Internal bleeding

Internal bleeding is bleeding occurring inside the body. It may be caused by high blood pressure (by causing blood vessel rupture) or other forms of injury, especially high speed deceleration occurring during an automobile accident, which can cause organ rupture. Depending on where it occurs (e.g. the brain), internal bleeding can be a serious medical emergency, potentially causing death if not given a proper treatment quickly.
Internal bleeding can be serious for two reasons:

• the blood can compress organs and cause their dysfunction (as can occur in haematoma)
• when it does not stop spontaneously, the loss of blood will cause hemorrhagic shock, which can lead to brain damage and death.

Internal bleedings are usually called hemorrhage, even though the term is general to all kinds of bleedings.
A minor case of internal bleeding is ecchymosis (a bruise): blood expands under the skin, causing discoloration.
Medical investigations are necessary to identify internal bleeding. The external signs are general signs of hypovolemic shock (see the article about shock for more information).

Wound

A wound is type of a physical trauma wherein the skin is torn, cut or punctured. Not only do severe wounds pose a significant chance of death due to loss of blood, there is increased chance of infection due to bacteria entering a wound that is exposed to air.
A person suffering from a significant wound may lose too much blood and go into shock, which requires serious medical attention. Due to the risk of infection, wounds should be kept clean, and closed if possible until professional help is available.
Before any medical or paramedical evaluation, a wound is considered as minor when:

• it is superficial;
• it is away from natural orifices;
• there is only a minor bleeding;
• it was not caused by a tool or an animal.

Any other wound should be considered as severe. If there is any doubt, a wound should be considered as severe. "Severe" does not necessarily means that it endangers life, but it must at least be seen by a physician.

Table of contents [hide]

1 Types of Wound 2 First aid 2.1 Minor wound (small cuts and grazes) 2.2 Severe/Major wound 2.3 If an object is embedded in a wound 3 Wound healing

Types of Wound

Wounds can be classified into a number of different types, according to the object that caused the wound. The types of wound are:

• Incisions - caused by a clean, sharp-edged object such as a knife or a razor.
• Lacerations - rough, irregular wounds caused by crushing or ripping forces.
• Abrasions (grazes) - a superficial wound in which the topmost layers of the skin are scraped off, often caused by a sliding fall onto a rough surface.
• Puncture wounds - caused by an object puncturing the skin, such as a nail or needle.
• Stab wounds - caused by an object such as a knife entering the body.
• Gunshot wounds - caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit.

All stab wounds and gunshot wounds should be considered major wounds.

First aid

Minor wound (small cuts and grazes)

1. Remove the cause of wound so nobody else gets hurt, or at least to lead the casualty away and mark out the dangerous area.
2. Wash your hands thoroughly with soap and water, dry them, and put on disposable gloves if available.
3. Wash the wound gently with clean, potable water (alternatively a sterile saline solution may be used), and clean the surrounding area with mild soap and water.
4. Pat the wound dry with a clean gauze swab or similar clean, non-fluffy material.
5. Cover the wound with a dressing (for small cuts a sticking plaster) is ideal.
6. If the bleeding does not stop, if there is a special risk of infection, or if the wound does not begin to heal within 48 hours, advise the injured person to seek medical attention.
7. Ask whether the casualty has been vaccinated against tetanus. If the injured person has never been immunised, or if he or she is unsure if the the course of vaccinations was completed, or if the last injection was more than ten years ago, advise the casualty to seek medical advice.

Severe/Major wound

The priority with major wounds is to prevent further blood loss. Treat the casualty to control the bleeding, prevent shock, and call for help as soon as possible.

