ICFM Magazine, November 2005
Over the years there has been debate over preparing a body for viewing at the funeral in cases where the remains would then be sent to a medical college for dissection in the gross anatomy classes. Some medical schools flat out will not accept a body that has been embalmed by a funeral home. Certainly most medical schools will not accept a body that has been aspirated.
The medical schools' position is understandable, to be sure, but most embalmers get mighty nervous and uptight when a viewing is planned for a body without arterial embalming. And most embalmers come close to a mental breakdown at the thought of a viewing for a body that has not been aspirated. I always thought a body not aspirated was truly a ticking time bomb.
It seems like, lifetime ago, but I used to teach clinical embalming at the Cincinnati College of Mortuary Science. The old adage is true: A teacher who is not also a student isn't much of a teacher. I learned a lot while ''teaching'' embalming, and one of the subjects we tackled back then was preparing remains for viewing in cases where the body was to be donated to a medical school.
We developed a procedure for dealing with a "normal" case, i.e., one where the remains are in an ideal condition. In such a case:
• The remains still retain body warmth.
• Death occurred no more than 12 hours before.
• The body has a normal protein content. When these criteria are met, the procedure as described below can be used.
The remains can be disinfected in the normal manner. The features may be set in whatever manner the embalmer normally uses.
Many medical schools require that the initial approach to injection be made via the right common carotid artery, and that drainage be taken via the right internal jugular vein.
In instances where additional drainage is desirable, some medical schools will accept one additional injection/drainage site, but most medical schools will protest the use of more than two sites.
Fluids and embalming procedures
The basic key to the procedure is to make liberal use of a pre-injection solution. It's not unusual for it to require more than four gallons of a pre-injection solution to adequately "flush out" the vascular system, as well as expand and lubricate the body's vessels. Liberal use of the pre-injection solution is essential.
Inject the pre-injection solution under closed drainage via the right common carotid artery until you observe any distention of the superficial veins in the hands, feet or temples. At this point, drainage should be taken from the right internal jugular vein, or the other selected site, or both. It's up to the individual embalmer to decide whether to use a drain tube or forceps, or any drainage device.
The embalming machine should be set at a conservative pressure and rate of flow. Because of the wide variety of machines available (including one that sets its own pressure!), it is difficult to suggest a definite selling for the injector. I have found, however, that an actual pressure of four-six pounds, with a rate of flow one quarter open, should not cause adverse effects.
Following the pre-injection, I suggest you mix a low index arterial chemical at a solution of 8 ounces to one gallon of water, making a two-gallon solution. There is no "rule" or even opinion concerning the use of dyes, lanolin or any other accessory chemicals with the arterial solution.
If after you've injected the two gallons of solution the desired preservation has not been achieved because of the size and-or weight of the body, mix a third gallon according to the same 8 ounces to one gallon formula.
Do not inject more than three gallon, of arterial solution. Why? Because too much arterial solution actually causes rapid hydration of the vessels, making it difficult—if not impossible—to then inject the high potency anatomical solution.
By following the procedure as outlined above, I have generally noted good results. The hands and face generally are preserved and discolorations in these areas have usually been removed successfully.
Following the injection procedure, ligate the vessels in the usual manner and suture the incision(s). You may use cotton or powder sealant when closing the approach incision(s) unless the specific medical school with which you are dealing prohibits it.
All the embalmers reading this are going to have questions about cavity treatment. We all know that aspiration is basically taboo in cases of anatomical donation. But if the remains are in the ideal condition as previously described and the arterial injection has been successful, you can do a form of aspiration without puncturing the organs and anatomical structures.
I must reiterate that this only applies if those conditions hold. Certainly if death occurred more than 12 hours earlier, or if the remains are distended, dropsical or show signs of decomposition, the process I'm about to describe will not work and should not be attempted.
In my research for this article, I consulted an ancient embalming textbook that I have in my library, 'The Art and Science of Embalming," by Dr. Carl Lewis Barnes, published in 1877. Dr. Barnes was a pioneer in embalming education. In 1910, he sold his embalming school in Chicago, Illinois, to professor Albert Worsham. Worsham College of Mortuary Science is still educating funeral directors and embalmers today.
But I digress. In his textbook, Dr. Barnes addresses the problem of embalming in a home when the family has forbidden aspiration. He mentions having family members standing guard in the room as the work is being done, either giving permission for or vetoing each embalming procedure—certainly an awkward position in which to work!
It's hard for us to imagine doing an embalming in someone's house, never mind having the family supervise, but that scenario is not as far removed from today's challenges as we might believe. After all, don't families today have a legal right to permit or forbid embalming? And don't some medical schools prohibit aspiration?
So when I read Dr. Barnes' procedure for performing an aspiration without puncturing the organs, I wanted to try it out. Here is how the Barnes method works:
• First insert a flexible rubber drain tube into the trachea and, by gravity, inject as much cavity fluid as the lungs will absorb.
• Then take the same flexible rubber drain tube and insert it into the nostril. By raising the chin to enlarge the aperture of the epiglottis, work the flexible rubber tube down the esophagus to the stomach. Manually aspirate the gases and contents of the stomach, then reconnect the rubber tube to the gravity injector and inject as much cavity fluid into the stomach as possible. (Can you imagine the strength of this fluid in 1877?)
• Massage the stomach area, pressing as much cavity fluid as possible into the large intestines, then massage the abdomen to try to distribute the cavity fluid into the small intestines.
• Repeat using the external anal sphincter and rectum as the point of entry.
Dr. Barnes would repeat this process over and over again until the firmness of the cavities was satisfactory.
At the CCMC's clinical lab, the students and I tried Dr. Barnes' method many times (only on cases fitting the profile) with very positive results. In fact, in cases that fit the profile, the University of Cincinnati Medical College Anatomy Department allowed families to have funerals with viewing of remains that were going to be sent to the Gross Anatomy Lab.
Again, this is a special technique not suitable for all cases. But by using this old procedure developed by an embalming pioneer, I was able to witness firsthand the appreciation of families who wanted to honor their loved one's wish and donate the body to the medical school but also wanted a formal funeral with the body present.
The desire to help educate future physicians causes some people to leave their body to a medical school. In normal cases, embalmers can enable this to happen while still affording the bereaved family the comfort of a final viewing and presence at the funeral.