Embalming


Embalming is the art and science of preserving human or animal remains by treating them to forestall decomposition. The intention is usually to make the deceased suitable for public or private viewing as part of the funeral ceremony, or keep them preserved for medical purposes in an anatomical laboratory. The three goals of embalming are sanitization, presentation, and preservation, with restoration being an important additional factor in some instances. Performed successfully, embalming can help preserve the body for a duration of many years. Embalming has a very long and cross-cultural history, with many cultures giving the embalming processes a greater religious meaning.
Embalming is distinct from taxidermy. Embalming preserves the human body intact, whereas taxidermy is the recreation of an animal's form often using only the creature's skin mounted on an anatomical form.

History

The Chinchorro culture in the Atacama desert of present-day Chile and Peru are among the earliest cultures known to have performed artificial mummification as early as 5000⁠–⁠6000 BC.
Perhaps the ancient culture that developed embalming to the greatest extent was Egypt. As early as the First Dynasty, specialized priests were in charge of embalming and mummification. They did so by removing organs, ridding the body of moisture, and covering the body with natron. The ancient Egyptians believed that mummification enabled the soul to return to the preserved corpse after death.
Other cultures known to have used embalming techniques in antiquity include the Meroites, Guanches, Peruvians, Jivaro Indians, Aztecs, Toltecs, Mayans, and Tibetan and southern Nigerian tribes.
The earliest known evidence of artificial preservation in Europe was found in Osorno and are about 5000 years old human bones covered in cinnabar for preservation, but embalming remained unusual in Europe up to the time of the Roman Empire.
In China, artificially preserved remains have been recovered from the period of the Han dynasty, the main examples being those of Xin Zhui and the Mawangdui Han tombs site. While these remains have been extraordinarily well preserved, the embalming fluids and methods used are unknown.
In Europe the ancient practice of artificial preservation had become widespread by about 500 AD. The period of the Middle Ages and the Renaissance is known as the anatomists' period of embalming and is characterized by an increased influence of scientific developments in medicine and the need for bodies for dissection purposes. Early methods used are documented by contemporary physicians such as Peter Forestus and Ambroise Pare. The first attempts to inject the vascular system were made by Alessandra Giliani, who died in 1326. Various attempts and procedures have been reported by Leonardo da Vinci, Jacobus Berengar, Bartholomeo Eustachius, Reinier de Graaf, Jan Swammerdam, and Frederik Ruysch.