1. Put on disposable gloves, if available, to protect yourself from infection. Remove or cut the casualty's clothing to expose the wound.
2. Get the casualty to raise the wound above the level of the heart (if the wound is in a limb) and, if there is no object embedded in the wound, apply direct pressure to the area with their own hand.
3. Help the casualty to lie down (on a blanket or carpet to protect them from the cold). If you suspect that shock may develop, raise the casualty's legs and support them on a chair or similar.
4. Apply a sterile dressing (or if none is available, an improvised dressing made from a clean towel or cloth). Secure the dressing with a bandage that is tight enough to maintain pressure on the wound (but not so tight as to impair circulation beyond the wound).
5. If blood seeps through the first dressing, apply a second dressing on top of the first. If blood seeps through the second dressing, remove both dressings and apply a fresh one, ensuring that sufficient pressure is applied.
6. Support the injured part in a raised position - a leg supported on a chair, or an arm rested across the chest (so that it is above the level of the heart).
7. Summon an ambulance, if you have not sent someone to do so already, and monitor the casualty's condition until help arrives.

If an object is embedded in a wound

If there is an object (for example, broken glass) embedded in the wound, or an open fracture where a broken bone sticks through the skin, do not apply pressure over the object or attempt to remove the object yourself. Treat as follows:

1. Put on disposable gloves, if available, to protect yourself from infection.
2. Press firmly on either side of the embedded object to push the edges of the wound together.
3. If the wound is in a limb, raise and support the limb above the level of the heart.
4. Help the casualty to lie down (on a blanket or carpet to protect them from the cold). If you suspect that shock may develop, raise the casualty's legs and support them on a chair or similar.
5. Build up padding on either side of the object (using dressing pads, rolled-up bandages, or similar), so that you are able to bandage over the object without pressing on it.
6. Summon an ambulance, if you have not sent someone to do so already (alternatively if the wound is minor, the wound is not bleeding heavily, and the casualty is comfortable, arrange to transport the casualty to hospital by another means). Monitor the casualty's condition until help arrives.

Wound healing

When a wound first occurs, a wound healing cascade is immediately unleashed. The events in this cascade overlap in time but are usually separated into three phases: the inflammatory, proliferative, and maturation phases. In the inflammatory phase, damaged tissue is debrided, bacteria and debris are engulfed by phagocytes, and chemical factors like growth factors are released to attract cells involved in the proliferative phase. In the proliferative phase, granulation tissue is formed, fibroblasts secrete collagen and other components of the extracellular matrix, new blood vessels are formed, the wound contracts, and the area is reepithelialized as epithelial cells migrate across the wound bed to cover it. In the maturation phase, collagen is cross-linked and realigned along lines of tension.

Starvation

Starvation is a severe reduction in vitamin, nutrient, and energy intake, and is the most extreme form of malnutrition. In humans, prolonged starvation (in excess of 1-2 months) causes permanent organ damage and may eventually result in death.
According to the Food and Agriculture Organization of the United Nations, more than 25,000 people die of starvation every day, more than 800 million people are chronically undernourished. On average, every five seconds a child dies from starvation.

Symptoms

Starved individuals lose substantial fat and muscle mass as the body turns to these tissues for energy. The skin's pale and dry appearance accompanies this emaciation.
Vitamin deficiency is common, often resulting in anemia, beriberi, pellagra, and scurvy. These diseases collectively may cause diarrhea, skin rashes, edema, and heart failure. Individuals are often irritable, fatigued, and lethargic as a result.

Treatment

Starvation is usually treated by slowly increasing food intake until no nutrient deficiencies remain. By this time, the diet of a recovering individual should consist of 5,000 calories and twice the Recommended Dietary Allowance of nutrients.

Capital punishment

Starvation has always been a means to carry a death sentence. From the beginning of civilization through to the Middle Ages people were immured and starved to death.
Rajmund Kolbe, a Polish friar, offered his life to save another inmate sentenced to death in the Auschwitz concentration camp. He was starved along with another nine inmates. After two weeks of starvation he and three other inmates were still alive and executed with injections of phenol.
Ugolino della Gherardesca, his sons and other members of his family were immured in the Muda, a tower of Pisa, and starved to death in the thirteenth century. Dante, his contemporary, wrote about Gherardesca in his masterpiece The Divine Comedy.

