Part 12

The important point we wish to impress now upon the minds of our professionals is, that circumstances in this case are to be strictly investigated; also, that a uniform treatment of all cases, however different the circumstances and conditions, will not prove successful; and that a thorough knowledge and experience are necessary to achieve satisfactory results.

Discrimination and judgment are to be used in every case. Some are too ready to condemn a certain process, or to question the properties of some antiseptics, because their first trial of either has proved an ignominious failure; whereas the real cause of all the trouble lies in their ignorance of the laws which govern the mode of proceeding, and the use of the chemicals placed at their disposition.

Others, again, are prone to extol the merits of some preparation, the component parts of which they do not know, but it may have done them good service in several instances; and when, contrary to their expectations, it fails to answer the purpose, they lose faith in it, discard it altogether as worthless, and never entertain the idea that an alteration in the quantity used, or in the combination and strength of the constituents, is the real source of mischief.

Hence, it is a fact not to be denied that a diagnosis (if it may be called so) is necessary before the work of embalming be entered into. And he who would endeavor to preserve the body of a stout, fleshy person by the same means employed in the preserving of a body emaciated by long sufferings, and under different conditions of temperature, might not meet with a success equal to his expectations.

CHLORINE:

ITS PROPERTIES AND USES.

_Chlorinated Lime._—In consequence of its powers as a disinfectant, chlorinated lime is a very important compound in its application to medical police; it possesses the property of arresting or preventing animal or vegetable putrefaction, and perhaps of destroying pestilential and infectious miasma. It is used with advantage in preventing bodies from exhaling an unpleasant odor before interment in the summer season. In juridical exhumations its use is indispensable, as it effectually removes the disgusting and insupportable fetor of the corpse.

The mode in which it is applied in these cases is, to envelope the body in a sheet completely wet with a solution made by adding about one pound of the chloride to a bucketful of water. It is employed also for disinfecting dissecting rooms, vaults, cemeteries and other places, which exhale offensive effluvia.

In destroying contagion and infection it appears to be highly useful. In short, all places deemed infectious from having been the receptacle of virulent disease may be more or less disinfected by its use, after having undergone the ordinary process of cleansing.

Chlorinated lime acts exclusively by its chlorine, which, being loosely combined, is disengaged by the slightest affinities. All acids, even the carbonic, disengage it; and as this acid is a product of animal and vegetable decomposition, noxious effluvia furnish the means, to a certain extent, of their own disinfection. But the stronger acids disengage it more freely, and amongst these sulphuric acid is the most convenient. Accordingly, the powder may be dissolved in a very dilute solution of this acid; or a small quantity of the acid may be added to an aqueous solution already formed, if a more copious evolution of chlorine be desired than that which takes place from the mere action of the carbonic acid of the atmosphere.

The great and only objection, so far, against the use of chlorinated lime by the profession, has been the strong smell of the chlorine evolved; but taking into consideration the great antiseptic properties, and also the strong bleaching and disinfecting qualities of the chlorine, we find that it cannot be overlooked as an agent of major importance in the preservation of bodies.

There are certain modes of using the chlorinated lime whereby the offensive odor can be to a great extent diminished, if not altogether done away with. When used in its crude state, it will be found difficult to handle; besides, it could not be used for the purpose of an injection; it needs, then, a certain amount of preparation before it be used in a liquid form. The following has been given as the simplest manner of preparing it for injecting:

Take, of chlorinated lime, one pound, carbonate of soda, two pounds, water, one gallon; dissolve the carbonate of soda in three pints of water by the aid of heat; to the remainder of the water add, by small portions at a time, the chlorinated lime, previously well triturated, stirring the mixture after each addition. Set the mixture by for several hours, that the dregs may subside; then decant the clear liquor, and mix it with the solution of carbonate of soda. Lastly, decant the clear liquor from the precipitated carbonate of lime, pass it through a linen cloth, and keep it in bottles secluded from the light.

The London _Pharmacopœia_ gives a still better process for preparing it, for reasons which will be given hereafter:

Take, of carbonate of soda, one pound, water, forty-eight fluid ounces, chloride of sodium (common salt), four ounces, black oxide of manganese, three ounces, sulphuric acid, two fluid ounces and a half; dissolve the carbonate of soda in two pints of water; then put the chloride of sodium and the binoxide or black oxide of manganese, rubbed to powder, in a retort, and add to them the acid, previously mixed with three fluid ounces of water, and cooled. Heat the mixture, and pass the chlorine first through five fluid ounces of water, and afterwards into the solution of the carbonate above directed. Upon the addition of muriatic acid, both these solutions emit carbonic acid and chlorine together.