Modern methods

The modern method of embalming involves the injection of various chemical solutions into the arterial network of the body to primarily disinfect and slow the decomposition process. William Harvey, the 17th century English physician who was the first to detail the system of blood circulation, made his discoveries by injecting coloured solutions into corpses.
The Scottish surgeon William Hunter was the first to apply these methods to the art of embalming as part of mortuary practice. He wrote a widely read report on the appropriate methods for arterial and cavity embalming in order to preserve bodies for burial. His brother, John Hunter, applied these methods and advertised his embalming services to the general public from the mid-18th century.
One of his more notorious clients was dentist Martin Van Butchell. When his wife Mary died on January 14, 1775, he had her embalmed as an attraction to draw more customers. Hunter injected the body with preservatives and colour additives that gave a glow to the corpse's cheeks, replaced her eyes with glass eyes, and dressed her in a fine lace dress. The body was embedded in a layer of plaster of Paris in a glass-topped coffin. Butchell exhibited the body in the window of his home and many Londoners came to see it; but Butchell drew criticism for the display. A rumor, possibly started by Butchell himself, claimed that his wife's marriage certificate had specified that her husband would only have control over her estate after her death for as long as her body was kept unburied.
Interest in, and demand for, embalming grew steadily in the 19th century largely for sentimental reasons. People sometimes wished to be buried at far-off locations which became possible with the advent of the railways, and mourners wanted the chance to pay their last respects beside the displayed body. Other motives behind embalming were prevention of disease and the wish to prepare funerals and burials, which were becoming more elaborate, without undue haste. After Lord Nelson was killed in the Battle of Trafalgar, his body was preserved in brandy and spirits of wine mixed with camphor and myrrh for over two months. At the time of his state funeral in 1805, his body was found to still be in excellent condition and completely plastic.
Alternative methods of preservation, such as ice packing or laying the body on so called 'cooling boards', gradually lost ground to the increasingly popular and effective methods of embalming. By the mid 19th century, the newly emerging profession of businessmen-undertakers - who provided funeral and burial services - began adopting embalming methods as standard.
Embalming became more common in the United States during the American Civil War, when servicemen often died far from home. The wish of families for their remains to be returned home for local burial and lengthy transport from the battlefield meant it became common in the United States.
The period from about 1861 is sometimes known as the funeral period of embalming and is marked by a separation of the fields of embalming by undertakers and embalming for medical and scientific purposes. Dr. Thomas Holmes received a commission from the Army Medical Corps to embalm the corpses of dead Union officers to return to their families. Military authorities also permitted private embalmers to work in military-controlled areas. The passage of Abraham Lincoln's body home for burial was made possible by embalming, and it brought the possibilities and potential of embalming to wider public notice.
Until the early 20th century, embalming fluids often contained arsenic until it was supplanted by more effective and less toxic chemicals. There was concern about the possibility of arsenic from embalmed bodies contaminating ground water supplies and legal concerns that people suspected of murder by arsenic poisoning might claim in defense that levels of poison in the deceased's body were the result of post-mortem embalming not homicide.
In 1867, the German chemist August Wilhelm von Hofmann discovered formaldehyde, whose preservative properties were soon noted, and it became the foundation for modern methods of embalming.
Dr. Frederic Ryusch was the first one to have used the arterial injection method for embalming. His work of embalming was so nearly perfect that people thought the dead body was actually alive; however, he only used it to prepare specimens for his anatomical work.

Today

Modern embalming is most often performed to ensure a better presentation of the deceased for viewing by friends and relatives.
A successful viewing of the body is considered to be helpful in the grieving process. Embalming has the potential to prevent mourners from having to deal with the rotting and eventual putrescence of the corpse.
This view has been challenged, however, by authors such as Jessica Mitford, who point out that there is no general consensus that viewing an embalmed corpse is somehow "therapeutic" to the bereaved, and that terms such as "memory picture" were invented by the undertakers themselves, who have a financial interest in selling the costly process of embalming to the public. Mitford also points out that, in many countries, embalming is rare, and the populace of such countries are still able to grieve normally.
Embalming is also a general legal requirement for international repatriation of human remains and is required by a variety of laws depending on locality, such as for extended time between death and final disposition or above-ground entombment.

Terms for embalmers

The roles of a funeral director and embalmer are different, depending on the licensing body for a region in which the Funeral Director and/or Embalmer operate. A funeral director arranges for the final disposition of the deceased, and may or may not prepare the deceased for viewing. An embalmer is someone who has been trained in the art and science of, and may or may not have any contact with the family, although many people fill both roles. The term mortician is becoming outdated, but may refer to someone who is a funeral director, an embalmer, or in some cases, both. Embalming training commonly involves formal study in anatomy, thanatology, chemistry, and specific embalming theory combined with practical instruction in a mortuary with a resultant formal qualification granted after the passing of a final practical examination and acceptance into a recognized society of professional embalmers.
Legal requirements over who can practice vary geographically; some regions or countries do not have specific requirements. Additionally, in many places, embalming is not done by trained embalmers, but rather by doctors who, while they have the required anatomical knowledge, are not trained specialists in this field. Today, embalming is common practice in North America, Australia and New Zealand while it is somewhat less frequent in Europe. In some countries, permits or licenses are required; in others it is performed only by medical practitioners, and the costs can be relatively high.
In the United States, the title of an embalmer is largely based on the state in which they are licensed. In Virginia and Maryland, a funeral director is someone who is licensed only to make arrangements and handle the business side of the funeral home, while a mortician is licensed to do these things as well as to embalm. As recently as 2015, Virginia has required that funeral directors also perform 25-50 embalmings as well as 25-50 arrangements during their apprenticeships as a requirement for their licensing, culminating in 3000 hours per apprenticeship.

