Anatomy and Embalming / A Treatise on the Science and Art of Embalming, the Latest and Most Successful Methods of Treatment and the General Anatomy Relating to this Subject

by Albert John Nunnamaker; Charles Otto Dhonau

Certain diseases predispose to abdominal fermentation as inflammatory diseases which effect the peritoneal covering of the organs, and cause a swollen abdominal wall after death.

Treatment.—In the treatment of these cases it is always advisable that the operator be familiar with the location of the disease, so that direct trocar application can be made to the affected part. The location of the affected part is not always the same, as it varies with the location of the particular tissue or organ affected. In appendicitis, where death has occurred without surgical attempts to remove the appendix, the operator should spray the right inguinal space with enough fluid to neutralize the cause of the gas. Where the cause of death has been typhoid, the umbilical, hypogastric and epigastric spaces should be sprayed. Where the cause of death is puerperal fever, the right and left inguinal and hypogastric spaces should be sprayed. The gas itself, will be eliminated from the cavity of the body by simply inserting the trocar and allowing the gas to escape until the internal pressure approximates that of the atmospheric pressure. This though does not prevent the reformation of gas, as the origin of the gas is the living and growing fermentative and putrefactive bacteria. To prevent a recurrence the bacteria must be killed, and this is done by spraying a germicidal fluid around the affected part. Abdominal fermentation and gas is much easier to treat than gastric or intestinal fermentation.

Gastric Fermentation.

—This is recognized by a frothy coffee colored purge from the mouth or nose caused by pressure in the stomach, due to putrefactive bacteria, and their action on proteid food substances which are present in the stomach. Where the cause of death has been principally from inflammatory processes, or where the deceased has died shortly after eating a full meal, this condition must be looked forward to. The swollen condition directly over the stomach is another visible sign of value in diagnosing the condition.

Treatment.—When the body is placed in your care, the embalmer should make a careful and thoughtful survey of the condition of the body and the cause of death. Any inflammatory disease of the abdominal tissues or a full meal eaten shortly before death will almost always predispose to the formation of gas. The treatment would be to take proper care of the stomach contents.

(a) Insert the trocar at a point two inches to the left of the median line, half the distance from the ensiform cartilage and the umbilicus. Direct the trocar downward and diagonally to the left to a depth of three to four inches. Remove the trocar rod and allow the gas to escape into a fluid bottle, containing a small amount of fluid, so that the gas may be deodorized. Before removing the trocar, inject not less than one pint of normal fluid into the stomach, so that the fermentable materials and the bacteria may be destroyed.

(b) Make an incision in the median line of the body, three inches long, from the tip of the ensiform cartilage downward toward the umbilicus, and proceed as directed for the direct incision described on [page 257].

The treatment for gastric fermentation demands the specific treatment as directed above. No short treatments can be depended upon for certain results. Cotton placed in the mouth only delays the time for the purging to begin from the mouth. Gastric fermentation can be prevented in all cases by the use of the specific treatments as described in (a) and (b).

If in your practice, you receive a body from a shipping undertaker, which unfortunately was not treated in the correct manner, and which is purging from the mouth, arrange to puncture the stomach in the manner described in treatment (a). This can be done without disturbing the position of the body in the casket, by opening the clothes above the stomach. After puncturing the stomach and allowing the gas to escape, inject not less than one pint of fluid therein, cleanse the mouth with absorbent cotton by the use of the lock forceps and a recurrence of the purge will not be possible.

If in your practice you have overlooked the possibility of gastric fermentation, and find, either by advice from the family or from your own observation, that purging is going on, use either the treatment (a) or (b), neutralize the fermentable material, cleanse the mouth and no recurrence will be possible.