The foregoing given preparation will be found to answer the purpose for disinfecting, injecting and preserving corpses. For injecting purposes, the solution should be used fresh, and the muriatic acid only added to it, for a more copious liberation of both carbonic acid and chlorine, when ready to inject the liquid, as the antiseptic properties of the solution depend altogether on its gaseous evolutions.

To inject the solution, it will be found that the axillary artery on the left side is a good point; also, the right jugular vein should be punctured, so as to facilitate the flow of blood from the head. But to make the operation complete, and to be sure of a perfect and thorough injection, the ascending aorta should be injected, and the inferior vena cava severed at a corresponding point. This mode of injecting has been described in a former chapter.

It is not possible to specify here the amount of liquid to be injected; but as a general rule there should be enough of the solution injected to fill the circulatory system, and the injection be continued until after the blood has ceased to flow from the wound in the vena cava and the injecting fluid appears in its place.

When injected with this solution, a corpse may present for a few hours afterwards a bloated and swollen appearance, and the face and body may be marbled over with white spots; but these symptoms will soon disappear, the body will collapse again to its normal size, and the color become of a uniform shade.

To preserve bodies during the summer season for a few days and without ice; also to prevent the swelling up of the abdomen and the purging at the mouth and nostrils, open the stomach, as explained in a previous chapter, empty out the contents, and inject into it some of the above solution; the bowels must be treated in the same manner, and also inject the lungs through the nostrils, by producing artificial respiration. If the liquid cannot be injected in this manner, cut into the trachea an incision large enough to admit of the nozzle of the injector being inserted, and pour in the necessary quantity.

If any fetor is exhaled from the corpse after being placed in the coffin, a sponge well saturated with the solution and being placed at the feet of the corpse will remove all foul effluvia; or better still, a china or porcelain bowl filled with the solution may be placed inside the case until a few minutes before the funeral and the screwing down of the lid.

The air of the room may also be purified by saturating some cloths with the solution and hanging them in different parts of the apartment. The vessels containing excretions should not be neglected, and some of the solution poured into them.

In fact, undertakers will find the above solution to be adapted to all purposes of disinfecting, deodorizing and preserving corpses.

INSTRUMENTS.

Undertakers will find it to their advantage to possess instruments of the best materials and make; they are always cheaper in the end, as they will resist the wear and tear to a greater extent, and will not be liable to get out of order when most needed.

Especially in injecting apparatus should a great amount of care be exercised about the selection. The greatest danger to be guarded against is corrosion, as all injecting fluids which are now in use contain more or less of either acids or metallic salts, all of which will attack and corrode, to a lesser or greater extent, the metals and other substances with which they come in direct contact.

Any injector, therefore, so constructed as to be free from danger to its mechanism from the corroding effects of the liquids above mentioned, will be the one to be chosen. According to the statements above given, any part of an apparatus which is required to operate with a certain degree of nicety must be kept from the corrosive effects of the fluids, and this result is to be gained only by the peculiar construction of the apparatus.

In the greater part of the injecting pumps now manufactured and in use in this country, the body of the pump, which contains the working part of the apparatus, is also filled with the liquid while in use; and, therefore, this part, which ought to be protected from injury, is constantly immersed in the strong corrosive solution during all the time that the injector is being worked.

The result of this constant corroding action upon the apparatus will soon show itself in the working of it, and constant repairs will be found necessary to keep it in order or in a state of comparative effectiveness.

It must be well remembered, that upon the working of the apparatus depends, to a great extent, the good or poor success of embalming; also, that upon the manner of using an apparatus, of whatever description it may be, the length of its duration and its effectiveness will be in the same ratio.

The automatic apparatus of Girard, for injecting purposes, is a marvel of simplicity and durability; there is no piston or force pump, which is liable at any moment to get out of order; no valves, which will wear out by friction, or leak from the effects of the liquid used.

The force used in ejecting the fluid is that of a gas, highly antiseptic in its nature, and which, being generated inside of a cylinder, saturates the injecting fluid (itself an antiseptic solution), and by its expansive force propels it into the arteries of the body.

All the appliances necessary to the perfect working of the apparatus are condensed into a small compass. The amount of gas generated can be increased or diminished at will. A pressure gage indicates the force of expansion acquired by the gas. A glass tube, similar to the water tube in use on some boilers, and with a graduated scale attached, shows both the amount of liquid used and also the quantity remaining in the apparatus; while a relief-cock insures safety to the operator against too rapid an accumulation of gas.

