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.