Modern practices

As practiced in the funeral homes of the Western World, embalming involves several distinct steps. Modern embalming techniques are not the result of a single practitioner, but rather the accumulation of many decades, even centuries, of research, trial and error, and invention. A standardized version follows below, but variation in techniques are common.
The first step in embalming is to verify the permissions and requests of the family followed by a careful plan for the deceased's preparation, including reviewing the medical certificate of death. The deceased is placed on the mortuary table in the supine anatomical position with the head elevated by a head rest. Before commencing any preparation the embalmer will verify the identity of the body. At this point, embalmers commonly perform an initial evaluation of the deceased's condition, noting things such as lividity, rigor mortis, skin condition, edema, intravenous injection sites, presence of fecal matter, tissue gas and numerous other factors which may affect the procedure and final outcome. The embalming procedure is a surgical one, albeit rather minimally invasive. The process requires significant effort over the course of multiple hours, including intensive planning, evaluation, and chemical selection.
Any clothing on the body is removed and set aside, and any personal effects such as jewelry are inventoried. A modesty cloth is commonly placed over the genitalia. The body is washed in a germicidal soap. During this process the embalmer bends, flexes, and massages the arms and legs to relieve rigor mortis. The eyes are posed using an eye cap that keeps them shut and in the proper expression. The mouth may be closed via suturing with a needle and ligature, using an adhesive, or by setting a wire into the maxilla and mandible with a needle injector, a specialized device most commonly used in North America and unique to mortuary practice. Care is taken to make the expression look as relaxed and natural as possible, and ideally a recent photograph of the deceased in good health is used as a reference. The process of closing the mouth and eyes, shaving, etc. is collectively known as setting the features. Features may also be set after the completion of the arterial embalming process, which allows the embalmer to clean and remove any purge that occurs during the embalming process.
The actual embalming process usually involves four parts:
  1. Arterial embalming, which involves the injection of embalming chemicals into the blood vessels, usually via the right common carotid artery. Blood and interstitial fluids are displaced by this injection and, along with excess arterial solution, are expelled from the right jugular vein and collectively referred to as drainage. The embalming solution is injected with a centrifugal pump, and the embalmer massages the body to break up circulatory clots so as to ensure the proper distribution of the embalming fluid. This process of raising vessels with injection and drainage from a solitary location is known as a single-point injection. In cases of poor circulation of the arterial solution, additional injection points are used. The corresponding veins are commonly also raised and utilized for drainage. Cases where more than one vessel is raised are referred to as multiple-point injection, with a reference to the number of vessels raised. As a general rule, the more points needing to be raised, the greater the difficulty of the case. In some cases draining from a different site from injection is referred to as a split injection. In certain cases the embalmer may deem it necessary to perform a restricted cervical injection, which involves injecting the head of the deceased separately from the rest of body. This is done in cases where distention has a greater chance of occurring. In many cases, an embalmer may select to perform what is known as a pre-injection. A pre-injection is a solution of chemicals that do not contain any preservative chemicals, but rather chemicals that encourage vasodilation, help disperse blood clots, and act as chelating agents. The focus of this "pre-injection" is to allow for a more complete drainage and better distribution of the arterial embalming solution.
  2. Cavity treatment/embalming refers to the removal of internal fluids inside body cavities via the use of an aspirator and trocar. The embalmer makes a small incision just above the navel and pushes the trocar into the abdominal and chest cavities. This first punctures the hollow organs and aspirates their contents. The embalmer then fills the cavities with concentrated chemicals that contain formaldehyde, which are delivered to the chest cavity via the trocar inserted through the diaphragm. The incision is either sutured closed or a "trocar button" is secured into place.
  3. Hypodermic embalming is a supplemental method which refers to the injection of embalming chemicals into tissue with a hypodermic needle and syringe, which is generally used as needed on a case-by-case basis to treat areas where arterial fluid has not been successfully distributed during the main arterial injection.
  4. Surface embalming, another supplemental method, utilizes embalming chemicals to preserve and restore areas directly on the skin's surface and other superficial areas as well as areas of damage such as from accident, decomposition, cancerous growths, or skin donation.
The duration of an embalming can vary greatly, but a common approximate time of between two and four hours to complete an embalming is typical. However an embalming case that presents excessive complications could require substantially longer. The treatment of someone who has undergone an autopsy, cases of extreme trauma, or the restoration of a long-bone donor are a few such examples, and embalmings which require multiple days to complete are known.
Embalming is meant to temporarily preserve the body of a deceased person. Regardless of whether embalming is performed, the type of burial or entombment, and the materials used – such as wood or metal coffins and vaults – the body of the deceased will, under most circumstances, eventually decompose. Modern embalming is done to delay decomposition so that funeral services may take place or for the purpose of shipping the remains to a distant place for disposition.

