CHAPTER XIII.

DISCOLORATIONS.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For the hypodermic injection we would suggest the following:

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

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

(d) =Gangrene.=—Gangrene can best be described as the death of certain areas of tissue of the living body. The death of the tissue may be brought about by very many causes; by vascular obstruction and arrest of the blood supply to a part, or of the outflow from a part; by enfeebled circulation; temporary stoppage of the circulation of a part or organ; acute infection; and by burns.

Gangrene with its peculiar color, a dark green, is not often found on the exposed surfaces of the body, but will more often be found on the lower extremities and then only on the bodies of aged persons. For this reason it will be unnecessary to treat it for the removal of color.

(e) =Ecchymosis, or Antemortem Staining.=—Ecchymosis is an extravasation of blood into the areolar tissues, forming a bruised place caused principally by a blow from a heavy instrument or missile.

This form of discoloration is mostly seen in accident cases, where death was due to mechanical causes.

In ecchymosis the blood capillaries being ruptured, the blood permeates the bruised tissues surrounding the ruptured vessels and thus gives the characteristic color of venous blood. There seems to be no positive treatment, but in some cases it can be remedied to some degree by a hypodermic injection of a good bleacher, and then massaging the part with a strong bleaching solution. Spots of this kind can sometimes be covered with flesh tints.

It is often important to determine whether violence has been inflicted on a body before death. In regard to this point, we must remember, first, that blows and falls of sufficient violence to fracture bones and rupture the viscera may leave no marks on the skin, even though the person has survived for several days; and, second, that there are postmortem appearances which simulate antemortem bruises. A severe contusion during life may present, at first, no mark or only a general redness. After a short time the injured part becomes swollen and of a red color, this color may be succeeded by a dark blue, and this in turn fade into a greenish yellow or yellow; these later appearances are due to an escape of blood from the vessels and to a subsequent decomposition of the hemoglobin. If, therefore, we cut into such an ecchymosis after death, we find extravasated blood or the coloring matter of the blood, in the form of pigment granules, free in the tissues. Postmortem discolorations, on the other hand, although their external appearance may resemble that of antemortem ecchymosis, are not formed by an extravasation of blood, but by a circumscribed congestion of the vessels or by an escape of blood stained serum. If you cut into such discolorations, therefore, we find no blood outside the vessels. Care should be taken not to mistake the lesions of hemorrhagic infection for traumatic ecchymosis.

Blows on the skin of a body which has been dead for not more than two hours may produce true ecchymosis with extravasation of blood, such as can be distinguished with great difficulty or not at all from those formed during life. If putrefactive changes be present, the difficulty of distinguishing between antemortem and postmortem bruises is greatly enhanced.

Hanging and strangulation are attended with the formation of marks on the neck which are described in works on forensic medicine. These marks must not be confounded with the natural creases of the skin of the neck. Many adults during life have creases of the skin of the neck, one or more in number, running downward from the ear under the chin or encircling the neck. After death these creases may be much more evident than during life, and may be rendered more decided by the position of the head, or if the body be frozen. They usually persist until the skin putrefies.

(f) =Wounds.=—The embalmer should notice the situation, extent and the direction of a wound, the condition of the edges, and the surrounding tissues. If it be a deep, penetrating wound, its course and extent should be ascertained by careful dissection rather than by the use of a probe.

If the edges of a wound be inflamed and suppurating, or beginning to heal, it must have been inflicted some time before death. In a wound inflicted a short time before death the edges are usually everted; there may be more or less extravasation of blood into the surrounding tissues, and the vessels contain coagulated blood; but sometimes none of these changes occur. The chief characteristics of a wound inflicted after death are absence of a considerable amount of bleeding, non-retraction of edges, and the absence of extravasation of blood into the tissues. But a wound inflicted within two hours after death may resemble very closely one received during life. In general, unless a wound is old enough for the edges to present inflammatory changes, the embalmer must be very careful in asserting its antemortem or postmortem character.

(g) =Fractures.=—It may be important to determine whether a bone was fractured before or after death. This point can not always be decided. Fractures inflicted during life are, as a rule, attended with more extravasation of blood and evidences of reaction in the surrounding tissues; but fractures produced within a few hours after death may resemble these very closely. Usually a greater degree of force is necessary to fracture bones in the dead than in the living body.

(h) =Scars and Tattoo Marks.=—The presence and character of these should be noted. Scars produced by any considerable loss of substance may become very much smaller and less conspicuous, but never entirely disappear. Slight and superficial wounds, however, leave marks which may not be permanent.

The discoloration produced by tattooing may, although it rarely does, disappear during life. The embalmer should not try to remove it.