CADAVERIC EMBALMING

SPEAKER: DR GOUSIA NISA MODERATOR:DR BASHIR A. SHAHASSOCIATE PROFESSOR

EMBALMING Embalming is the art and science of preserving human remains by treating them with chemicals to forestall decomposition.

suitable for public display at a funeral, for religious reasons, or for medical and scientific purposes (anatomical specimens).

replacement of blood with preservative chemicals, similar to transfusion.

DEFINITION

The American Board Of Funeral Service Education defines embalming as “ the chemical treatment of the dead human body to reduce the presence & growth of micro-organisms, to temporarily inhibit organic decomposition & to restore the dead human body to an acceptable physical appearance.

GOALS

Embalming preserves the human body intact and is one of the mankind's longest practised art

sanitization, presentation and preservation (or restoration ).

HISTORY Long and cross-cultural history, with many

cultures giving the embalming a greater religious meaning.

• Chinchorro culture in the Atacama desert(Chile and Peru) are among the earliest cultures known to have performed artificial mummification as early as 5000-6000 BC.• Egypt, where, as early as the 3200 BC specialized priests .•Ethiopeans, Guanches, Peruvians, Jivaro Indians, Aztecs, Toltecs, Mayans, and Tibetan and southern Nigerian tribes also practised embalming.•In Europe the knowledge and practice of artificial preservation had spread widely by 500 AD. The period of the Middle Ages and the Renaissance is known as the Anatomists period of embalming .

ADVANTAGES The process of embalming makes the following possible:

Temporary preservation & sanitization Body inoffensive by slowing postmortem changesPreservation for anatomical study & research by medical

institutionsRestore a favorable body image by removing the adverse effects

of disease, trauma or postmortem changesMove the deceased to a distant location for final dispositionSeeing the body allows the friends & family to accept the reality

of deathAllows time to organise ceremony & ritualsSlow the breakdown of the body over time (desiccation rather

than putrefaction)

TYPES OF PRESERVATION• Natural- obtained without deliberate human

intervention like freezing, dry cold, dry heat, nature of soil at the place of interment.

• Artificial- secured by deliberate action of humans. Eg. Simple heat, powders, evisceration & immersion, evisceration & drying, evisceration, local incision & immersion, simple immersion in alcohol or brine, arterial injection & evisceration, cavity injection & immersion, arterial injection, artificial cold, arterial injection & cavity treatment ( used by present-day embalmers, taught in schools & colleges of embalming today).

EMBALMING CHEMICALS Embalming chemicals are a variety of preservatives,

sanitizers, disinfectant agents and additives used in modern embalming to temporarily delay  decomposition and restore a natural appearance for viewing a body after death. A mixture of these chemicals is known as embalming fluid, and is used to preserve deceased individuals( funeral/ indefinitely).

Typical embalming fluid contains a mixture of  formaldehyde, glutaraldehyde, ethanol, humectants and wetting agents. The formaldehyde content generally ranges from 5 to 35 percent, and the ethanol content may range from 9 to 56 percent.

MECHANISM OF ACTION

The embalming chemicals & proteins combine to form a latticework of inert, firm material (cannot be easily brokendown by bacterial or autolytic enzymes).

Body proteins have many reactive centers & a great affinity to hold water. Embalming destroys these reactive centers & the new protein –like substance no longer has the ability to retain water i.e. are more stable & long-lasting.

The germicides & preservatives inactivate body enzymes & destroys both pathogenic & non-pathogenic bacteria( sanitized).

Embalming Treatment ClassificationsArterialCavitySurface and Hypodermic

Arterial EmbalmingCan be used to prepare general or localized body regionA limb or an entire body can be arterially embalmed.Is used with both autopsied and un-autopsied remains. Consists of injecting 3 to 4 gallons of preservative solution under pressure, into the circulatory through an artery while concurrently draining blood from a vein.Arterial fluid flows through the body’s circulatory system but not through the heart.Arterial embalming is also referred to as capillary embalming. 85% of the body’s blood is contained in the capillaries. The embalming fluid must go through the capillaries to enter the tissue spaces where it makes contact with the cells of the tissue and body protein thus embalming the body.

Cavity EmbalmingCavity embalming is performed after arterial embalming.It is the direct treatment of the body cavities.Those cavities include abdominal, thoracic, and pelvic.The process is carried out by aspirating the cavity and then filling it with concentrated chemicals.The trocar is the instrument used in the cavity embalming process.The purpose of cavity embalming is to reach the hollow organs that are not penetrated by the arterial embalming solution. It is important that the organ’s gases and solids be released through the cavity embalming process. Approximately 1 to 2 16oz. Bottles of cavity fluid is used to penetrate the organs and preserve them. Cavity Embalming may be performed more than once on a body in the case of purge or odor.

Hypodermic Embalming Hypodermic embalming is the subcuticular injection of suitable preservative chemical directly into the tissues.It is accomplished by use of a syringe and needle, or an infant or standard trocar.The treatment area can include finger tips, the cavity walls of an autopsied body, or a limb that won’t accept arterial embalming.

