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

—Sometimes before the body is embalmed or a day or two after the body has been embalmed, there is a distention of the abdominal wall indicating gases and there may or may not be purging from the mouth and nose. From the great number of cases that have been posted in our anatomical laboratories, it has been found that the gas that has accumulated is as a rule located in either the stomach, the transverse colon, or the colons in general, but rarely in the small intestines to the extent that it would do much damage. By the use of the direct incision, make a cut with a sharp scalpel, about three inches long in the median line of the body over the abdomen. Start the cut about one inch below the ensiform process of the sternum and cut toward the navel. After a cut has been made three inches in length on the skin, direct the scalpel downward so that it enters the abdomen. Place the index and second finger in the incision thus made pressing the organs from the abdominal wall, and carefully cut upward between the two fingers. This will prevent the operator cutting any of the underlying intestines.

The incision having been made, it is evident now that the part containing the gas will come up into the incision. If the stomach contains the gas it will come up, if the transverse colon contains the gas it will come up, but that makes no difference, for it is the part with the gas that the operator is after. Usually the transverse colon will be the first to come up into the incision, now take hold of the part with your artery forceps and with a pair of scissors make a clip through the wall, this will let the gas escape. Do not let the gas escape into the room not deodorized, so place over the hand quickly after you have made the clip, a towel, or absorbent cotton that has been saturated with formaldehyde, this will both deodorize and disinfect the gas. Keep hold of the part until all the gas has escaped, and then pick up the arterial tube and inject a small quantity of fluid in the colon, and then sew up with the circular stitch. Then locate the stomach, which can easily be found if it contains gas and treat it in the same way, relieving the gases and then placing a small amount of fluid inside. Treat the other several parts of the intestines in the same way if gas be present and it is remarkable how quickly the abdomen sinks to its normal level. After this has been done place hardening compound or common salt in the cavity, and placing a layer of absorbent cotton in the abdomen under the incision, sew up neatly.

The one great advantage of this method is that you can actually see what you are doing, you can see the part that contains the gas and treat that part particularly, the operator is not working blindly, but is able to place the fluid in the part that he desires and is assured of the fact that it is in the part for his eyes do not deceive him as the sense of feel and touch sometimes do. By this method the operator is able to surround the parts of the abdominal cavity with a hardening compound, and thus feel sure that his case if it is to be shipped, will be received in proper condition, at least it will be as far as the abdomen is concerned, if it is treated under this method. This method is one sure cure for purging, for the gases once properly relieved from the stomach and the contents disinfected, there is no chance for them to recur. If the stomach is found to be full of liquid as well as of gas, as is the condition during purging, the liquid can be taken from the stomach with a drainage tube or a stomach pump, and lastly every part is deodorized and disinfected properly.

A seeming disadvantage might be that a critic might suggest that you are mutilating the body with your abdominal incision. Let a fair question be asked. If it were your sister that was to be embalmed and gases had to be removed, which would you rather see some operator running a trocar here and there through the abdomen, relieving gases and injecting fluid here and there, or, the use of the neat surgical incision, made as a surgeon would make it.

Embalming of the Subcutaneous Tissue.

—It is not always possible to fill the tissues of the body through the arterial system, the arteries may be full of blood in a coagulated condition so that it can not be removed, the walls of the arteries may be diseased, or they may be severed at many places the result of accidental death, such as railroad accident, etc. If any of the above conditions be present or other similar conditions, it will be impossible to inject the arterial system, or it may be that arterial injection is only partly possible. In order, in arterial embalming, to have the tissues embalmed the fluid must reach the capillaries, and to fill the capillaries it is first necessary to fill the larger arteries. So if for any reason it is impossible to reach all or certain tissues by arterial embalming, it becomes necessary to resort to some other means.

With these difficulties then in view, the best operation for filling the tissues, that is the subcutaneous tissue covering the bony framework of the body, is the direct injection of fluid into the part by means of (1) the hollow needle trocar, and (2) the hypodermic needle.

The hollow needle trocar is to be used for the rough work, so called. Inserting the trocar into the center of the popliteal space it can be pushed through the tissues of the foreleg, and fluid injected; then reversing, push the trocar through the tissues of the leg proper, and inject fluid. Inserting the trocar into the center of the bend of the elbow it can be pushed into the tissues of the forearm, and fluid injected; then reversing, push the trocar through the tissues of the arm proper and inject fluid. Turn the body over so as to trocar the back. Insert the trocar above the sacrum bone in the middle line of the back, and push the trocar through the fleshy parts of the gluteal regions, and inject fluid. Again insert the trocar in the middle line of the back between the two scapulae bones, and inject fluid into the region of the shoulders and the small of the back.

After each puncture, before the trocar is removed a circular stitch should be thrown around the trocar and when the trocar is removed draw the puncture shut, the circular stitch acting as a draw string.

A large amount of fluid may be injected in this manner, it being possible to inject several gallons into a body of average size. The fluid transudes through the tissues very readily filling them up completely, but of course, not as certainly as if the fluid were injected arterially. It is an easy matter to inject from two to three gallons of fluid into the soft tissues on the outside of the skeleton of a body weighing from 130 to 140 pounds.