BY: ALOK SAXENA

The beginnings of the art and techniques of embalming are associated principally with ancient Egypt.

An accidental unearthing of natural mummy possibly led the Egyptian to firmly believe in an afterlife.

The heart of the dead person was weighed against "the feather of truth," a symbol of Ma'at (the goddess of truth, justice, and order).

The ultimate punishment for the living, according to Egyptians was not living in hell, but ceasing to exist!!

The heart was not taken out of the body because it was the centre of intelligence and feeling and the man will need it in the afterlife.

Intestines

Qebehsenuef

Imsety

Stomach Lungs

Duamutef

Hapy

Liver

A long hook was used to smash the brain and pull it out through the nose.

After the organs were removed, the body was washed with wine and rubbed with spices. The alcohol in the wine acted as an antiseptic, helping to kill bacteria.

The corpse was then covered with natron for 40 days to dry out.

Finally 68th to the 70th day----coffined.

Middle Ages (Era of Anatomists)

During middle ages, there were increasing number of those who wanted to study the human body and preservation was no longer for the purpose of an after-life but for study purposes.

Crusades period (1095 to 1291) There were series of wars & no preservation technique was developed. The procedure included removal of soft tissues and then boiling the bones until they were free of all soft tissues. The bones were then dried and wrapped within bull hides and returned to their homeland for final rites.

William Harvey (1578-1657)

Embalming by arterial injection as a mortuary practice was developed after Harveys discovery of circulation.

The English word --to put on balm (spices & perfumes).

EMBALMING Perfusion of the cadaver with fixative fluid for the purpose of preventing putrefaction.

In the middle ages embalming became an art.

His secret formula was Balsamic spirit. 1 pound of tartar dissolved in 6 pounds of water, to which he added half pound of sal ammoniac.
Dr. Frederick Ruysch (1665-1717)

After filtration it was ready for embalming.

Hunter Brothers

1718-1783

1728-1793

Hunter brothers were permitted to be sole agency for embalming and for performing anatomical dissections in the city of London. William Hunter and John Hunter injected the femoral artery with a solution composed of oil of turpentine, oil of lavender and vermilion dye.

This is the scene from a battlefield showing the embalmer searching for cadavers. He would ignore the cries of the injured, but look for dead bodies that he had been paid to embalm.

Middle Ages:

What they lacked, was a magic chemical!

The modern embalming is defined as the study and science of treating a dead human body to achieve antiseptic condition, premortem appearance and preservation.

The Embalming process acts on the body proteins.

It changes the colloidal nature of proteins and forms a

lattice-work of inert, more stable, longer-lasting and firm substance that can no longer serve as food for bacteria.

This new protein form cannot be broken down by the

enzymes from body cells or bacteria.

The

process

of

embalming

consists

fundamentally of an injection of some suitable disinfecting preservative (arterial fluid) into the vascular system augmented

by the relieving of the blood from the veins.

Receipt of the Dead Body

In the Anatomy Department the dead body is received as 1. Unclaimed Body

2. Donated Body

Most important is legal documentation

Identification of the body. Consent. Death certificate. No objection from police. Clearance from the embassy.

NOW WE ARE READY TO

EMBALM

Transfer the body on the Embalming table.

 Remove clothing from body and shave hair.

 Wash and Disinfect the body.

Size of vessel- should be sufficiently large to afford proper insertion of cannula. Depth of location of vessel- superficial enough to avoid unnecessary dissection. Proximity to the heart- In unautopsied body, vessels should be close to both aorta and right atrium. Special cases of infants - vessels of choice are abdominal aorta and inferior vena cava.

ARTERIES

VEINS

Right femoral artery Right common carotid artery Both right and left common carotid arteries Right axillary artery

Femoral vein Internal jugular vein Right atrium ,using a trocar (in difficult cases)

Vessels of right side of the body are commonly used ???

ARTERIES

VEINS

Abdominal aorta is used directly for injection.

Inferior vena cava

Other sites
Right and left common carotid arteries

Right and left femoral (external or common illiac) arteries

Right and left subclavian (axillary) arteries

Most commonly used artery for injection is Femoral Artery.

And most common vein for drainage is Femoral Vein.

But there are other sites also.. Common carotid artery and internal jugular vein Axillary artery and axillary vein Radial artery

After exposure pass two ligatures under the artery. Use a scalpel to open the artery. Now cannulate the artery towards the heart.

Transverse

Diagonal

T-shaped

Wedge-shaped

Arteries are empty after death, therefore, best suited to carry the fluid to the tissues. They do not collapse when cut.

Veins are large, thin walled with valves,

usually engorged after death and collapse if empty.

The hooks are used mainly in retraction of skin and superficial fascia

In raising the artery or a vein to the surface of the skin for arterial injection.

IN UNAUTOPSIED BODIES

IN AUTOPSIED BODIES

One point injection Split injection

Six point injection

Multipoint injection
(in case of failure of one point injection technique)

Done by embalming machines. Gravity method Electric pump method

 Traditional, simplest, most commonly practiced and least expensive method . It requires a graduated glass bottle of the capacity of ten litres with an outlet with a T connection which leads to two rubber tubings connected to two cannula. One Cannula is directed downwards and the other upwards. The T connection contains a screw clamp to control the rate of flow of the fluid.

