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ESCO HistoryspacerApplied Embalming
 

Applied Embalming

By John A. Chew, Director of Education and Ray LaFramboise, Director of Sales

Embalming is defined as the disinfecting, preserving and restoration of the dead human body to a natural form and color.
Embalming is a temporary process which prevents, retards and controlspostmortem changes known as decomposition.
Embalming bypasses the rotting stages, allowing for an eventual body breakdown through oxidation and dissolution. (Oxidation being the loss of electrons from + to –, a combination with oxygen. Dissolution being a separation of compounds.)

Sanibalming is the primary purpose of the embalming process. It interacts with intrinsic, and extrinsic,microbial agents and their enzymatic products. It also provides a neutralization for the bodies normal enzymes, which at death activate the autolysis process called self digestion.Decomposition is an overall description of a series of processes which occur within the body’s components after death.

The body is made up of elements combined to form compounds, which combine to form the basic structural unit of the body, a cell. Cells combine to form tissues, tissues combined form organs, and the organs combine to form the systems of the body.

The tripod of life is formed by three interrelated systems, the nervous, the circulatory, and the respiratory. Eight other systems are dependent on the tripod of life. However, the tripod is so dependent on itself that if any part dies, it activates a reverse process. The systems break down, followed by the organs, the tissues, the cells and the compounds, until the body reverts back to the elements.

THE ANALYTICAL APPROACH TO EMBALMING – PRE ANALYSIS

The preparation room should be private. Only licensed personnel should be admitted during any procedure. A preparation room should be on the order of a hospital operating room, designed to provide a clean, safe working environment. The preparation room should meet all local and OSHA standards providing a safe and sanitary environment for the licensed intern and practitioner. Universal Precautions should be followed at all times. Establishment standards and sanitation measures should be followed, which must include sterilization of equipment and procedural instructions.

Pre Analysis: To reiterate the afore-mentioned cognitive information, and to incorporate it into practical manipulative skills associated with the art and science of embalming. The study of disease and its organic and microbial interaction through an amalgamated approach, has led you, the practitioner, to a broad understanding of the value of the analytical analysis to the embalming process.

We began with the study of anatomy, then microbiology, pathology and sanitation. Each is a necessity to the analytical approach to embalming and specific safeguards for the licensed practitioner and the general public. It is the primary goal to systematically provide the authorized practitioner with a cognitive overview of those specific, and nonspecific conditions related to disease processes that may have a direct influence on the embalming process of the dead human body. Having successfully completed the initial studies of anatomy, the practitioner will have an understanding of surgical dissections required to accomplish the actual embalming. In addition the practitioner will be able to treat the autopsied, and donor bodies upon completing the total amalgamation of the learning process and ongoing confrontation with the many pre-disposing conditions associated with dying and death.

DIAGNOSTIC CRITERIA – PRE ANALYSIS
Overall Picture of the Body: Size, weight, age and sex, position and shape of organs, color, surfaces and cavities, consistency of the tissues, odors, intrinsic body conditions. Overall observation by the eyes sees more than color. We see form, luster, (dry or moist) transparency, surface appearance (smooth or irregular) and overall consistency. Pigments (melanin) may alter organ appearance. BLACK: malignant melanoma; CARBON BLACK: anthracosis of the lungs; YELLOW: pancreas, liver, kidneys, infections, and tumors; YELLOW ORANGE: carotenoids from foods.

Predisposing Criteria: Cause of death, surgical procedures, disease processes, chemotherapy, delayed embalming, refrigeration, drug addiction, drug therapy, trauma and antibiotics.

The Sense of Smell: ACETONE: diabetic coma and cancers; RAW LIVER: hepatic coma; AMMONIA: uremic conditions; FOUL-ROTTED: gangrenous; ALMONDS: cyanide; ONIONS: phosphorus; GARLIC: arsenic; HYDROGEN SULFIDE: decomposition.

Under current laws, rules and regulations, funeral service practitioners are not given the necessary information
to protect themselves. The responsibility is that of the practitioner within the workplace. Just having proper work
attire isn’t enough. We should be concerned with methods of sterilization and sanitation. Having only limited
information as to the cause of death, medications, or specialized treatments prior to death, the practitioner/embalmer
must resort to a practical approach without losing sight that no two bodies are the same. Just treat every remains as
a potential hazardous condition. This is, of course, the best rule of thumb possible.

PRIMARY BLOOD VESSELS FOR VASCULAR INJECTION

Right Common Carotid Artery:
The most common artery used in embalming. This vessel has a large accompanying vein (Internal Jugular). The artery follows the course of the trachea and esophagus. The carotid sheath contains the Common Carotid Artery, the Internal Jugular Vein, and the Vagus Nerve (Pneumogastric Nerve or 10th Cranial Nerve).

Common Carotid Artery: The imaginary guideline for the Right Common Carotid Artery is from the sternoclavicular articulation, to the angle of the jaw, ear lobe or the mastoid process (behind the ear). The incisions vary as to the practitioner.

The Medial Supraclavicular: Between the clavicular and sternal attachment of the sternoclavicular muscle. The incision is approximately 1-inch in length with the clavicle (collar-bone) used as a support for cutting. The tissue is pulled slightly upward prior to making the incision. Blunt dissection exposes the carotid sheath containing the necessary vessels for injection and drainage. Some practitioners lift the whole sheath, separate the vessels and place two ligatures on each vessel (superior and inferior) using straight forceps, the aneurism hook (needle) or a thread passer. Care must be taken not to twist the vessels. Other practitioners pick up the vein first and others the artery first. The technique is optional. All prepare the vessels for the insertion of the necessary tubes.

