We do not however believe that blood should be removed from every subject, in order to get good cosmetic effect. Rather there are times when blood should not be removed, the conditions which are as follows:
(1) In the thin emaciated subject where there is no discoloration. An example of this condition would be in the tubercular subject, where before death the body has become very thin and emaciated. We would not remove blood when the subject is in this condition, for as a rule the body will take plenty of fluid, the arteries are as a rule empty after death, and besides we desire to leave the blood in the body, in order to give the skin of the face a more filled out healthy cosmetic effect.
(2) In the pale, marble-like, anemic subject. We would not remove blood in this case, first because it is not necessary, for there is a lack of blood in the surface capillaries showing that the arterial system is completely empty, and there is no congestion of the veins; secondly, experience teaches us that in these cases, you probably would not get any blood if you did try to remove it, and thirdly what little blood is in the surface capillaries is needed to build up a more healthy cosmetic effect.
There are times when blood should be removed from the subject after death which are as follows:
(1) Whenever blood is found in the arterial system. An example of this might be found in those cases of sudden death, such as drowning, suffocation, electric shock, or general heart failure. Whenever there has been a case of sudden death, the operator may expect to find blood in the arterial system. The last contraction of the heart normally would drive all the blood out of the arteries and arterial capillaries into the venous capillaries and veins, but this is not accomplished in the cases of sudden death. Whenever, on incising an artery, you find blood in the artery, and it runs freely, it indicates that there is a considerable quantity of blood in the arterial system. This blood then should be removed, because, were fluid to be injected into the artery, when it is full of blood and in this congested condition, all of this blood would be pushed ahead of the fluid toward the center of pressure, and from there large quantities would be pushed back into the tissues of the face, which would result in a greatly discolored face and a very poor cosmetic effect. DO NOT FORGET. Always remove blood when you find it in the arteries. The regular blood drainage tube should be placed in the artery, and all the blood removed that is possible, before attempting to inject. If this blood is not removed, the operator need not be surprised if he causes a decided blood discoloration of the face and a bad cosmetic effect. In these cases blood should be removed from the veins too, for that procedure will help to make room for what blood does remain in the arteries and capillaries, so that it can be pushed by the fluid into the veins rather than the tissues of the face.
(2) When the venous blood vessels are congested with blood and gas. An example of this might be found in almost any case. When the operator makes the incision to disclose the vessels and finds the venous channels congested, or when over the body the surface veins show signs of congestion and distention with gases, then blood should be removed.
(3) In dropsical cases. Often in these cases the tissues throughout the body are in a hydropic condition (filled with water), the arteries as well as the veins are filled with a watery, bloody colored fluid. It will be best for the operator to remove all this watery blood from the arteries, veins, and the tissues also, in order to get the greatest amount of preservative action from his fluid.
(4) In heavy, fleshy subjects. Experience teaches us that these bodies are as a rule difficult to handle from a cosmetic, as well as from a preservative standpoint. It seems advisable to draw blood from these subjects whenever possible, and by so doing bring about a clear non-discolored cosmetic effect; also the removal of blood will give more room for a greater supply of fluid, and thus the tissues will be better preserved.
(5) When the face is discolored. Whenever the operator takes charge of a body and finds the face discolored, no matter what the cause of the discoloration may be, it is a good indication to remove blood from that body.
By removing blood from the larger venous channels, the operator will make room for the blood to leave the face, and in this way better cosmetic effect is assured. Massage the face toward the internal jugular vein, and push the discoloring blood from the tissues of the face, out into the larger channels, that have been emptied by the removal of blood.