CHAPTER XIV.

DISCOLORATIONS.—Continued.

=Discolorations Occurring After death.=—Those discolorations occurring after death would be as follows:

(a) Desiccation. (b) Greenish tinge of putrefaction. (c) Chemical action. (d) Postmortem discoloration. (e) Postmortem staining. (f) Capillary or venous congestion.

=Desiccation.=—This is a brownish color caused by the drying of the skin. Various conditions might cause this color of which a few are considered here:

Natural evaporation, the drying action of formaldehyde, freezing the skin, feverish conditions of the body before death, absence of a normal amount of moisture in the skin of the dead body.

_Natural Evaporation._—The passage of moisture from the skin into a dry atmosphere reduces the normal amount of moisture in the skin, thereby producing an altered color. The extent of the moisture reduction governs the color produced. When evaporation begins, the skin loses its softness and becomes slightly yellow in color. As evaporation continues the skin becomes more hard and the color changes from yellow to brown. At this time nothing can be done to restore the original color as in the absence of the blood circulation, the pigment of the skin will not take up moisture, nor will moisture penetrate the skin itself.

_Treatment._—The only treatment for a condition of this kind is necessarily a preventive one. While embalming a body, the operator should apply either water or one of the commercial face solutions to the skin of all the exposed portions of the body. If the condition within the skin is one in which there is a predisposition toward dryness, the face solution or the water by being present on the skin will reduce evaporation from the skin itself; in this way maintaining the natural degree of moisture. Should a hard, dry spot appear in the absence of any preventive treatment, the operator can only coat the spot with grease paint and thereby hide it.

_The Drying Action of Formaldehyde._—Formaldehyde is derived from methyl spirits, which in itself has an active affinity for water. The amount of water ordinarily mixed in formalin in the compounding of a formaldehyde fluid is not sufficient to satisfy the appetite of the formaldehyde for more water. When a formaldehyde fluid comes in contact with moisture laden skin, there will be a movement of moisture from the skin toward the formaldehyde fluid, thereby reducing the degree of moisture in the skin and in that way causing it to become dry. When the skin becomes dry, it changes in color the same as in natural evaporation.

_Treatment._—There are three conditions in the skin met by the operator. The first is where there is a predisposition toward dryness and this is where the skin does not contain a normal amount of moisture to begin with. In old age cases, tubercular, and anemic bodies, the ordinary embalming fluid should be diluted at least one half for the first part of the injection, thus reducing the appetite for moisture on the part of the fluid. In addition to this, water or a face solution should be used externally to prevent outward evaporation from further reducing the moisture in the skin. The fluid exhibits a tendency to draw water into the pores, thus maintaining to a large degree, the normal moisture percentage.

The second condition met with is one in which the skin contains a normal amount of moisture. In this case it would not be necessary to reduce the strength of the standard fluid at any time during the injection, but it is necessary to apply water or a face solution externally to limit outward evaporation and to provide a source whereby moisture could be drawn into the pores by the appetite of the formaldehyde, thus again maintaining the normal percentage of moisture in the skin.

The third condition is one in which the skin along with the balance of the body, will contain more than a normal percentage of moisture. This condition may be looked for in edematous or dropsical cases. The injection in these cases should be normal in strength unless the dropsy is very pronounced, when an overnormal injection can be given without reducing the moisture percentage in the skin below the normal point.

Should the above precautions not be used and the skin be dried through the appetite of formaldehyde for water, no treatment can be given which will restore the moisture to the skin. When moisture is drawn from the skin and the percentage is below normal, the skin will shrink and will draw tight against the bones and subcutaneous tissue. This frequently gives rise to the sharp nose and to the drawn appearance so common in those cases. Prevention is the only remedy.

_Freezing the Skin._—When the body is subjected to a temperature of 32 degrees Fahrenheit, the moisture in the skin freezes, thereby removing it from its usual consideration, as the element that is responsible for the usual softness and flexibility of the skin.

In the cold months, bodies are sometimes left in cold rooms with the windows open. The embalmer did this in the past, thinking that subjecting the body to the influence of a cold atmosphere would simplify preservation.

From the standpoint of preservation alone, this theory is correct, but in accomplishing the above result the moisture of the skin may be frozen. The resulting color is light yellow. The texture of the skin is changed from soft to a slightly hardened condition.

_Treatment._—Never allow the room temperature to approach the freezing point. Should the above treatment be disregarded, and the yellow color become present, have the room warmed, and the color will slowly disappear.

_Feverish Conditions in the Body Before Death._—Fever is the name usually given to the rise of temperature that goes with inflammation. In severe inflammatory diseases, the tissues lose much of their moisture through the arrest of the saturating power of the blood stream and the disturbance of circulation. The skin contains a sub-normal amount of moisture when the embalmer reaches these cases, which may be further reduced by outward evaporation and the dehydrating power of the embalming fluid. Small brown spots resembling the fever blister in the living body may be present around the mouth.

_Treatment._—Use half strength fluid for the first part of the injection, followed by normal fluid for the second, third and fourth parts. Apply water or a commercial skin or face solution while the injection is going on.