INSERTION OF TUBES
Two arterial tubes are inserted into the Right Common Carotid, one upward (superior) and one downward (inferior) for control and convenience. For maximum control it is recommended that a drain tube be inserted into the Internal Jugular. This allows for the practitioner to control intervascular pressure and distribution. The addition of a plastic hose to the drain tube to the point of drainage provides a system of control for drainage and a method of environmental control for the practitioner/embalmer. The insertion of the drain tube may be difficult. If the vessel is twisted, a pair of angular forceps may be used to prepare the way for the arterial tube. The rule of thumb is to use the largest drain tube possible. If resistance occurs, use a smaller size. If there is still resistance, gently lift the right shoulder when inserting the drain tube changing the direction in a circular motion.

The supraclavicular incision is made at the middle third of the clavicle. The vessels are located toward the midline, hugging the trachea. Anatomically the trachea lies anterior to the esophagus. The trachea is made up of C shaped concentric rings of cartilage, which can easily be identified by digital touch. Some practitioners may pick up the Left Common Carotid from the incision made on the right side by dissecting the tissue above the trachea, or between the esophagus and the trachea. After the embalming process, some practitioners may make an incision between the concentric cartilage of the trachea and pack the trachea superiorly and inferiorly with cotton saturated with Mouth Fix or use MF (Multipurpose Filler) to control purge (liquid or gas).


Additional Injection Sights for the Common Carotid Arteries

The parallel incision is made posterior the sternocleidomastoideus. Restricted cervical, both Common Carotid Arteries are used for specific procedures. Half moon, a crescent incision from the center of one clavicle to the center of the other clavicle. Transverse incision is from the center of one clavicle, to the center of the other clavicle. Flap incision, is an incision made under the breast from one axillary, space to the other axillary space. Commonly used doing a restricted thoracic autopsy.

Axillosubclavicular or infraclavicular incision is made in the lateral infraclavicular fossa. The arterial tube is inserted into the Axillary Artery directly into the Subclavian Artery. Usually the femoral vein is used as the drainage point, but the drainage point is the option of practitioner.

Axillary Artery: An imaginary guideline for the Axillary Artery is from the infra clavicular fossa (outer border of the first rib) to the beginning of the bicipital grove (teres major muscle). The incision is made along the anterior margin of the hairline.

Brachial Artery: An imaginary guideline for the Brachial Artery is the bicipital grove. The incision is made between the bicep and tricep muscles. This has become a preferred injection point, allowing for natural positioning of the arms and hands. Drainage point would be the option of the practitioner.

Femoral Artery:
An imaginary guideline for the Femoral Artery, is from the middle third, center (a point midway between the iliac spine or crest, and the symphysis pubis) of poupart’s (inguinal ligament), to the inner prominence of the knee joint (medial epicondyle). The upper third is scarpha’s triangle or femoral trigone. To locate the Femoral Artery, the practitioner may place his/her thumb on the superior crest of the ilium and the little finger on the crest of the pubic bone. The index finger points toward the middle of the knee and will indicate the position where the femoral incision should be made.

SECONDARY VESSELS FOR VASCULAR INJECTION
Facial Artery:
An imaginary guideline for the Facial Artery is from the inferior border of the angle of the mandible, anteriorly along the inferior border of the bogy of the mandible just beyond the inferior mandibular notch. The distance is determined by digital pressure. The incision is made between the anterior and posterior borders of the notch (1/4 of an inch). (Used when an obstruction may be preventing facial distribution of the embalming chemical or when the organs of the neck and throat have been removed during an autopsy.)

Ulnar and Radial Arteries: An imaginary guideline for the Ulnar and Radial Arteries is an extension of the axillobrachial guideline, passing through the center of the anti cubital fossa, where the brachial bifurcates into the Radial and Ulnar Arteries. The anti cubital is located 2/3 of an inch below the bend of the elbow (forearm). The incision may be made vertical or transverse through the center of the anti cubital space. At this point using the terminal section of the brachial, both the radial and ulnar may be injected at the same time. From this same point the practitioner can inject either the Ulnar or the Radial Arteries.

Ulnar Artery: An imaginary guideline for the Ulnar Artery is 2/3 of an inch below the bend of the elbow (anti cubital fossa) on the anterior surface of the forearm just above the annular ligament (wrist), above the little finger. The incision is made between the tendons of the flexor carpi ulnaris, and the flexor digitorum sublimis, which may be defined by digital pressure.

Radial:
An imaginary guideline for the Radial Artery is 2/3 of an inch below the bend of the elbow (anti cubital fossa) on the anterior surface of the forearm just above the annular ligament (wrist), above the center of the ball of the thumb (thenar eminence). The incision is made between the flexor carpi radialis and the supinator longus muscle. Laterally to the tendon of the flexor (carpi-radialis).

External Iliac Artery: An imaginary guideline for the External Iliac Artery, begins at a point about 1/2 of an inch to the left of the umbilicus to a point in the middle third of the inguinal ligament. The superior portion represents a guideline for the Common Iliac Artery, which is important in embalming the autopsied body. The lower portion represents the guideline for the External Iliac Artery, 1-inch above the middle third (center) of the inguinal ligament (poupart’s ligament). The incision is made along this guideline where the External Iliac is most superficial.

Popliteal Artery: An imaginary guideline for the Popliteal Artery is through the center of the popliteal space posterior to the bend of the knee. The incision is made along the medial side at the bend of the knee to avoid the large number of muscle attachments in that region.

Posterior Tibial Artery: An imaginary guideline for the Posterior Tibial Artery is from the inferior border of the popliteal space, to a point between the medial malleolus (inner ankle) and the calcaneus (heal). The incision is made between the inner ankle and heel.

Anterior Tibial Artery: An imaginary guideline for the Anterior Tibial Artery, is from the center of the popliteal space, to a point between medial malleolus (medial ankle joint) and the lateral malleolus (lateral ankle joint) between the big toe, and the next toe. The incision is made high on the instep, 1-1/2 inches below the annular ligament of the ankle, or 2-inches above the annular ligament along the flat lateral side of the tibia.

