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.