This last danger need scarcely be apprehended, as, after the pressure gage indicates the force of expansion required, the further generation of the gas can be entirely stopped, until the vacuum created by the outflow of liquid needs to be replaced by a new supply of gas. For it is a fact well understood, that the force of expansion of the generating power decreases in the same proportion as the volume of the liquid is diminished, thereby causing a greater vacuum in the apparatus.

The inside of the apparatus is thickly coated with lead, as that metal is not sensibly acted on by either muriatic or sulphuric acid, except at very high temperatures.

The jet or stream of liquid can be regulated by a screw cock, attached to the neck of a metallic tube reaching to the bottom of the apparatus, inside, and provided at its inner extremity with a perforated bulb, which, acting as a filter, prevents any impurity or sediment from finding its way into and stopping the circulation of the fluid through the arterial system; at the same time it prevents any excessive amount of pressure upon the rubber tube five or six feet in length, which is connected with the delivery tube outside, and at the end of which the nozzle is attached.

The nozzle or cannula itself is a very important part of the apparatus, and is of a peculiar shape; it consists of a thin copper tube about eight inches in length and a little over an eighth of an inch in diameter; it is to be inserted at full length, or nearly so, into the artery to be injected, as by doing so it meets a point where the walls of the artery are strengthened by the surrounding tissues.

The shape of the apparatus is that of an elongated cylinder, rounded off at both ends, resembling somewhat a soda fountain; it stands upright, upon four curved legs about four inches in height, and possesses a symmetrical and substantial appearance.

The other apparatus—Ronsard’s—is about similar in construction, but the power exerted in forcing out the liquid is not gas, as in the former apparatus, but compressed air, forced into the body of the reservoir by means of a pump.

The body of the apparatus consists of a cylinder holding about five gallons; this constitutes the reservoir containing the liquid to be injected. Outside of this cylinder and running alongside of it is the body of the pump. The pipe communicating the air forced inside the cylinder above the liquid enters the bottom of the reservoir, and, passing through the liquid, runs along the inner side of the vessel until it has reached a point almost to the top of the cylinder. In the center of the apex at the top of the cylinder is a small funnel connected to a pipe running inside of the apparatus; this pipe, which is furnished with a cock, is intended to conduct inside the apparatus the liquid poured in at the funnel; it will act also as a relief cock, should it be found necessary to relieve the pressure on the liquid.

This apparatus is not provided, like the other, with a pressure gage, from the fact that the pressure being the result of a mechanical cause, the operator will soon be able to judge the amount of pressure by the number of strokes of the piston.

The delivery pipe is similar in every respect to the one in the apparatus described formerly; the graduated tube outside showing the quantity of liquid inside the apparatus is also the same; in fact, the similarity between the two is striking. But the principal feature of the apparatus, and that which recommends it to the profession, is the perfect isolation of all the working parts of the apparatus from direct contact with the liquid injected. The greatest objection in this case, as in the other, is removed, as the most important part of the work, namely: that of compressing the air, is performed without any danger to the generator.

Another apparatus—that of Waldon—combines the two systems in one, and can be operated with equal facility either by means of compressed air or by means of gaseous expansion.

Still, these instruments require a certain amount of familiarity in the handling before they can be operated with efficiency, as, to a person not fully conversant with their mechanism, they may prove awkward.

The instruments of Messrs. G. Tiemann & Co., of New York, which I have employed so far very successfully, could be rendered perfect by adopting some modifications in their make.

GASEOUS COMPOUNDS.

Too little attention has been paid heretofore to the antiseptic powers of certain gases. It is a well known fact, that some of the gases which are the result of animal and vegetable decomposition are, to a certain extent, the means of their own disinfection; hence, some of these are endowed with deodorizing as well as antiseptic properties.

We have already given at length the properties of chlorine. Carbonic acid gas is another of those antiseptic agents which will occupy our attention.

It exists in the atmosphere as a product of combustion and of the respiration of animals; it is a result, also, of the slow decomposition of most vegetable substances, and is evolved in great quantities from the ground in volcanic countries. In the formation of sugar it is produced in abundance, along with alcohol.

For the purposes of the chemist, it is generally prepared by decomposing marble by means of some stronger acid. From its cheapness and the solubility of the residual salt, muriatic acid is generally employed.

The properties of carbonic acid are very remarkable; it is perfectly colorless and invisible; it is irrespirable, producing, when an attempt is made to breathe it, violent spasms of the glottis. If it be respired mixed with air, even in the proportion of one to ten, it gradually produces stupor and death, acting as a narcotic poison. Hence, when disengaged in large quantities, whether by natural operations or in process of manufacture, it accumulates in all cavities within its reach, and may cause fatal accidents to animals who enter unadvisedly.