Dorsalis Pedis Artery: An imaginary guideline for the Dorsalis Pedis Artery is from the center of the ankle on the instep to a point between the big toe and the next toe.

ADDITIONAL LINEAR GUIDELINES FOR THE EMBALMER

Abdominal Aorta:
An imaginary guideline for the Abdominal Aorta is from a point 1/2 inch below (posterior) and 1/2-inch to the left of the umbilicus in an upward direction for 5 or 6 inches, gradually sloping toward the median line (vertebrae). The Abdominal Aorta terminates at the 3rd and 4th vertebrae where it bifurcates into the right and left Common Iliacs. Can be used as a site for infant embalming.

Common Iliac and External Iliac: An imaginary guideline for the Common Iliac and External Iliac, is from 1/2-inch below and 1/2-inch to the left of the umbilicus to a point 1/2-inch medial to the middle of the right or left inguinal ligaments. The upper halves of these linear guidelines will represent the linear guidelines for the Common Iliac Arteries, and the lower halves of the linear guideline will represent the linear guidelines for the External Iliacs.

Common Iliac and the Internal Iliac: An imaginary guideline for the Common Iliac and Internal Iliac, is from 1/2-inch below and 1/2-inch to the left of the umbilicus to a point 1-1/2 to 2-inches to the bifurcation of the External and Internal Iliacs (hypogastric). (Which sends numerous branches to the buttocks, pelvic walls, pelvic viscera and the external genitalia. ) A common problem is if the Internal Iliac is nicked or cut during a post mortem examination.

Internal Carotid/Middle Cerebral: Located on both sides of the sella turcica on the floor of the cranial vault. To expose the Internal Carotid/Middle Cerebral the sella turcica must be chipped away opening the sphenoidal sinuses providing necessary length of vessels to secure arterial tubes. Reverse injection will provide distribution to the inner eye and inner ear. For proper distribution, the most inferior portion of the Internal Carotid must be tied off.

GUIDELINES FOR VEINS USED FOR DRAINAGE OR INJECTION
Internal Jugular Veins:
An imaginary guideline for the Internal Jugular Veins is from the sternoclavicular articulation to the ear lobes, angles of the mandible, or the mastoid processes of the temporal bones. The Internal Jugular Veins lie lateral and superficial to the Common Carotid Arteries.

Brachiocephalic or Innominate Veins: An imaginary guideline for the Brachiocephalic or Innominate Veins is from a point just posterior to the sternoclavicular articulation, and posterior to the right margin of the sternum at the first intercostal space. Improper positioning of the neck obstructs the flow of blood through these veins during the embalming process, creating discoloration in the face and/or frogging of the neck.

Superior Vena Cava: An imaginary guideline for the Superior Vena Cava is from a point just posterior to the sternum in the first intercostal space, to a point to the right margin of the sternum at the third intercostal space. This enters in the formation of the right atrium of the heart. This is the site of importance to the practitioner who must retrieve blood samples from tissue donors.

Axillary Vein: An imaginary guideline for the Axillary Vein is a point at the middle of the lateral boundary of the base of the axillary space, to a point at the center of the axillary space (hairline). A continuation of the Brachial/Basilic Vein, which terminates at the outer border of the first rib.

Brachial/Basilic Vein: An imaginary guideline for the Brachial/Bacilic Vein is along bicipital groove between the bicep and tricep muscles. The vein lies above the brachial artery, and provides a visual landmark for the artery.

Inferior Vena Cava:
An imaginary guideline for the Inferior Vena Cava is a point 1 inch inferior to the umbilicus and right of the vertebral column, and extends inferiorly 6 to 8 inches sloping laterally from the midline approximately 1 inch. The Inferior Vena Cava bifurcates at the 3rd and 4th lumbar vertebrae. To be correct, the origin of the Inferior Vena Cava is the union of the Right and Left Common Iliac Veins at the 3rd or 4th lumbar vertebrae. (The venous system begins at the most distal points and flows toward the heart.)

Common Iliac and External Iliac Veins: An imaginary guideline of the Common Iliac and External Iliac, is from a point 1/2-inch medial to the middle third of the inguinal ligament (poupart’s ligament), to a point 1-inch below the umbilicus and slightly to the right of the vertebrae column. The lower half of these guidelines represents the External Iliac Veins, and the upper half represents the Common Iliac Veins.

Femoral Veins: An imaginary guideline of the Femoral Veins is from the medial epicondyle of the femur (knee joint) to a point 1/2-inch medial to the middle third of the inguinal ligament (poupart’s ligament). The upper 2/3 represents the Femoral Vein.

CHEMISTRY OF EMBALMING
To understand the interaction between body chemistry and the use of specially formulated chemicals used in the process of embalming, one must understand basic combinations of inorganic and organic chemistry as they relate to disinfection and preservation.

Inorganic: Deals with inanimate or lifeless matter; the study of all the elementary substances.

Organic: Considers matter of which living things are composed or which is associated with life forms; the study of the compounds of carbon.

