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.