Embalming

Embalming Iintroduction, history & chemical fluids

Dr. S. Prabhu1st year PGAnatomy PIMS

Introduction

Embalming, one of humankinds longest practiced arts, is a means of artificially preserving the dead human body.

Modern embalming is defined as the study & science of treating a dead human body to achieve antiseptic condition, a pre mortem appearance & preservation.

Esmond R Long M.D., a Medical Historian

Nothing gives a better perspective of the subject than an appreciation of the steps by which it has reached its present state

Types of preservation

Natural means.

Artificial means.

Natural means of preservation

Freezing ice, snow, glaciers.Dry cold cold dry air.Dry heat dry warm air.Nature of the soil at the place of interment.

Freezing

Inca human sacrificeSnowcapping

Dry cold

Dry cold preservation of Bishop Peder Winstrup, 1605-1679, church of Sweden.

Dry heat

Egyptian mummies

Nature of soilLong term burial in peat bogs.Soil impregnated with salt, aluminium or copper.

Artificial means of preservationSimple heatPowdersEvisceration & immersionEvisceration, local incision & immersionEvisceration & dryingSimple immersionArterial injectionArterial injection & eviscerationCavity injection & immersionArterial injection & cavity treatmentArtificial cold

Simple heatSimple heat slow drying in an oven that is heated with mixture of slaked lime.

PowdersPowders sawdust + zinc sulphate or other preservatives.

Evisceration & immersionEvisceration & immersion used by Egyptians.

Evisceration & drying Guanche method.Evisceration, local incision & immersion EuropeSimple immersion alcohol, brine or other liquid preservatives.Arterial injection & evisceration Hunter BrothersCavity injection & immersion Gabriel Clauderus method.

Arterial injection mode of treatment of Gannal, Sucquet.Arterial injection & cavity treatment now a days method.Artificial cold refrigeration inhibits bacterial activity.

Period of embalming history

1st period

Originated in Egypt.3200 BC to 650 AC.Religious motive, believe in resurrection.Variation in techniques.

Continue..2nd period

650 AD to 1861Practiced in Europe.Period of Anatomists.Motive is to advance the development of embalming.

Continue..3rd period or modern period

1861 till now.Europe to America.Funeral purpose, sentiments, public transportations.Preserve for further study & research in anatomy.

Chemicals & fluidsPreservativesGermicidesBuffersWetting agentAnticoagulantsDyesVehiclePerfuming agent

PreservativesFormaldehyde MethanolPhenol

Formaldehyde Discovered in 1856, by british chemist, August Wilheld Von Hofmann.ColourlessPungent odourCommercially available as formalin containing 37% of formaldehyde in water.7% methyl alcohol, 37% formaldehyde remaining water.

MethanolVolatile, inflammable & poisonous.If consumed, causes blindness & death.Best preservative that precipitates proteins and kills many organisms.Best useful dilution is 75% isopropyl alcohol.It is cheaper, toxic than ethanol.Stabilises formalin.Penetrates & diffuses easily.

PhenolCarbolic acid, Coal tar derivative, extremely poisonous, colourless, Crystalline solid.Light exposure, turns dark(oxidation).Rapidly absorbed by protein contents of tissues.Non soluble in water, Soluble in ether, ethanol, chloroform & glycerine.Powerful germicide & fungicide.Greying of tissues.

GermicidesSurface disinfectantsKill microbesEg: phenolic derivatives, zephiran chloride, glutaraldehyde.

BuffersWeak acids or basic salts are used to stabilise the pH, called buffers.Stability of the chemicals in embalming depends on pH of the medium.Eg: sodium borate, sodium bicarbonate, magnesium carbonate, sodium carbonate.

Wetting agentLowers high surface tension of water & facilitates penetration and distribution of embalming fluids.Eg: glycerine, glycol, sorbitol, sodium lauryl sulphate.