Grooming

After the body is rewashed and dried, a moisturizing cream is applied to the face, hands and arms. Ideally the deceased will usually sit for as long as possible for observation by the embalmer. After being dressed for visitation or funeral services. Cosmetics are commonly, but not universally, applied to make the body appear more lifelike and to create a "memory picture" for the deceased's friends and relatives. For babies who have died, the embalmer may apply a light cosmetic massage cream after embalming to provide a natural appearance; massage cream is also used on the face to prevent it from dehydrating, and the infant's mouth is often kept slightly open for a more natural expression. If possible, the funeral director uses a light, translucent cosmetic; sometimes, heavier, opaque cosmetics are used to hide bruises, cuts, or discolored areas. Makeup is applied to the lips to mimic their natural color. Sometimes a very pale or light pink lipstick is applied on males, while brighter colored lipstick is applied to females. Hair gel or baby oil is applied to style short hair; while hairspray is applied to style long hair. Powders are applied to the body to eliminate odors, and it is also applied to the face to achieve a matte and fresh effect to prevent oiliness of the corpse. Mortuary cosmeticizing is not done for the same reason as make-up for living people; rather, it is designed to add depth and dimension to a person's features that lack of blood circulation has removed. Warm areas – where blood vessels in living people are superficial, such as the cheeks, chin, and knuckles – have subtle reds added to recreate this effect, while browns are added to the palpebrae to add depth, especially important as viewing in a coffin creates an unusual perspective rarely seen in everyday life. During the viewing, pink-colored lighting is sometimes used near the body to lend a warmer tone to the deceased's complexion.
A photograph of the deceased in good health is often sought to guide the embalmer's hand in restoring the body to a more lifelike appearance. Blemishes and discolorations occasioned by the last illness, the settling of blood, or the embalming process itself are also dealt with at this time. It is also common for the embalmer to perform minor restoration of the deceased's appearance with tissue building chemicals and a hypodermic syringe. Tissue building chemicals become solid with the introduction of liquids such as water or interstitial fluids. Commonly the area where the Spheoid and Temporal bones meet; this can also be referred to the temples. In the event of trauma or natural depressions on the face or hands, tissue builder can also be utilised to return those regions of the face to the expectations of the family.