Surface EmbalmingSurface embalming is the application of an embalming chemical directly to the surface of the tissues.The chemicals are applied with an aerosol spray, or painted on with a brush using a liquid or gel, and can even be applied using cotton as a surface compress. Areas that are surfaced embalmed can be under the eyelids, the cavity walls in autopsied bodies, and underneath the cranial scalp when a cranial autopsy has been performed.

Anatomical embalmingFor anatomy education a different process is

used. the first priority is for long-term preservation.

Medical embalmers use embalming fluids that contain concentrated formaldehyde(37-40% known as Formalin) or glutaraldehyde or phenol & are made without dyes or perfumes.

One must give respect to cadaver/dead body. Maintain the dignity of cadaver. Cover the cadaver to prevent drying effect because once the part is dried it can’t be restored.

Safety and InstrumentsSafety measures: Apron- To protect the clothing. Shoes/boot – Use shoes/boot because it gives safety

to foot from dropped scalpels or sharp instruments. Gloves – Use gloves to avoid the contact from

preservatives and other chemicals.Instruments:Along with dissection box we need gloves, cap mask,

goggles, saving kit, embalming apparatus with Murphy’s chamber & controlling device and vessel’s cannula/catheter , knife handle with blade ,artery forceps, forceps-plain , toothed, hook retractor with eye, thread,needle(cutting)-straight , curved, gauze piece.

Technique Performed into a closed circulatory system. The fluid is injected with an embalming machine into an artery

under high pressure & flow, & allowed to swell & saturate the tissues, & the body is left to sit for a number of hours. The venous system is generally opened & the fluid is allowed to drain out

Some choose to use gravity feed embalming where the container dispensing the embalming fluid is elevated above the body level & the fluid is slowly introduced over an extended time.

There is no separate cavity treatment of the internal organs. The embalmed cadavers have a uniform grey colouration (formaldehyde / embalmer’s grey ).

Cont…. A standardized formula for embalming is used at the University of

the Orange Free State( UOFS ). This formula has proven to be successful, as no fungal growth has appeared on cadavers. The composition is as follows:

96%Ethanol- 12L Formalin- 500ml Glycerine-750ml Water-500ml 80% Liquid phenol-3.5L

The addition of plastination of biological material to the list of preservation techniques, has necessitated the development of revised fixation techniques. This formula is injected into the radial artery under pressure of 1 -1.5 kilopascal, until the cadaver is filled (± 25L for a 60 kg cadaver). The blood flows into the veins and the arteries are therefore empty, allowing the subsequent red Latex-injection. The injection of Latex should be done after a minimum of 5 weeks following embalming. A red colorant, Rubine Toner, at a ratio of 6-1 is used.

Specialist embalming Badly decomposing bodies, trauma cases, frozen,

or drowned bodies, and those to be transported over long distances also require special treatment beyond that for the "normal" case.

The restoration of bodies and features damaged by accident or disease is commonly called restorative art or demi-surgery, and all qualified embalmers have some degree of training and practice in it. For such cases, the benefit of embalming is startlingly apparent.

Autopsied Embalming Embalming autopsy cases differs from standard embalming

because the nature of the post-mortem examination irrevocably disrupts the circulatory system, due to the removal of the organs and viscera.

In these cases, a six-point injection is made through the two iliac or femoral arteries, subclavian or Axillary vessels, and Common carotids, with the viscera treated separately with cavity fluid or a special embalming powder in a viscera bag, "shake and bake".

In many morgues in the United States and New Zealand, these necessary vessels are carefully preserved during the autopsy; in countries where embalming is less common, such as Australia and Japan, they are routinely excised.

RELIGIOUS ASPECTSMost branches of the Christian faith generally allow

embalming. Some bodies within Eastern Orthodoxy profess an absolute ban against embalming except when required by law. The Church Of Jesus Christ Of Latter-Day Saints does not discourage or prohibit embalming.

 Members of Iglesia ni Cristo allows embalming for the view of their loved ones. It forbids autopsy and cremation because they believe the body of the deceased is sacred and should be cared for with respect.

Some Neopagans generally discourage embalming, believing it unnatural to disrupt the physical recycling of the body to the Earth in the mistaken belief that embalmed bodies do not decompose. They encourage the use of green graveyards.

Zoroastrians traditionally hold a type of sky burial within a structure known as a Tower of Silence in which the body is exposed to weathering and predation to dispose of the remains, and thus embalming the body is contrary to their funeral designs.

CONT…….. Embalming is not practiced by Muslims. The

body is covered in a plain white burial shroud, called "kafan". They do not use coffins. Instead, the body is buried in a grave.

Occupational RisksBloodborne & airborne pathogensClostridium difficile – mutated toxin is 20 times

more potentMRSA, Actinobacter haumanii, VRE, VRSA, VISA,

Pseudomonas aeruginosa & CJD HIV, Hep.B & CTB-MDRFemale embalmer during pregnancy- TORCH,

Human Parvovirus B19, SyphilisExposure to chemical hazards- formalinMaintain good personal hygiene, wear proper

PPE & work in an environment at safe OSHA formaldehyde levels

Notable embalming Lord Nelson, Abraham Lincoln, Joseph Stalin,

the most famous embalmed body of the 20th century is that of Vladimir Lenin, which continues to draw crowds decades after his death in 1924, and is seen in his Moscow mausoleum.