Carbonic acid does not support combustion; a taper plunged into a jar full of the gas is instantly extinguished. Carbonic acid is also a check on putrefaction, and arrests decay.

SULPHUROUS ACID.

Sulphurous acid exists at ordinary temperature and pressure in the gaseous form; it is one, however, of the most easily liquified gases. It is produced always when sulphur burns, either in air or in pure oxygen; sulphur not being capable of passing directly to a higher degree of oxydation. In the burning of sulphur, the volume of sulphurous acid gas formed is exactly equal to the amount of oxygen consumed.

Sulphurous acid gas may also be simply prepared by heating three parts of flowers of sulphur with four of peroxide of manganese. The reaction is very simple: one part of the sulphur uniting with the metal, and another with the oxygen, form sulphuret of manganese and sulphurous acid.

Another and quicker way to obtain this gas in small quantities is, to decompose a solution of hyposulphate of soda, by adding muriatic acid to it, so as to liberate the hyposulphurous acid, which immediately decomposes into sulphur and sulphurous acid.

Sulphurous acid is absorbed by water. It is colorless and transparent, possessing an odor peculiarly irritating (the smell of burning sulphur), and cannot be breathed. It is not combustible, nor does it support combustion. Water dissolves about thirty-seven times its volume of sulphurous acid; the solution possesses the properties of the gas in a very high degree, and bleaches vegetable colors with great power; when kept for some time it gradually absorbs oxygen, and the sulphurous becomes changed into sulphuric acid. The sulphuric acid is one of the feeblest acids, and is expelled from its combinations by almost all but the carbonic acid.

As has been demonstrated, all these gases are absorbed by water, and a saturated solution possesses the properties of the gases themselves.

PHYSIOLOGY.

GENERAL VIEW OF THE CIRCULATING APPARATUS OF MAN.

The course and relative positions of the principal arteries and veins of the Systemic circulation are shown in this plate. The arteries commence from the great arterial trunk, called the aorta, and their branches are distributed to all parts of the system. The venous branches, which accompany the arteries, unite into two great veins, the superior and inferior vena cava, which convey the blood back to the heart.

_a_, The left ventricle of the heart. _b_, The right auricle. _c_, The superior vena cava. _d_, The root of the pulmonary artery. _e, e_, The aorta, which is seen arching backward over the heart, and passing downward into the abdomen, where it divides into its two great branches, the iliac arteries, through which the blood passes to the lower extremities. _f_, The inferior vena cava, which accompanies the descending aorta and its branches, and returns the blood from the lower extremities. The dotted lines represent the outlines of the kidneys.

PRINCIPAL DIVISIONS OF THE AORTA AND VENA CAVA.

It should be remembered that most of the branches which spring from the great artery and vein are double—that is, each right branch has a corresponding one at the left side—so that there are, for instance, the right and the left carotid arteries, the right and the left jugular veins, etc.

From the arch of the aorta are sent off those arteries which are distributed to the head and arms. The principal ones among these are named as follows:

_g_, The carotid artery, which ascends in the side of the neck, and divides into the temporal artery, _h_, which is distributed in the temple, and the facial artery, _i_, which supplies the face; and also sends a branch, called the internal carotid, to the parts within the skull.

_j_, The sub-clavian artery, lying beneath the clavicle or collar-bone. That part of the continuation of this artery which passes through the axilla or arm-pit is called the axillary artery, _k_; that which lies in the upper arm, the brachial artery, _l_; and in the fore-arm it divides into the radial and ulnar arteries, _m_, _n_, which are distributed to the hand and fingers in the manner indicated in the plate.

The principal branches of the descending aorta are named as follows:

The iliac artery, _o_, on passing into the thigh becomes the femoral artery, _p_, and in the leg divides into the tibial and peroneal arteries, _q_, _r_, which form numerous branches for the supply of the leg and foot.

Before dividing into the iliac arteries, the descending aorta gives off several important branches, as the cœliac artery, from which the stomach and liver are supplied; the renal artery, which goes to the kidneys, and the mesenteric artery, to the intestines; besides many other sub-divisions in various parts of its course.

The branches of the vena cava generally accompany those of the aorta in their distribution, as shown in the figure, and are often called by the same names. The principal divisions of the superior vena cava are: The jugular vein, _s_, which accompanies the carotid artery the sub-clavian vein, _t_, which accompanies the artery of the same name, and receives the blood from the arm and hand.

The inferior vena cava, like the aorta, divides into two great branches, the iliac veins, _u_, the sub-divisions of which accompany those of the arteries, and are called by the same names. The manner in which the superficial veins ramify and anastomose with each other is shown on the upper and lower extremity of the left side.

ORGANS OF DIGESTION.