THE THREE TYPES OF EMBALMING FLUIDS

Pre-Injections and Capillary Washes:
True pre-injection fluids have no formaldehyde preservatives and have a
triple base

Arterial Fluids
: Firming or Hard, Medium or Semi-Firm, Low firming, and Cosmetic

Cavity Fluid:
Regular fuming, Low fume, Odorless, and Non-Irritant

SUPPLEMENTAL
FLUIDS
Co-Injection:
Edema Pro (an Edema reducer), Humectants, Water conditioner Sofner and Anti-Coagulant Cosmetic dyes and Stains

Special Purpose Fluids: Jaundice, Extra firming, Edema fluids

Accessory Embalming Agents: Hardening compounds, Pulverized, and BTU (granular low to no dust)

Embalming Powders:
San-Veino, Positive powder, Quad and Hexaphene powder

Surface Sprays: Nu-It, San-Veino and CSD in spray form

Gels:
Cadisol, Nu-Leco and San-Veino, or Hexaphene MA-22 and For-Jey

Creams: External Moisturizing Cream, Soft Skin and Emollient Cream

Bleaches:
Cadisol, Hexyethylphenoform and Bruise Bleach

Deodorizer: R.G.S., Odeo and Nu-It

SPECIAL APPLICATIONS CHEMICALS
Sealing Compounds:
Leakproof Skin, M-F and Sealit

Drying Compounds: Cadisol and Sealit

Tissue Builders: Tissue Filler regular (BB-58), Tissue Filler firming, Tissue Filler water soluble Adhesives: Aron Alpha and Leakproof Skin

Water Conditioners: Sofner

Drug and Stain Neutralizer: Drug and Stain Remover
Drainage and Pre-Injection Fluids: Pre-injection chemicals and Capillary Washes are designed to prepare the vascular system for arterial preservative. Increased penetrative power of preservative solution prevents clotting, dilutes blood and offsets astringent and dehydrating properties of the preservative solution. Used prior to arterial preservative chemicals lubricates and dilates blood vessels, may be neutral or alkaline in composition, a neutralizer of acidic conditions. Reduces rigor mortis rigidity, builds up moisture content, insures uniform distribution of preservative chemical and improves cosmetic effect.

Pre-Injection Fluids: Pro Line Primer, Epic Pre-Injection & Drainage, Calsec Pre-Injection & Drainage. Contains triple base preservatives non-Formaldehyde, non-coagulative to blood, non-astringent to capillary network, removes calcium, dilutes blood, does not effect fragmented hemoglobin, fragments blood clots and sludge. Can be used as co-injection, neutralizes drugs and other therapeutic chemicals, and does not create waterlogging.

Arterial Fluid
Concentrations of less than 1% do not gel proteins

Concentrations of less than 1% non bacteriacidal

Concentrations of more than 1% gels then fixes proteins

Concentrations of more than 1% bacteriacidal

Prevents autolysis from bodies own enzymes, fixes muscle tissue preventing sagging and/or distortion, allows for creation of natural appearance, permits leisurely disposal of body under adverse conditions, provides for transfer or shipping cases, provides for viewing.

Types of Arterial Fluids
The old standards of formulated chemistry vary in description.

Firming or Hard: High in formaldehyde content, 25 to 35 index. Has some buffers, definite degree of firmness.Quite dehydrating, definite degree of firmness used more for problem cases.

Medium, Semi-Firm or Cosmetic: Formaldehyde content, 17 to 25 Index. Moderate fixation, rubbery firmness, little dehydration.

Low-Firming: Formaldehyde content 3 to 10 Index. Used for special cases (infants & children), minimum rigidity or fixation.

Cavity fluid
Regular:
about 25 to 35 index. High odor

Mild odor: about 20 to 25 index. Medium odor some odor masking agents

Low odor:
about 8 to12 index. Has secondary quick acting preservative chemical.

These cavity chemicals have as above-stated formaldehyde content, or formaldehyde potential compounds, strong fixing agent, strong germicidal agent. Should not be used safely as an arterial chemical. Fumeless, formaldehyde potential compounds, odor suppressing agents, odor masking perfumes, and amounts of alcohol, and phenols.

Formaldehyde: the primary preservative of most embalming fluids and may be bactericidal due to its chemical nature to inactivate protein. Triple-based arterial fluids provide additional preservatives for complete interaction with variable body tissues. Formaldehyde HCHO is a colorless gas with a pungent and irritating odor. Soluble in water, Formaldehyde is used in the gaseous form as a germicide and disinfectant and in water solution (formalin) as a preservative and germicide.

Formalin: A saturated aqueous solution of HCHO, 40% of a mixture is HCOH gas, 60% of a mixture is water and other solvents, 40% HCHO gas in 60% water = 100% formalin, 30% HCHO gas in 70% water = 75% formalin, 20% HCHO gas in 80% water = 50% formalin, 10% HCHO gas in 90% water = 25% formalin.

When formalin was first introduced in its raw form as a body preservative (see history of ESCO), the major problem was the “walling-off” effect and graying action. As chemical formulation developed, a new industry developed out of need, an industry based on the scientific method, which became the foundation of the art and science of embalming. Early practitioners searched for a method to recreate the dead human body to what they called a “lifelike” form. Today we seek to create a natural, restful memory picture.

Notes of general concern
Death brings about natural acidity to tissue and acidity has a tendency to cause cells/tissues to absorb moisture. Acidity is what causes degrees of rigidity (rigor mortis). Formalin is a dehydrating agent, vapor phase causes fixation. Less than 1% dilution causes gelling, fixes protoplasm (bio chemical of cell), shrinks colloidal mesh, reacts to accessory buffer chemicals to control formalin reactions. Formulated formalin creates rubbery firmness. Formalin is not fungicidal or an insecticide. Formalin action increases with heat and decreases with cold. Formalin has a strong affinity for water.

Formaldehyde take-up is the rate proteins absorb and react to HCHO. A 10% concentration of HCHO diffuses into the tissues faster than it hardens the protein. Beyond a 10% dilution, hardening is faster than the diffusion process. Hardening of cross-linked tissue creates the “walling-off” effect. Surface embalming may be apparent but depth preservation is lacking. Subjects tissue softening during decomposition from inadequate chemical preservation.

