It is not an unusual condition to find a whole lobe rotten and broken down at the base of the lung, and when such a diseased condition exists the lungs become firmly attached to the chest walls, and unless fluid is placed below these adhesions it does not reach the diseased parts. The intelligent embalmer, will never trust to the fluid passing from the tops of the lungs to the base, as in almost all cases the adhesions between the lungs and the walls absolutely prevent this taking place.
It is necessary first to draw off by aspiration, at the bases of the lungs, the fluids which have accumulated and which may be either water, pus or blood. This is done by inserting a curved trocar of small size, between the fifth and sixth ribs on the axillary line. The thoracic cavity extends in the back as low as the last rib and the twelfth dorsal vertebra and it may be necessary to pass the trocar down into this part of the cavity in order to remove the fluids.
As soon as the fluids are removed, inject from a pint to a quart of strong formaldehyde on either side. By so doing the gangrenous and decomposed part of the lung will be put to soak in the embalming fluid, which will insure perfect disinfection and an absence of bad odors.
Abdominal Cavity.
—Often it will be found necessary to do cavity work in the abdominal cavity. Gases may arise causing a distention of the abdominal wall, resulting in purging from the mouth and nose. This gas is the result of putrefaction and fermentation in the alimentary canal. When one of the principle arteries is injected, the fluid finds its way to the minute capillaries of the organs of the abdominal cavity, including the stomach and the intestines. It must be remembered that often there is a great amount of undigested food and fecal matter in the stomach and intestines. The only way the fluid which is in the minute capillary circulation of the stomach and intestines, is able to reach the inside of those organs and come in contact with the undigested food and the fecal matter is by soaking through the mucous wall. No doubt a certain quantity of the fluid does soak through, and when it does, if there is not much undigested food or fecal matter in these parts, disinfection will be accomplished and it is in these cases that we do not have any trouble with distentions of the abdomen. When however, there is a great amount of undigested food and fecal matter inside the stomach and the intestinal tract, it is only obvious that enough fluid can not possibly soak through to disinfect, and consequently a host of putrefactive, and fermentative germs will begin their work, with the formation of gases and the distended abdomen, and perhaps purging from the mouth and nose.
To prevent the formation of gas now which has arisen, a second injection will do no good. More drastic measures will have to be used. One method that has long been in vogue is the use of the trocar.
The Trocar Method.—In this method a trocar varying in length from six to fourteen inches is used. It may either pierce the abdominal wall through the umbilicus, or two inches above and two inches to the left of the umbilicus. Then after the trocar has entered the abdomen the secret of removing gases successfully depends very largely upon the operator having a very correct idea of the location of all the abdominal organs. It is difficult to know when the trocar has pierced the interior of the stomach, or in fact even to make it pierce the stomach at all for the peritoneum which is a covering for all the organs of the abdominal cavity contains a serous fluid which makes the organs slippery, and even the sharp pointed trocar often does not take hold as it should. Again it must be remembered that the stomach is a hollow organ, and for example let us try to pierce a soft rubber ball, containing air and a small opening, a condition resembling the stomach, with a trocar, we know that the one wall, will have to be pushed up against the other wall, and then placed against something firm, before the trocar will pass through. Just this condition happens with the stomach when the trocar tries to pierce the arterial wall of the stomach there is nothing solid to bear against and consequently the front wall will be pushed up against the back wall and then if enough pressure is now used to push the trocar through, it is very liable to pass all the way through both walls.
Again it must be remembered that the descending aorta passes very close behind the stomach and should the trocar go all the way through the aorta might be pierced and the circulation in a measure ruined. The one main disadvantage of this trocar method is that the operator is always working blindly, it is always impossible to tell just how much damage may be done to the internal organs and the circulation, and again should the operator desire to place fluid in a certain part—say the inside of the intestines or the inside of the stomach or the colons, will the operator have assured knowledge that he has actually placed the fluid in the part desired. From the number of experiments that have been carried out in our anatomical rooms, the proof seems to be in every case that the fluid has not reached the part it was supposed to reach.
The advantage of this method is the fact that by introducing the trocar into the abdominal cavity two inches above and two inches to the left of the navel that after the abdomen has been treated that the trocar then can be directed upward into the thoracic cavity and fluid there distributed to the several parts, but this is seldom necessary. After the trocar has been removed or better, just before the trocar is entirely pulled out the operator should sew a circular stitch about the wound and then as soon as the trocar is pulled out, pull the stitch closely together as if it were a draw string, and tie. This will prevent any further leakage from the part.