Usually, embalming is not done for a non-viewable case unless it is required for mausoleum entombment or airline shipping. This is the process of preparing such a case for an international flight.
When shipping any human remains, you cannot be too careful with your method of preservation. Pressure changes during shipping can cause the body to shift or leak. All we can do is attempt to minimize this by using stronger fluids and a lot of cushioning around the body in the casket.
With cases to be viewed, it’s not wise to simply inject them with gallons of undiluted fluids that will cause staining, swelling or mottling of the skin. Additionally, the positioning of a non-viewable case is not of importance, and when the arms don’t need to be folded with the hands clasped in a natural manner, stronger fluids can be used.
I had a case who was found after being dead an estimated three weeks. He was badly decomposed, infested with maggots and very swollen with gas. There was not much liquid purge present and very little liquids removed via aspiration.
The case was not autopsied. The first task was to separate human from non-human material. Any human material which became detached from the body was placed into a biohazard bag and treated with cavity fluid. (Normally I would use a fluid containing 50% formaldehyde, but we were out and only had the 5% solution. It is almost always adequate.) The non-human material was enough to fill one standard large biohazard bag. Clothing was cut off the body in order to minimize skin slippage. Pockets were checked for personal effects and none were found.
After I had just the human remains with no other material interfering, I made a test incision in the area of the femoral artery to check his arterial condition. If his arteries came apart in my hands, he could not be traditionally embalmed and would have to be submerged in fluids and hypodermically embalmed. His femoral artery was in good condition so I decided on a six-point injection of one gallon of straight Metasyn (Dodge Chemicals, 24% formaldehyde.) I did not add water correctors or arterial conditioners.
His legs and arms took the fluids very well. Although the skin color was impossible to make out, I could see spots in his legs turning pink. [Note: people of all races, even dark-skinned black people, will show a bit of a rosy flush when the fluids take effect.] When I injected his axillary arteries, the fluids started to drip out of his hands due to extensive skin slippage.
His stomach and throat were very distended. I palpated these areas and found them extremely firm to the touch. I inserted a trocar abdominally and left it there while I injected his carotid arteries. No fluid leaked from his stomach but the stomach immediately shrank in size due to the release of gaseous buildup.
I felt a lot of this gas in his tissues as well, so I made small incisions in his face, arms and legs in order to let the gases escape. I will leave this case with all incisions open overnight so that more gas may escape.
I injected the carotids and saw the veins on his scalp distend, so I knew he was getting the fluids even though no changes were visible in his face. The face was still not recognizable as human and was devoid of features.
He did have some arm and leg tattoos that were still visible. I took photos of these – one of the rare times I will photograph a deceased person – and I also saved the clumps of hair that came off his head. This is a young person and his parents may wish to have these tattoo photos and a lock of hair. I made sure no other body parts or fluids were visible in these photos. I placed the hair in the bucket of miscellaneous human material to be cleaned later.
I surveyed the entire body again and made more incisions in places where gaseous buildup was located.
I transferred the case from the operating table to a dressing table, on top of a plastic sheet sprinkled with large amounts of powdered formaldehyde and baking soda. I placed strips of cotton over all exposed areas of skin and then poured about three bottles of phenol solution over him. I wrapped him up in the plastic and returned him to the cooler.
A lot is still left to be done. I will go in today to have a look at him, and may re-inject the whole body with a fluid that treats edema. I will check on the state of the tissue gas. Tissue gas can spread from body to body via instruments, so I will sterilize the instruments all over again and clean the floor and walls. Most likely, after this case leaves the building, the entire cooler will need to be sterilized. Tissue gas causes extreme swelling and will completely distort one’s appearance, so any time a tissue gas case has been present in your facility, assume every human remains is infected and treat accordingly.