 After the cannula is secured, the embalming bottle is filled with the arterial fluid and kept at a height of 4-6 feet from the embalming table. By the pressure of gravity the fluid starts flowing Complete injection takes nearly 7-8 hrs

ADVANTAGES
This can be a substitute when there is a electric power failure. This method provides a slow, steady and more thorough distribution of fluid.

DISADVANTAGE
The method is time consuming and needs constant refilling of the bottle.

ELECTRIC PUMP METHOD

Simple device where pressure is generated to force fluid from an injection tank into the vascular system.

Duration it delivers 810 liters of arterial fluid within 30-45 min.

Very high pressure should not be used as it can rupture the arterial walls.

Through veins. Blood is present in large amounts in veins at the time of death.. Contents of drainage? Purpose of the drainage?

Methods of drainage Alternate

Advantages Thorough distribution of fluid

Disadvantages More time consuming

Concurrent (continuous) Intermittent

Less time consuming

Incomplete Distribution of fluid

Less time consuming with thorough distribution of fluid

Golden Rule for Drainage:

Good drainage can be expected

only when the interval between Death and Embalming is short.

Of proper and complete embalming:

Skin looses elasticity. Face becomes fixed. Fluid oozes out from orifices.

Arterial embalming- arterial fluid is injected into selected artery.

Cavity embalming- involves two steps: Aspiration of the cavities and their contents. Injection of a strong preservative chemical. If the cavity treatment is not done the continued activity of the bacterial flora, already exist in the viscera, will promote putrefaction and ultimately cause failure of embalming.

Hypodermic embalming using hypodermic needle. Surface embalming using cotton packs soaked in arterial or cavity fluid.

What is an embalming fluid?? A disinfectant? A preservative? Will it prevent contamination? Produces life like appearance?

Preservatives Germicides Buffers Wetting agents Anticoagulants Dyes Vehicle Perfuming agents

Formalin/ formaldehyde Discovered in 1856 by August Wilheld Von Hofmann. It is 37% by weight or 40% by volume of formaldehyde gas in water. Methyl alcohol acts as stabilizer (about 10% is added).
August Wilhelm von Hofmann

It is a bactericidal but not an effective fungicidal and insecticidal.

Other preservatives Methanol and Phenol ..

Germicides Eg: Phenol and its derivatives, zephiran chloride and glutaraldehyde.

Buffers Assist in stabilizing the pH and provide good medium for reaction of preservatives with cellular proteins. Eg. Sodium borate/ Bicarbonate/ Carbonate and magnesium Carbonate act as neutralizer of formalin.

Wetting agentsare used to lower the surface tension and subsequently to facilitate the penetration and distribution of embalming fluid through vascular bed. Eg. Glycerin, sorbitol and sodium lauryl sulphate. AnticoagulantsEg. Sodium Citrate and oxalate.

Dyes Simulates the natural coloring of the tissues. Also enable the embalmer to detect patchy embalming effects if any. Eg. Eosin Vehicles A solvent that help the ingredients in the solution in a stable and uniform state during transport through the vascular system to different parts of the body. Eg. Water Perfumes Eg. Methyl salicylate

Muscle relaxantsEg. Magnesium chloride Recent view- relaxing agents are ineffective in a cadaver.

But what about quantity of fluid???

CHEMICALS

PURPOSE Preservative Buffer Anticoagulant Wetting agent

AMOUNT (for 1 lit.)

Formalin Methanol
Sodium borate Sodium citrate Glycerin

10.0% 55.0%
15.0% 15.0% 15.0% (20%*)

Phenol
Water Thymol (dissolve in alcohol) 1% eosin Methyl salicylate

Germicide
Vehicle

5.0%
15.0% (10%*) Few crystals 5.0ml 10.0ml

Fungicide
Dye Perfume (For 1 ltr) increase glycerine and decrease water in Thin subjects*

CHEMICALS Formalin Methanol Glycerin Phenol Mercuric chloride Lavender

PURPOSE Preservative Wetting agent Germicide Insecticide and disinfectant Perfume (for 1 ltr fluid)

AMOUNT 60.0% 25.0% 2.5% 10.0% 1.0% 1.0%

Used to keep the dissections moist.

CHEMICALS Glycerin Alcohol Phenol Water Thymol PURPOSE Wetting agent Preservative and to mix thymol Germicide Vehicle Fungicide AMOUNT 75.0% 10.0% 5.0% 10.0% Few crystals

For immersing the embalmed cadavers.

CHEMICALS Formalin Glycerin Phenol Water AMOUNTS 15.0% 20.0% 5.0% 60.0%

To prevent drying of the isolated dissected parts.

CHEMICALS AMOUNT 5.0% 50.0% 5.0% 40.0%

Formalin Glycerin Phenol Water

Thymol

Few crystals

Use 10% formalin only.

Burnt bodies. Radiation bodies.

Fetuses.
Autopsied bodies. Diseased bodies like ascites, bed sores.

HIV infected bodies

Treat the body with sodium hypochlorite (effective germicides) Consider all bodies are potentially dangerous with HIV (universal work precautions) for minimizing the risk of exposure to blood and body fluids.

(As per CDC ,Centers for disease control, recommendations).

Considerations for the health of embalmers. Considerations for disposal of human remains and other infected materials.

Protective Equipment

The practice and purpose of embalming has undergone a sea change over the years and the guiding purpose has shifted from predominantly cultural to educational. With advances in modern practice, we can look forward to further glorification of the dead in future.

Thank you