_Absence of a Normal Amount of Moisture in the Skin of the Body._—The normal amount of moisture in the skin has been determined to be an amount equal to seventy-five per cent. of the weight of the skin. Any percentage less than seventy-five per cent. is considered subnormal. This condition can be expected in all fever cases, in anemics, and in old age.

_Treatment._—When the skin appears rather dry, the injection of fluid should be half strength for the first and second parts, normal for the third and fourth. The skin of the exposed parts of the body should be dampened with an application of water or a commercial face or skin solution, while the injection is being made.

=Greenish Tinge of Putrefaction.=—Putrefaction discolorations are those which are produced when putrefactive bacteria become active in the skin or subcutaneous tissue.

This discoloration appears generally about the second day, unless preservative fluids have been applied to prevent it. It first begins in the ileocaecal region or lower part of the abdomen. The skin covering these parts assumes a brownish color which shades to yellow, yellowish green, and finally a green color. This green discoloration will in a few days spread all over the surface of the body.

Among the putrefactive bacteria is the bacillus fluorescens, a chromogenic germ, which produces a greenish color when it becomes active in the tissues. One of the first external evidences of putrefaction is the production of a greenish color in the abdominal wall. This, of course, could not occur when embalming had been done with any degree of completeness. Should an insufficient circulation be encountered when embalming a body, the part which does not receive the fluid, being unprotected, may be affected by the color producing germ mentioned above. The most likely to be affected by an insufficient circulation will be located somewhere in the extremities of the circulation, that is to say, in the skin. We can place the affected part more definitely in the skin of the face, particularly the nose, which has a rather poor circulation. This condition will not make its presence known until three or four days after embalming has been done, making it almost entirely absent in bodies embalmed in ordinary practice. Should several days elapse between the time the body died and embalming, allowing the discoloration to appear, the following treatment would be advisable:

_Treatment._—Inject a very small portion of the following solution just under the skin, using a hypodermic needle.

Alum 10 gr. Corrosive Subl. 10 gr. Zinc Chloride 5 gr. Grain Alcohol 4 fl. oz. Formaldehyde 2 fl. oz.

Just a small portion of the above solution is all that will be necessary, working it under the skin with the finger tip, so as to avoid destroying the features by swelling the tissues.

This treatment being a chemical one, it is necessarily slow in its action of bleaching the green color. Should haste be necessary, inject a very small quantity of embalming fluid to arrest the putrefactive process and then cover the spot with theatrical grease of the proper color to match the surrounding skin.

=Chemical Action.=—Chemical action is any discoloration of the skin or tissues of the body which may be caused by the action of opposing chemicals. There is only one known discoloration occurring in the body after death as a result of the presence of a chemical in the body, which, when coming in contact with formaldehyde, produces a discoloration. This particular discoloration, greenish in color, is the result of the work of the drug methylene blue in contact with formaldehyde.

Often, in cases of chronic malaria, or diseases of the liver, or again as a general antiseptic, methylene blue will be administered by the attending physician, and you should learn this fact beforehand, for if methylene blue has been administered it is advisable not to use a formaldehyde fluid. There is a chemical action set up between the formaldehyde and the methylene blue, which gives the tissues a greenish color, which is quite objectionable.

In this case you would use some fluid which does not contain formaldehyde, benzoate of soda, or borax, or peroxide solution should be used.

Another good formula to use is the following:

Rx

Carbolic acid 5 oz. Borax 12 oz. Glycerine 1 oz. Water, sufficient to make 1 gall

or

Rx

Carbolic acid 5 oz. Oxalic acid 12 oz. Boracic acid 2 oz. Water, sufficient to make 1 gall

=Postmortem Discoloration.=—This is a general expression, and refers to any discoloration which might occur on the body after death.

What is usually meant, though, when this term is used is _the settling of the blood to the dependent parts of the body after death_. If the body is lying on the back, the blood will naturally gravitate toward the back, into the azygos system and cause a bluish discoloration, or the same condition will result, if the body is found lying on the face and stomach, in which case the discoloration will be in the face and the anterior chest and abdominal walls.

=Postmortem Staining.=—This condition is caused by changes in the blood while in the veins. The blood becomes more fluid in character and the red blood corpuscles become granular and give off their oxygen which escapes through the walls of the veins and carrying with it the haemoglobin or coloring matter of the blood, stains the tissues over the superficial veins a purplish red color. This discoloration only appears on the ventral surface of the body and along the course of the large superficial veins. An excellent example of this discoloration is seen in the drowned subject where almost always all the superficial veins can be easily traced by this discoloration.

=Capillary or Venous Congestion.=—This term includes those discolorations either caused by gas distension or by the unskillful injection of fluid into the vascular system. Gas forming in the abdominal or thoracic cavities will so press upon the heart as to empty it of its blood, which will be forced upwards into the large venous trunks of the head, neck and axilla. All embalmers are familiar with the flushed face which often appears when the arterial system has been injected in a too hasty manner. It causes the veins and capillaries of the face and neck to become congested the same as that caused by the formation of gases in the cavities.