Practical application to body
The rate of take-up is fastest during and soon after injection (rate of HCHO take-up parallels with rate of firmness), and decreases continually in 12 to 24 hours. The rate is faster at first because of the concentration of HCHO. As HCHO content moves into the tissues, concentration decreases. As concentration decreases, take-up rate decreases. Take-up depends on tissue disorganization of structures. Cold storage increases HCHO demand since rigor mortis has a profound effect on HCHO demand. Breaking rigor mortis increases demand. Bending, flexing, rotating and massaging increases HCHO demand. Use of Pre-injection fluid neutralizes acidity of rigor mortis. The greatest HCHO demand is from viscera, muscle, skin and arterial walls.

Additional general components of Arterial chemicals

Preservatives, modifying agents/buffers, germicides, penetrating agents, blood solvents, anti-coagulants, sequestering agents, coloring agents, perfuming agents, solvent or vehicles, humectants, and also a modifying agent. Each component is broken down into a series of ingredients that, when carefully formulated and combined, create modern embalming chemistry. Combinations of specific ingredients for the many specialized chemicals are available to the practitioner. All ESCO Arterial injection formulations are formulated to be compatible when used in combination for special effects. Preparation of the vascular system is essential to achieving the best results. Continuous research and thorough field
testing of every ESCO chemical formulation is assurance to quality control.

The following dilution chart represents dilution factors for Arterial fluids. To develop the following chart, the index of the concentrated Arterial fluid, is divided into 128 ounces, which is the amount of ounces in a gallon of solution:

• 20 (index) divided into 128 ounces = 6.4 ounces, therefore 6.4 = a 1% dilution factor
• 121.6 ounces of water, plus the 6.4 ounces of Arterial fluid = 128 ounces or a 1% solution
• 116.2 ounces of water, plus 12.8 ounces of Arterial fluid = 128 ounces or a 2% solution
• 108.8 ounces of water, plus 19.2 ounces of Arterial fluid = 128 ounces or a 3% solution
• 102.4 ounces of water, plus 25.6 ounces of Arterial fluid = 128 ounces or a 4% solution
• 96.0 ounces of water, plus 32.0 ounces of Arterial fluid = 128 ounces or a 5% solution

Dilution Chart                  
Index     1% 2% 3% 4% 5% 6% 7% 8% 9%
36 .9 1.8 3.5 7.0 10.5 14.0 17.5 21.0 24.5 28.0 31.5
35 .9 1.8 3.6 7.2 10.8 14.4 18.0 21.6 25.2 28.8 32.4
32 1.0 2.0 4.0 8.0 12.0 16.0 20.0 24.0 28.0 32.0 36.0
31 1.0 2.0 4.1 8.2 12.6 16.4 20.5 24.6 28.7 32.8 36.9
28 1.1 2.3 4.5 9.0 13.5 18.0 22.5 27.0 31.5 36.0 40.5
25 1.2 2.5 5.1 10.2 15.3 20.4 25.5 30.6 35.7 40.8 45.9
24 1.3 2.6 5.3 10.6 15.9 21.2 26.5 31.8 37.1 43.4 48.7
23 1.3 2.7 5.5 11.0 16.5 22.0 27.5 33.0 38.5 44.0 49.5
22 1.4 2.9 5.8 11.6 17.4 22.2 29.0 34.8 40.6 46.4 52.2
21 1.5 3.0 6.0 12.0 18.0 24.0 30.0 36.0 42.0 48.0 54.0
20 1.6 3.2 6.4 12.8 19.2 25.6 32.0 38.4 44.8 51.2 57.6
18 1.7 3.5 7.1 14.2 21.3 28.4 35.5 42.6 49.7 56.8 63.9
17 1.8 3.7 7.5 15.0 22.5 0.0 37.5 45.0 52.5 60.0 67.5

There is a difference in today’s embalming chemical formulations due to the combination of various components not used at the time formaldehyde was introduced as an embalming fluid (see ESCO history). The early preservative formulation was 40% HCHO and 60% water.

Research indicates that the concept of 1 gallon of embalming fluid per 50 pounds of body weight was the base standard. This fluid was astringent, and required that eye and mouth closures be accomplished by suturing. The use of theatrical oil cosmetics came into popular use to cover up formaldehyde gray reaction and excessive dehydration.

Index 1/4% 1/2% 1% 2% 3% 4% 5% 6% 7% 8% 9%
40 .8 1.6 3.2 6.4 9.6 12.8 16.0 19.2 22.4 25.6 28.8


DILUTION FACTOR of 100% HCHO Solution
40% HCHO plus 60% H2O = 100% Formalin
16 oz HCHO + 112 oz H2O = 5% Dilution Walling off Graying Drying
32 oz HCHO + 96 oz H2O = 10% Dilution Walling off Graying Dehydration
48 oz HCHO + 80 oz H2O = 15% Dilution Walling off Graying Dehydration
64 oz HCHO + 64 oz H2O = 20% Dilution Walling off Graying Dehydration +
80 oz HCHO + 48 oz H2O = 25% Dilution Walling off Graying Dehydration +
96 oz HCHO + 32 oz H2O = 30% Dilution Walling off Graying Dehydration +
107 oz HCHO + 21 oz H2O = 35% Dilution Walling off Graying Dehydration +
128 oz HCHO + 0 oz H2O = 40% Dilution Walling off Graying Dehydration ++



When non-modified, formalin acts alone on proteins that make up the body, and a condensation or fixation (synersis) reaction occurs. Hardening results almost immediately, creating a hardening or “walling-off” and a hardened layer of tissue on surface areas and encapsulated organs. The condensation creates a combined shrinking, fixation and drying reaction. This makes tissue resistant to distribution and diffusion, and inhibited to the concentrated formalin solution. High concentrations of formalin are acidic and highly reactive, and tend to produce an unnatural appearance of the body.

