Spinal cavity, 81
Spinal nerves, 82
Spine, 71
Spirituous fermentation, 180
Spleen, 116
Stomach, 103
Sucquet, 23
Superior maxillary bone, 74
Suprarenal capsule, 117
Surgical anatomy, 34
Syndesmology, 33
Synovial membranes, 57
Systemic circulation, 125
Systemic system, 134
T.
Tattoo marks, 194
Teeth, 52, 97
Temporal bone, 74
Tendons, 55
Tests of death, 155, 158
Thoracic autopsy, 351
Thoracic cavity, 83, 252
Thoracic duct, 45
Tibia bone, 78
Tissue, 37
Trachea, 85, 250
Transverse colon, 111
Treatment of accidents, 341
Arm severed, 343
Body severed, 342
Broken neck, 341
Burns, 347
Chest crushed, 346
Foot crushed, 345
Gun shot in abdomen, 347
Hanging, 341
Head crushed, 345
Head severed, 344
Leg severed, 344
Scalds, 347
Strangulation, 341
Treatment of diseases, 285
Actinomycosis, 293
Ague, 295
Alcoholism, 354
Anasarca, 339
Aneurism, 328
Anthrax, 285
Aortic incompetency, 321
Aortic insufficiency, 321
Aortic regurgitation, 321
Aortic stenosis, 321
Appendicitis, 336
Arsenicism, 357
Arterio sclerosis, 325
Ascites, 337
Black death, 303
Black vomit, 296
Bubonic plague, 303
Carbuncle, 285
Carcinoma of liver, 333
Cardiac atrophy, 324
Cardiac dilatation, 324
Cardiac thrombosis, 323
Cerebro spinal fever, 286
Cerebro spinal meningitis, 286
Charbons, 285
Chicken-pox, 309
Chills and fever, 295
Cholera, 302
Cirrhosis of liver, 333
Dengue, 294
Diphtheria, 297
Dropsy, 337
Elephantiasis, 359
Drowned cases, 359
Endoarteritis, 325
Endocarditis, 320
Erysipelas, 287
Famine fever, 308
Farcy, 288
Fatty degeneration of arteries, 326
Floater, 359
Gangrene, 362
Gangrene of lungs, 312
Glanders, 288
Heat stroke, 357
Hemopericardium, 319
Hospital fever, 308
Hydropericardium, 318
Hydrophobia, 289
Hydrothorax, 317
Hypertrophy of heart, 324
Influenza, 301
Jail fever, 308
Jaundice, 329
Leprosy, 301
Lockjaw, 292
Lumpy jaw, 293
Malaria, 295
Malignant pustule, 285
Marsh fever, 295
Measles, 306
Mercurialism, 357
Mitral incompetency, 321
Mitral insufficiency, 321
Mitral regurgitation, 321
Mitral stenosis, 322
Morphinism, 356
Mother and unborn child, 360
Mumps, 307
Obesity, 358
Parotitis, 307
Pericarditis, 318
Peritonitis, 336
Pertussis, 308
Plumbism, 356
Pneumonia, 314
Pneumopericardium, 319
Pulmonary abscess, 314
Pulmonary hemorrhage, 312
Pulmonary incompetency, 323
Pulmonary insufficiency, 323
Pulmonary stenosis, 323
Putrid fever, 308
Pyemia, 311
Rabies, 289
Relapsing fever, 290
Rubeola, 306
St. Anthony's fire, 287
Scarlatina, 304
Scarlet fever, 304
Scarlet rash, 304
Senility, 361
Septicemia, 310
Ship fever, 308
Small-pox, 305
Splenic fever, 285
Spotted fever, 286
Swamp fever, 295
Syphilis, 290
Tetanus, 292
Tricuspid incompetency, 322
Tricuspid regurgitation, 322
Tuberculosis, 298
Typhoid fever, 299
Typhus fever, 308
Varicella, 309
Variola, 305
Whooping cough, 308
Wool-sorter's disease, 285
Yellow fever, 296
Treatment of posted cases, 351
Abdominal post, 351
Cranial evisceration, 351
Posted cases, 352
Thoracic autopsy, 351
Trocar method, 255
U.
Ulna bone, 77
Ulnar artery, location, 240
Umbilical region, 103
Ureter, 117
Urinary bladder, 118
Urine, removal of, 263
Uterus, 118
V.
Vasa-vasorum, 60
Vascular system, 123
Veins, structure of, 60, 61
Venous circulation, 134
Venous congestion, 204
Vermiform appendix, 109
Vertebral column, 71
Vomer, 75
W.
Winslow, Foramen of, 121
Wounds, 193
Y.
Yellow jaundice, 188
Transcriber's Note
Original spelling, hyphenation and punctuation, even where
inconsistent, have been preserved. Minor typographical errors have been
corrected without note.