AnticoagulantsUsed to precipitate the calcium to non ionized state.They maintain blood in liquid state & facilitate removal of blood and distribution of arterial fluids.Eg: sodium citrate, sodium oxalate

Dyes Produce an internal cosmetic effect that simulates natural colouring of tissues.Eg: tetra bromo fluorescein(eosin), ponceau, erythrosine, amaranth, acid fuchsin, toludine red & rhodamine.

VehiclesDiluents or solvents or a mixture of solvents.Helps the ingredients in solution in a stable and uniform state during transport through vascular system to different parts of body.Eg: alcohols, glycerine, sorbitol, water

PerfumesMasking agents, water soluble or made water soluble by surfactants.They are floral compounds.Eg: methyl salicylate(oil of winter green), clove oil, cinnamon oil of peppermint(minthol) or lavender.

Muscle relaxantsRelaxes smooth muscles in arterial wall & assist flow of fluids in vascular system.Eg: magnesium chloride

DisinfectionDisinfectant - agent used to inanimate by destroying microbial agent but not bacterial spores.Germicide - agent used to inanimate by destroying microbial agent but not bacterial spores.Sterilization effective decontaminates completely.

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Embalming fluidsArterial fluidsCavity fluidsPre injection fluids

Arterial fluidsInjected into vascular system.Dilution varies with types of bodies dehydrated, obese, oedematous.Also varies with special conditions like refrigerated bodies, burnt bodies, infants.

Arterial fluids for obese subject1Preservativesformalin methanol10 %55%2BuffersSodium borate15 gm.3AnticoagulantsSodium citrate 15 gm.4Wetting agentGlycerine 15%5GermicidePhenol 5%6VehicleWater 15%7Fungicide Thymol Few crystals8Dye 1% Eosin 5 ml.9Perfume Winter green oil10 ml.

Arterial fluids for thin subjects1Preservativesformalin methanol10 %55%2BuffersSodium borate15 gm.3AnticoagulantsSodium citrate 15 gm.4Wetting agentGlycerine 20%5GermicidePhenol 5%6VehicleWater 10%7Fungicide Thymol Few crystals8Dye 1% Eosin 5 ml.9Perfume Winter green oil10 ml.

Cavity fluidsFluids injected into body cavities i.e. thoracic, abdominal and pelvic cavities with a trocar.

For an average body, about 2 lts of cavity fluid is injected.Preserves & disinfects the walls & parenchyma of organs, contents of hollow viscera & space between visceral organs.

Cavity fluid compositions1Formalin 60%2Methanol 25%3Glycerine 2.5%4Phenol 10%5Mercuric chloride1%5Lavender 1%

Pre injection fluids

Continues..Pre injection fluid is injected before injecting arterial fluids.It allows to drain the blood from vascular system.4 to 5 litters injected, wait for 30min before injecting arterial fluids.Loosens clots, improves drainage.Contains anticoagulants & buffers.

Fluids used in dissection laboratoriesPaint mixture for keeping moist.

1Glycerine 75%2Alcohol 10%3Phenol 5%4Water 10%

Tank (immersion) fluid for immersing cadavers1Formalin 15%2Glycerine 20%3Phenol 5%4Water 60%

Cloth fluid prevent drying of area under dissection & isolated dissected part.1Formalin 5%2Glycerine 50%3Phenol 5%4Water 40%

Methods of embalmingArterial embalmingCavity embalming

Supplemental methodHypodermic embalmingSurface embalming

Hypodermic embalmingTo preserve small or large local body areas by subcutaneous injection.May be arterial fluid or cavity fluid.Hypodermic syringe, 8 to 19 gauge of varying length.

Surface embalmingLocal body areas are preserved by applying suitable chemicals to surface of the body.May be arterial or cavity fluid.Packs of cotton or gauge are soaked, applied to eternal skin.Eg: burned tissues, bed sores, surface lesions

Embalming procedure

Factors determining the flow of fluids into tissuescapillary resistance,chemical composition,injection pressure,osmosis, diffusion & gravity.