Clothing

In the Western world, men are usually buried in business attire, such as a suit or coat and tie, and women in semi-formal dresses or pant suits. In recent years, a change has occurred, and many individuals are now buried in less formal clothing, such as what they would have worn on a daily basis, or other favorite attire. The clothing used can also reflect the deceased person's profession or vocation: priests and ministers are often dressed in their liturgical vestments, and military and law enforcement personnel often wear their uniform. Underwear, singlets, bras, briefs, and hosiery are all used if the family so desires, and the deceased is dressed in them as they would be in life.
In certain instances a funeral director will request a specific style of clothing, such as a collared shirt or blouse, to cover traumatic marks or autopsy incisions. In other cases clothing may be cut down the back and placed on the deceased from the front to ensure a proper fit. In many areas of Asia and Europe, the custom of dressing the body in a specially designed shroud or burial cloth, rather than in clothing used by the living, is preferred.
After the deceased has been dressed, they are placed in the coffin or casket. In American English, the word coffin is used to refer to an anthropoid form, whereas casket refers to a rectangular box. No such distinction is made in Commonwealth English, where coffin is the preferred term and casket can be used interchangeably. It is common for photographs, notes, cards, and favourite personal items to be placed in the coffin with the deceased. Bulky and expensive items, such as electric guitars, are occasionally interred with a body. In some ways this mirrors the ancient practice of placing grave goods with a person for their use or enjoyment in the afterlife. In traditional Chinese culture, paper substitutes of the goods are buried or cremated with the deceased instead, as well as paper money specifically purchased for the occasion.

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, sometimes only until the funeral, other times indefinitely.
Typical embalming fluid contains a mixture of formaldehyde, glutaraldehyde, methanol, humectants and wetting agents, and other solvents that can be used. The formaldehyde content generally ranges from 5-35%, and the methanol content may range from 9-56%.
Environmentalists generally disapprove of embalming because of the harmful chemicals involved and their interactions with the environment. Recently, more eco-friendly embalming methods have become available, including formaldehyde-free mixtures of chemicals.

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 demisurgery, and all qualified embalmers have some degree of training and practice in it. For such cases, the benefit of embalming is startlingly apparent. In contrast, many people have unrealistic expectations of what a dead body should look like, due to the near-universal portrayal of dead bodies by live actors in movies and television shows. Ironically, the work of a skilled embalmer often results in the deceased appearing natural enough that the embalmer appears to have done nothing at all. Normally, a better result can be achieved when a photograph and the decedent's regular make-up are available to help make the deceased appear more as they did when alive.
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.
Long-term preservation requires different techniques, such as using stronger preservatives and multiple injection sites to ensure thorough saturation of body tissues.

For anatomy education

A rather different process is used for cadavers embalmed for dissection by medical professionals, students, and researchers. Here, the first priority is for long-term preservation, not presentation. As such, medical embalmers use anatomical wetting fluids that contain concentrated formaldehyde or glutaraldehyde and phenol, and are made without dyes or perfumes. Many embalming chemical companies make specialized anatomical embalming fluids.
Anatomical embalming is performed into a closed circulatory system. The fluid is usually injected with an embalming machine into an artery under high pressure and flow, and allowed to swell and saturate the tissues. After the deceased is left to sit for a number of hours, the venous system is generally opened and the fluid allowed to drain out, although many anatomical embalmers do not use any drainage technique.
Anatomical embalmers may choose to use gravity-feed embalming, where the container dispensing the embalming fluid is elevated above the body's level, and fluid is slowly introduced over an extended time, sometimes as long as several days. Unlike standard arterial embalming, no drainage occurs, and the body distends extensively with fluid. The distension eventually reduces, often under extended refrigeration, leaving a fairly normal appearance. No separate cavity treatment of the internal organs is given. Anatomically embalmed cadavers have a typically uniform grey colouration, due both to the high formaldehyde concentration mixed with the blood and the lack of red colouration agents commonly added to standard, nonmedical, embalming fluids. Formaldehyde mixed with blood causes the grey discoloration also known as "formaldehyde grey" or "embalmer's grey".

Religious practices

Opinions differ among different faiths as to the permissibility of embalming. A brief overview of some of the larger faiths positions are:
, detail from a carte de visite