As professional individuals, we must understand that the use of quality and properly formulated chemistry is our
best insurance against embalming failure. A common sense approach to the art and science of embalming is a must for
the future. One ounce of 100% formaldehyde will combine with approximately 37 pounds of receptive body tissue.
The average 16 ounce bottle of a 36 index fluid contains 6 ounces of 100% Formaldehyde, meaning it could in actuality
interact with 222 pounds of receptive tissue if retained within a body. Under current continuous injection and drainage
methodology, most enters the sewers.


Major concerns for preservation failure:

1. Lackadaisical attitudes and approach to the process of embalming with too little time devoted to actual art and
science of embalming
2. No preparation of the vascular system prior to preservation treatment
3. Too strong of a formulated embalming solution
4. Too weak of a formulated embalming solution
5. Basing preservation on tissue rigidity or firmness
6. Excessive injection speed (rate of flow)
7. Excessive pressure injection
8. Excessive drainage
9. Lack of drainage
10. Inadequate or lack of treatment of viscera
11. Lack of topical preservation treatment
12. Lack of internal packs or hypodermic treatment
13. Reaspiration and reinjection prior to viewing or shipping
14. Irresponsible use of plastics instead of specialized treatments
15. Lack of cognitive training and direct supervision

The following represents a minimum amount of preservative chemical (HCHO) if totally retained in the tissue
protein based on a 30% formulation. 470.8 grams of a 30% HCOH solution will combine with 100 pounds of protein.
706.2 grams of a 30% HCHO solution will combine with 150 pounds of protein. Supplementary preservatives will
combine with fats, carbohydrates and etc if present.


Protein weight Proteins grams Ounces HCHO
25 1,950 8
50 3,900 16
100 7,800 24
150 10,700 40 ( Average Body Weight )
200 15,600 56
250 19,500 72
300 23,400 80

Formulated HCOH in 16 ounce bottles according to INDEX (Guide Number). Inactivation of tissue changes.

WATER CONDITIONERS

Water conditioners control the PH of the water and blood coagulation.

Sofner
The necessity of controlling water variables is essential to the use of Arterial fluids in the preservation process. Foreign
particles found suspended in the water will create blockages in the capillary network. Visually, the water may appear
cloudy. Hardness is expressed in terms of calcium carbonate parts of hardness per million parts of water (ppm). Water
hardness may be temporary or permanent in accordance to the geographic location of the funeral establishment, or
central embalming facility. A standard water treatment for every gallon of water should be used to get the best
embalming results. With the growing environmental contamination of ground water, our concerns center on chemical
control. In light of that, and ESCO’s continual concern for the environment, each of our salesmen can test an individual
establishment’s water supply at no charge. Do-it-yourself test kits are also available.

Sofner Recommendations

Hardness ppm Minimum Control
0 to 68 2 oz. per gallon of Arterial fluid soft
69 to 153 3 oz. per gallon of Arterial fluid soft
154 to 221 4 oz. per gallon of Arterial fluid medium
222 to 304 5 oz. per gallon of Arterial fluid hard
305 to 374 6 oz. per gallon of Arterial fluid very hard
375 to 442 7 oz. per gallon of Arterial fluid extremely hard
443 to 527 8 oz. per gallon of Arterial fluid use a hammer

Injection Apparatus and Methodology
Methods of creating similar intravascular pressure as created by the heart during life to force preservative chemical throughout the body. Normal heart action pressure at the aorta is approximately 4.5 to 5 pounds pressure. Recommended pressure is between 3 and 12 pounds, just enough to overcome internal resistance. With death, heart action ceases and the blood pressure decreases. Embalming must recreate, as close to possible, the intravascular pressure. The arch of the aorta becomes the center of the embalming process. The major concern to the embalmer is the thickening of the blood, development of sludge, plugging up portions of the capillary network. To overcome the vascular systems deficiency and natural obstructions it must be rehydrated to establish a pathway for the pre injection preparatory and preservative chemicals. The use of antibiotics prior to death creates an albuminous adhesiveness reaction of the capillary endothelium walls restricting the fluid distribution. Preparatory treatment, pre-injection is highly recommended.

Pressure Terminology
Pressure being the force to distribute pre injection and preservative chemicals throughout the vascular network, resistance is determined by intravascular and extravascular factors:

Potential: The predetermined estimated pressure setting based on the opinion of the practitioner on preanalysis of the body condition. Set with pressure gauge and rate of flow gauge closed.

Actual: The initial reading indicated on the pressure gauge at the time of opening the rate of flow. Indicator needle will drop lower than the predetermined estimated reading.

Differential: Indicates the difference between the potential and actual pressure. Indicating the degree of vascular and extravascular resistance.

Rate of Flow: Amount of embalming solution injected over a specific time period. As determined through preanalysis of overall condition of the body, to achieve uniform distribution. High rate of flow can create distension and swelling.

Time (minutes) Ounces per minute
5 25.6
6 21.3
7 18.2
8 16.0
9 14.2
10 12.8
11 11.6
12 10.5
13 9.8
14 9.1
15 8.5
16 8.0
17 7.5
18 7.1
19 6.7
20 6.4

Early preservative criteria of 1-gallon to 50 pounds of body weight was a rule of thumb based on a 40% formaldehyde to 60% water concentrate of pure formalin (100%). Modern formulations of embalming chemicals do not meet the same criteria. A modern specially-formulated 30 index Arterial fluid to inactivate a 150 pounds of body would require 56 ounces of concentrate if it was all retained in the tissue (this equals 3.35 bottles of concentrated fluid). Continuous injection and drainage, a common practice today, would not meet the preservation requirements.