Gravity injectionTraditional, safest, simplest & least expensive.Graduated glass bottle, 10 litters with an outlet.Outlet is corked through which the nozzle is passed, connected to transparent rubber tube with screw clamp to regulate rate of flow.Other end is attached to injecting needle or cannula.Bottled filled with arterial fluid is kept 4 to 6 feet from embalming table.Raise of 1 foot gives fluid pressure of 0.43 pound.

Electric pumpSimple device generates pressure to force fluid from tank to vascular system.Provides steady & high pressure.Delivers 8 to 10 litres within 30 to 45 min.

Embalming II

Processes during embalmingInjectionDistributionDiffusionDrainage

Criteria for choosing artery- Size/diameter of the artery- Practicality of drainage form the accompanying vein- Depth/location of the artery- Branches of the artery- Proximity to the Arch of the Aorta

Criteria for choosing vein- Size/diameter of the vein- Proximity to the Right Atrium of the Heart- Depth of vein- Ease of raising the vessel

Injection techniques- One point injection- Split injection/drainage- Multipoint injection- Restricted cervical injection- Six point injection (sectional embalming)

One point injection- One location is used for both injection & drainage- The most common location is the RIGHT COMMON CAROTID ARTERY & the accompanying JUGULAR VEIN- The FEMORAL artery & vein is the 2nd most popular- The least common location is the AXILLARY/BRACHIAL artery & vein

Split injection/drainage- The injection of solution from one location & drainage from another.- This method may reduce short-circuiting of fluid.- The most frequently used split injection/drainage sites are:1. The right FEMORAL artery for INJECTION2. The right JUGULAR vein for drainage.

Multipoint Injection- Injection from 2 or more arteries.- Drainage may be from one or more locations- A multipoint injection solves the problem of poor distribution

Six point Injection (sectional embalming)- Method is always used for bodies that have been autopsied.- Method may be used as a primary injection technique for advanced decomposition.- Drainage may be taken from one location but usually at each injection point.

Identify, raise & ligate the following vessels (6 point injection)Right internal jugular vein (insert a drain tube toward the heart)1. Right common carotid artery (insert injection tube toward the head/heart)

2. Left common carotid artery (insert injection tube toward the head, tie off the proximal end)

3. Right axillary or brachial artery (insert injection tube toward the right hand, ligate the proximal end)

4. Left axillary or brachial artery (insert injection tube toward the left hand, ligate the proximal end)

5. Right femoral artery (insert injection tube toward the foot, ligate the proximal end)

6. Left femoral artery (Insert injection toward the foot, ligate the proximal end)

Inject in the following order (6 point Injection)Right leg, left leg

Right arm, left arm

Trunk of body (using the right common carotid)

Left side of the head, right side of the head

Restricted cervical injection- The head is embalmed separately from the body.

Raise the right common carotid artery & internal jugular (restricted cervical injection)- Insert an arterial tube toward the head, with stopcock open.- Insert an arterial tube toward the trunk.- Insert a drain tube toward the heart.

Raise the left common carotid artery (restricted cervical injection)- Insert an arterial tube toward the head, with stopcock open.- Clamp or ligate the distal end of the artery.

Restricted cervical injection trunk- Inject the trunk of the body, with drainage taken from the jugular vein.(solution entering the head by collateral circulation exits from the open stopcocks)- Inject the left side of the head, leaving the right stopcock open.- inject the right side of the head, leaving the left stopcock open

Restricted Cervical Injection is recommended in the following situations- Bodies with general oedema- Bodies that are likely to purge- Poor distribution- Bodies with facial or head trauma- Cases of eye enucleation- Delayed embalming

DrainageIs brought about by displacement,

Arterial solution is injected into the circulatory system & forces the blood to come out.

Drainage is composed of- Blood & blood clots

- Interstitial fluid & lymphatic fluid

- Embalming fluid

Purpose of drainingTo make room for arterial fluids.Ensure even distribution.Avoid discoloration, odour, formation of gas.Prevents decomposition.Reduces microbial activity.

