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.