Preservation based on Index (Hypothetical, with complete chemical retention)


Index   Body weight Ounces of fluid Weight of fixed tissue
0.10 x 25 lb. 2.5 22.5 lb.
0.10 x 50 lb. 5 45 lb.
0.10 x 100 lb. 10 90 lb.
0.10 x 150 lb. 15 135 lb.
0.10 x 200 lb. 20 180 lb.
0.10 x 250 lb. 25 225 lb.
0.10 x 300 lb. 30 270 lb.
0.15 x 25 lb. 3.7 21.3 lb.
0.15 x 50 lb. 7.5 42.5 lb.
0.15 x 100 lb. 15 85 lb.
0.15 x 150 lb. 22.5 127.5 lb.
0.15 x 200 lb. 30.0 170 lb.
0.15 x 250 lb. 37.5 212.5 lb.
0.15 x 300 lb. 45 255 lb.
0.20 x 25 lb. 5 20 lb.
0.20 x 50 lb. 10 40 lb.
0.20 x 100 lb. 20 80 lb.
0.20 x 150 lb. 30 120 lb.
0.20 x 200 lb. 40 160 lb.
0.20 x 250 lb. 50 200 lb.
0.20 x 300 lb. 60 240 lb.
0.25 x 25 lb. 6.2 18.8 lb.
0.25 x 50 lb. 2.5 37.5 lb.
0.25 x 100 lb. 25 75 lb.
0.25 x 150 lb. 37.5 112.5 lb.
0.25 x 200 lb. 50 150 lb.
0.25 x 250 lb. 62.5 187.5 lb.
0.25 x 300 lb. 75 225 lb.
0.30 x 25 lb. 7.5 17.5 lb.
0.30 x 50 lb. 15 35 lb.
0.30 x 100 lb. 30.0 70 lb.
0.30 x 150 lb. 45 105 lb.
0.30 x 200 lb. 60 140 lb.
0.30 x 250 lb. 75 175 lb.
0.30 x 300 lb. 90 210 lb.

 

It is necessary to prepare the vascular system prior to the injection of the formaldehyde preservative. An Arterial fluid of less than a 1% will gel the protein materials and create a secondary pseudo sludge within the vascular network. Once this occurs, complete distribution, saturation and preservation may be deficient. Once the vascular system is compromised by formaldehyde action there is no way of correcting it except possibly by complete hypodermic treatment. The question may be, “how do we know when preservation is compromised?”.

A minimum guideline for the average body after the vascular system has been prepared follows initial dilution due to HCHO demand. 1 hour to 24 hours = 1% dilution, 2 Days = 2% dilution, 3 Days = 3%, 4 Days = 4% dilution, 5 Days = 5% dilution.

The use of quality fluids, time and an understanding of the principles of pre embalming analysis, pre injection, pressure and controlled rate of flow are the best insurance to quality professional workmanship. Using the best quality of fluids and sundries may cost about $25.00 per body when done properly.

During arterial injection, the superior and inferior mesenteric arteries carry preservative to the walls of the intestines which creates fixation. Materials inside these organs remain untouched and bring about autolytic breakdown if not aspirated and injected with a quality controlled formulated cavity fluid. Then they are reaspirated and reinjected prior to dressing or shipping.

Failure to treat the viscera may lead to liquidification, odor, gas and purge. In the case of evisceration during an autopsy, a product such as NU-LECO or Hexaphene MA-37 should be used. The same care and treatment is necessary prior to returning the organs to the body. The average adult body contains 15 to 25 pounds of viscera. The rule of thumb is to use two bottles (32 ounces) into the cavities, 16 ounces superior and 16 ounces inferior.

ANALYTICAL APPROACH TO THE EMBALMING PROCESS
The ability to observe specific conditions that relate to antemortem and postmortem conditions develops with experience. The three most common embalming complications that are associated with a large variety of pathological conditions are:
1. Discolorations 2. Dehydration 3. Edema.

Discolorations are classified according to their cause. Intravascular blood discolorations may be antemortem, or postmortem. This may be removed by arterial injection (with the help of additive chemicals such as Hexyethylphenoform, which has an internal bleaching effect on the tissue) and by venous drainage.

During life a hypostatic condition may develop associated with poor or stagnant circulation in the dependent parts of the body or an organ. This is commonly referred to as hypostasis. The area in severe conditions may take on a bluish-black color or may be internal (sometimes referred to as capillary congestion). Again, use of chemistry such as Hexyethylphenoform or other co-injection fluids can be used.

Carbon monoxide poisoning creates a cherry red complexion within the tissue. If an individual is given methylene blue prior to death, it may react with the formaldehyde creating a blue-green discoloration. Neither can be removed by ordinary arterial injection. ESCO Drug and Stain Remover should be used to clear the discoloration. Extravascular discolorations are common antemortem conditions. Ecchymosis and Hematomas are associated with trauma but may be related to a series of organic diseases. Petechia is associated with both organic and microbial diseases. Flushing the vascular system with special pre injection solution Calsec or Sofner, or both combined, will prepare the vascular system for maximum preservation chemicals without setting the discolorations in the tissue.

Controlled drainage is essential in building up intravascular pressure. This may be accomplished by using a drain tube. Once intravascular pressure is achieved and drainage is established, the body may be manually massaged using a low suds disinfectant soap to clear postmortem discolorations. In some cases hydro massage of portions of the face may be used. Some discolorations may be reduced by hypodermic injection or compresses using a bleaching agent (such as San Veino, Bruise Bleach, Hexyethylphenoform, or Cadisol). In some cases, cosmetic masking may be necessary.

How to Remove Common Surface Discolorations
Adhesive tape: use Isopropyl Alcohol; Blood: use soap and cold water; Fingerprint Ink: use Permatex Hand Cleaner; Tobacco stains and Nicotine: use Lemon juice; Gentian Violet: use Acid Alcohol; Hair Dye: use Dry Shampoo; Grease: use Dry Shampoo; Iodine: use Sodium Thisulfate; Methiolate: use Acid Alcohol; Paint: use Turpentine; Silver Nitrate: use Iodine Wash & Sodium Thisulfate; Tar: use Kerosene.

