The undertakers' manual

by Auguste Renouard

The body is to be kept constantly moist with the aforesaid solution, and as soon as evaporation has dried up the surface of the skin, a new application of the solution becomes necessary; in fact, the process should come as near complete immersion as possible. The eyes must be well closed. To avoid the sinking, which after a certain time must inevitably take place, and which will disfigure the best prepared corpse, I would here suggest the use of the wax shells, to be inserted under the eyelids—these shells, as stated in a previous chapter, are manufactured by John C. Rulon, of Philadelphia, and can be had by the quantity on very moderate terms—to keep the eyelids in their place; the outside of the shell must be coated with white gum shellac, dissolved in alcohol.

After the insertion of the shells thus coated, the lids are brought together and held in place by the fingers. Shelac dries quick, and in about five minutes’ time it will be found that the gum has acquired enough of consistency to hold the lids together. As a matter of course it will get harder in time and prevent the lids from starting apart.

The operator will then cut a straight line through the skin with a scalpel, the line to extend from the superior part of the sternum to the umbilical region.

Another incision of the skin is to be made at right angles from the first, about six inches in length, and one inch below the lower bend of the last rib.

Then, with the thumb and forefinger of the left hand, seize the skin firmly at a point where the two lines intersect each other, and with the scalpel held in the right hand, carefully separate the skin from the fascia underneath. This operation is repeated on the four sides, and the flaps of the skin turned over the sides of the body. This will leave exposed to view a diamond shaped opening of the epidermis, with its apex reaching above to the superior portions of the sternum, and the lowest angle reaching to within two inches of the navel; the two lateral points extend on both sides of the body from the region of the stomach to the liver, and almost immediately above the transverse arch of the colon.

To cut through the abdominal fascia, carefully puncture it above the stomach, so the opening will be large enough to admit the forefinger of the right hand being introduced through the opening; then holding the scalpel with its edge upwards, the back resting along the extended forefinger, introduce both into opening, and cut from downward upwards into the fascia of the abdomen in a straight line across from the stomach to the liver in a similar way to that above described for cutting through the skin. This last incision is to follow the same course as the one cut in the epidermis, and will extend from one to the other lateral angles of the diamond shaped opening in the skin. This opening will reveal the stomach on the left, the liver on the right, and the transverse arch of the colon immediately beneath.

Then another cleaving of the fascia is to be performed, downwards and in a similar manner, from the middle of the transverse opening to within two inches of the navel; this last opening exposes the small intestines.

The reason why the cutting of the fascia of the abdomen should be performed in this manner, that is, with the scalpel being held edge upwards along the extended forefinger, is obvious; the forefinger in this case acts as a guide to the scalpel in dividing the tissues, and also protects the viscera from being wounded by the sharp point of the knife.

The abdominal viscera being thus exposed, the lungs, heart and other parts of the thoracic viscera must also be uncovered. For this purpose, and with the cartilage knife separate the ribs from the sternum about two inches on either side of the latter; commencing from the second rib down to the last one, and extending to the transverse opening made in the abdomen, it will be found that the ribs at that distance from the sternum are attached to it by a cartilage, which it is very easy to cut in children, harder in adults, and it may sometimes be indispensable to use a saw on old persons. This cutting through the ribs must be carefully performed, for fear of wounding some of the organs which lay immediately beneath and against the ribs.

The sternum being thus freed from the ribs, it can be turned back over and against the face, and will reveal through the opening thus made, the lungs, the heart, the arch of the aorta, etc.