Drainage sitesInternal jugular veinFemoral veinRight atrium of heartInferior vena cava

Methods of drainageAlternate drainageConcurrent drainageIntermittent drainage

Cavity embalmingNot a visible process.Two steps aspiration & injection.Done after arterial embalming

Organs treatedPancreasSpleenKidneyLiverLungsHeartStomachIntestineBrain & brain stem

InstrumentsScalpel

Electric aspirator

Hydro aspirator

Pointed trocar

Rubber tube

Hand pump

Nasal tube aspirator

Autopsy aspirator

Needle

Quadrants of abdomen

Trocar guidesTrocar is inserted into abdominal wall, kept close to ant. Abdominal wall until it reaches the specific organ.2 inches to left & 2 inches superior to umbilicus.

Standard trocar point

Right side of heart move trocar along line of left anterior iliac spine to right ear lobule.

heart

Stomach direct towards intersection of 5th intercostal space & left mid axillary line.

Stomach

Caecum directed to of distance btw line from pubic symphysis to right anterior superior iliac spine. when the point of trocar is 5cm from line point is depressed then thrust forward to pierce caecum.

Caecum

Urinary bladder directed towards pubic symphysis in median plane until it touches bone. retract the trocar slightly, depress the point gently & pierce into the bladder.

Urinary bladder

Period for cavity embalmingImmediately after arterial embalming.Several hours after arterial embalming.

Thoracic aspiration

Abdominal aspiration

Cranial aspiration

After aspirationCavity fluid is injected in all cavities & over the viscera.Concentrated fluid is injected because the residual blood, lymph can dilute it.Cause decomposition.

On an average, 70kg body needs 1 litter of cavity fluid for each thorax & abdominal cavity.Injected either by 100ml syringe or lumbar puncture needle.Trocar & cannula for aspiration.

After completion of cavity treatment.Openings are closed using 2 sutures commonly.Nylon threads are used.

ReferencesAjmani, M.L (1998) 'Embalming: principles & legal aspects', , (), pp. .Andrew, L. Hodges (2006) 'Embalming explained', Funeral Home, (), pp. .Bajrachaya, S., Magar, A (2006) 'Embalming: an art of preserving human body', Medical journal, 4(16), pp. 554-557.James, H. Bedino (2009) 'Modern embalming', Article # 20090206, (), pp. .Natekar, P.E. (2012) 'A new embalming fluid for preservation', JKISMU, 1(16), pp. 2231-4261.

Embalming IIILegal aspects

Historical backgroundMid 19th century, during civil war times.Mass causalities, military dead buried near battle field.Embalming was in demand.Increased interest among scientists for discovering novel methods in performing embalming at its best.

Dr . Richard Burr (1865)

His embalming tent

Final military order 1865Hereafter no persons will be permitted to embalm unless acting under licence of Marshall of army, dept. or district.They will grant licence only to those who furnishes proof of skill & ability as embalmer. Also establish scale of prices.Applicants for licence will apply to Marshall of the army.

Sir Jean Nicolas Gannal (1791-1852)Chemist in profession.Experiments on various chemical combinations.Arsenic as one of the component.

Embalming should not be done prior to autopsy in MLC.Heavy metals should be avoided in embalming mixture.

Current situation in IndiaIncreasing medical institutes.Increase in demand for cadavers for teaching.

Anatomy Act (1949)An Act to provide for the supply of unclaimed bodies of deceased persons to hospitals and medical and teaching institutions for the purpose of anatomical examination and dissection.Enacted by Medical Council of India in 1949.

In other words..ACT PROVIDES FOR THE COLLECTION OF DEAD BODY FOR TEACHING PURPOSE ONLY IF THE DEATH OCCURS IN STATE HOSPITAL OR IN A PUBLIC PLACE WITHIN THE PRESCRIBED ZONE OF MEDICAL INSTITUTE, PROVIDED THE POLICE HAVE DECLARED AFTER LAPSE OF 48 HOURS THAT THERE ARE NO CLAIMENTS, AND CAN BE USED FOR MEDICAL EDUCATION.