Many discolorations are associated with skin lesions that are traumatic or pathological and change in structure of the integumentum. Unbroken skin with discolorations and scaling associated with exanthematous diseases.

Unnatural deaths and/or storage practices create various changes in appearance and color: Refrigeration, Electrocution, Carbon Monoxide poisoning, Drowning, Poisons, Mutilations, Burns, Hanging, Exsanguination.

Predisposing vascular conditions leading to various discolorations:

Arteriosclerosis Atheroma Varices
Clots Emboli Phlebitis
Thrombosis Hemorrhage Endocarditis
Tuberculosis Fibrile diseases Tumors
Freezing Gangrene Gunshot
Mutilation Severances Corrosive poisons
Asphyxiation Pneumonia Burns
Syphilis Leukemia Hanging
Shock Decomposition

Early unseen signs of decomposition begin in the region of the larynx and trachea. The first external sign is a green area about the size of a dime in the right inguinal region.

Predisposing conditions associated with decomposition:

Hydrocephlus Edematous bodies Peritonitis
Burns Gangrene Mutilations
Pregnancy Febrile diseases Septicemia

Jaundice
Basically there are six forms of jaundice on the ecterus index. Of these types some are more reactive to oxidation than the others. Jaundice is measured in degrees on a color index. A comparison in intensity of color with that of potassium-dichromate, normal being in a numeric range of 3 to 5. When an excessive amount of bilirubin is present and jaundice becomes apparent, the index is usually 15 or higher. There are approximately 20 or more types of causes of jaundice. During primary disinfection and scrubbing of the body excessive bilirubin is washed off. To date there is no know way for a practitioner to determine the oxidative process and how it will effect any given body. The oxidative process converts bilirubin yellow into biliverdin green, or verdirubin. Occasionally a body will turn black. Black Jaundice is a symptomatic condition of viral hepatitis. The rule of thumb is to treat any jaundiced body as a potential hazard.

Bilirubin in the vascular system prevents clotting so the practitioner will rarely find clots in a jaundiced body. A common post embalming problem is blistering, due to the practitioners failure to use overly diluted Arterial fluids. Extensive edema in the extremities may be associated with some primary causes symptomatic jaundice. A pre-injection fluid such as Calsec, Pro Primer or Epic Drainage may be used with Sofner as a primary injection solution to flush the vascular network of excessive ammonia and water. Small punctures may be made in the wrist or posterior upper leg, and channeled with a straightened wire and wicked. Elevate affected areas to stimulate gravitational force and treat areas with topical cauterants and preservatives. Cadisol, Hexaphene MA-22 and San-Veino Gel are ideal for this purpose. Always use intermittent drainage.

Rubin-X is a two-part buffered concentrate that is a specially formulated jaundice fluid. When Rubin-X is used you
must follow the directions in every way to obtain the desired effect, which is total bleaching
.

Dehydration may be due to physiological, pathological or environmental conditions. It is a major concern to the practitioner in creating a natural appearance. In nature, dehydration is a natural process of preservation.Dehydration can be caused by heat or cold. It is in many cases a predisposing consideration associated with hemorrhage, emaciation, refrigeration, burns, pyrexia, and malaria. AIDS for example may cause fever, dehydration, emaciation, jaundice, and edema, connective tissue tumors and or hemorrhages all in one body. This creates a number of different approaches to the embalming process.

Rehydrate using a triple base preservative pre injection chemical such as Calsec and Sofner. Large volume of fluid, low pressures, and low rate of flow. Room temperature water. Diluted preservative chemicals containing lanolin should be considered and conditioner should be added for molecular retention. If additional preservation should be required, add additional Arterial fluid and moisture retaining chemicals, such as Epic Conditioner, and Celtrol. Skin texture, embrittlement or natural incarnadining effects are found in a low index Arterial fluid such as Peer, Ming, CLAF and Celtrol. (The exception to this rule is Drug and Stain Remover, which is not compatible and can not be used with any fluid containing formaldehyde.) The use of massage creams, Soft Skin, and other emollients is recommended.

Follow-up using experiential determination of modified fluid and/or humectant-based preservative chemical to restore natural contours, sectional embalming 1 through 6 points.

Edema
in its many forms may be a major predisposing consideration in the treatment of bodies especially those where
the life support system comes into play. The old term for edema that was used during the 1930s and 1940s was dropsy.

Renal failure Congestive heart failure Cirrhosis of the liver
Phlebitis Trauma Alcoholism
Burns Carbon monoxide poisoning Cancer
Parasites Lymph vessel obstructions Drugs
Allergic reactions Pulmonary Cytotoxic

Primary Concerns When Dealing with Edema
A distention of tissues, increased dilution factor, desquamation (skin slip), leakage, capillary and venous congestion, increase in permeability of capillary walls, decrease in osmotic pressure of the blood. Recommended minimal treatment of symptomatic conditions associated with myriad of diseases.

The embalmer-practitioner must blend cognitive knowledge with manipulative skills to meet the challenges of the 21st century. Handle with extreme care as not to separate the epidermis from the dermis creating manipulative desquamation. Use stronger dilutions of a higher index fluid due to the bodies abnormal water content. Leakage pre and post embalming. Distortion of features, and rapid decomposition. The previously identified symptomatic conditions may be associated with many diseases individually or in various numbers. The following may be of major concern in the analytical pre analysis of the dead body prior to embalming:

Dehydration Emaciation Edema
Jaundice Discolorations Decomposition
Purge Skin slip

IN CONCLUSION

Review the ESCO, GOLDCREST embalming chemicals and sundry chemicals which may be used in the preparation of the body. Guidelines for common basic conditions have been addressed as they relate to various specific scenarios. One must remember the fore-mentioned provide a starting point. Basic cognitive schooling, practical experience and continuing education are the necessary foundations for the future.

 
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