For ordinary cases we do not feel that it is necessary to make a cavity injection in the head for the reason that the circulation there is complete, only in rare instances do we find an obstruction.
Purging.
—By purging, as the embalmer uses the term, is meant, the fluid which emerges from the mouth and nose of the cadaver. If this fluid is a brownish coffee-like substance, it signifies it is coming from the stomach, but if it is a bloody frothy mixture it signifies it is coming from the lungs.
The real cause of purging is the living and growing saprophytic bacteria, which were normally in the body, or having gained access later, produce as a result of their development, gas formations. These gases confined as they are, press out from the stomach and lungs the contained fluids of the color mentioned above.
Purging from the stomach may either be due to the presence of gases in the stomach itself, or in the intestines or in both. If the gases have formed in the intestines, they would dilate the canal sufficiently to fill the entire abdominal cavity, thus pressing the stomach against the diaphragm with enough force to cause the contents to escape through the upper end of the alimentary canal.
Purging from the lungs is due to the presence of bacteria of putrefaction, which begin to develope in the diseased portions. These cause liquefaction of the lung substance and the formation of gas. The gas will force the liquefied matter, of a bloody, frothy color out through the respiratory tract.
Before embalming of the chest and the abdominal cavity is begun the trachea and the esophagus should be treated in order to prevent purging. There are two ways of doing this:
The first method consists of placing a ligature about the trachea and the esophagus, this is done by making an incision through the skin and tissues over the left edge of the trachea, one-half inch above the top of the sternum. Insert the right forefinger, passing it to the right side behind the trachea and the esophagus to separate the tissues from them. In doing this great care should be taken so as not to injure the carotid on the left and the innominate artery on the right side. Pass the aneurism hook threaded with narrow tape (this must be very strong tape) along the inner side of the finger, below the trachea and the esophagus, to the point of entrance on the left side. You will have no difficulty now in tying securely both the above tubes, and there will be no possibility of purging from either the lungs or the stomach.
The second method of preventing purging from the lungs and stomach consists in plugging the pharynx through the mouth, there-by plugging the trachea and the esophagus. The only disadvantage of this method is that it can not be done successfully after the body has been embalmed arterially. And for this reason, after arterial embalming, the lower jaw will be firmly set and to use this method, it would mean that the lower jaw must be pried back in order to gain access through the mouth. Then it will be found very difficult and in some cases impossible to set the lower jaw again in its proper position. If this method is to be used at all, it is advised that you do the plugging of the pharynx before the arterial embalming has been done.
To do this, take your position at the head of subject on the right side, and open the mouth wide enough to admit two fingers. Roll several pieces of dry cotton, the size of an English walnut, and holding the corner of the mouth back with the left hand, insert a ball of cotton with the right hand and shove it hard down behind the tongue (this can best be done with a pair of clamp forceps). Continue to do this until the pharynx is well and firmly filled, but avoid bulging out the side of the cheek. If properly done this plug will prevent an ordinary amount of purging and dry cotton seems much better to use for this purpose than absorbent. It must be borne in mind that simply filling the mouth is of no use; nothing is plugged by this procedure, as it leaves the opening into the nose open.