Stab wound

A stab wound is a type of wound that tears the skin by means of a sharp object. Stab wounds can be caused from anything like a corkscrew to a sword. Stab wounds are a common cause of death for many people. One or more of the following result from recieving a stab wound:

• Causes blood vessels to burst, which leads to either internal, or external bleeding.
• Causes the body's immune system to react against the foregin object, causing bodily complications, and eventually death if not removed properly and promptly.
• Causes the lungs to be torn open. When the lungs are torn open, breathing is impossible, which causes the person to suffocate.
• Causes the body's nerve system to overload the brain with pain signals, which can trigger severe shock in a person. This severe shock can cause the body to go unconcious, or could even cause the heart to go into cardiac arrest.

Table of contents

1 Stab Wounds Involving the Lungs 1.1 Severity of Lung Punctures 1.2 Reoccuring Pneumothorax and Treatment 2 Penetrating Abdominal Injury 2.1 Evaluation

Stab Wounds Involving the Lungs

Severity of Lung Punctures

A punctured lung from a medical lab. The arrow points to the wound.

Sometimes, there is a chance that a stab wound penetrates the lungs. Penetration into any vital organ poses a large threat to your health, but the lungs are one of the more severe threats to your health, if stabbed. If the lungs are stabbed, removal of the weapon or object that pierced them will automatically result in an unbalance of air volume in the lungs. Without this balance, the victim will be unable to properly breath, and could die, not because of the stab wound directly, but because of suffocation. If the wound is in the chest cavity or pleural space, the area around the lung, then the victim will suffer from what is called Pneumothorax. Pneumothorax is a condition in which air or some other gas collects in the chest or the pleural space. When a gas or air collects in the pleural space, it can cause part or all of a lung to collapse. If a victim is able to survive suffering from Pneumothorax, there is a 50% chance that a person will have a reoccuring Pneumothorax, even if there is no stab wound piercing the lungs a second time. Symptoms that a person is having a reoccuring Pneumothorax are:

• A chest pain that is made worse when the person either takes a deep breath, or coughes.
• Shortness of breath.
• Chest tightness.
• Easy fatigue.
• An increasing heart rate.
• A bluish color of the skin on the chest because of a shortage of oxygen.

Reoccuring Pneumothorax and Treatment

It is common for these symptoms to begin during sleep. It is also possible that if a reoccuring Pneumothorax happens, shock can accompany it, increasing the chance of the victim to die. Smaller Pneumothoraces have the possibility of going away on its own. Larger Pneumothoraces 'require' the removal of the extra air around the lungs or they will collapse. A chest tube will be inserted into the area around the lungs through a surgical hole made between the ribs. This process allows the lungs to re-expand and takes several days to complete (during those several days, the tube is left in place inside the ribs). The victim must remain in the hospital the entire time the tube is in place. There is no way to prevent another Pneumothorax from happening, except to not smoke to decrease the risk of one.

Penetrating Abdominal Injury

Stabbed in abdomen after arguement

The abdomen extends from the nipples to the groin crease anteriorly, and the tips of the scapulae to the gluteal skin crease inferiorly. Any penetrating injury to this area, or that may have traversed this volume, should be considered as a potential abdominal injury, and evaluated as such.
The incidence of penetrating injury will vary from hospital to hospital and region to region. Some institutions will have a very low incidence of penetrating trauma, and yet it is vital that penetrating injury is treated differently to blunt trauma. The mechanisms and physical characteristics of injury are different, as are the relevance and accuracy of investigations and the methods and timing of repair.

Evaluation

These guidelines apply only to those patients stabbed in the anterior abdomen (see anatomic boundaries in box below), who meet all three of the following criteria:

• Hemodynamically normal (i.e.. are not hypotensive, tachycardic

or diaphoretic)

• Have no evidence of peritonitis

• Have no bowel or omental evisceration through the wound

The presence of any one or more of the above mandates immediate abdominal exploration - without delay for further investigative maneuvers or x-rays.

Embalming

Embalming, in most modern cultures, is the art and science used to temporarily preserve human remains to forestall decomposition and make it suitable for display at a funeral. It has a long history, and other cultures had embalming processes that had much greater religious meaning.

Table of contents [hide]

1 History Of Embalming 2 Modern Embalming 3 Embalming Chemicals 4 Specialist Embalming

History Of Embalming

Embalming has been in many cultures. In classical antiquity, perhaps the Old World culture that had developed embalming to the greatest extent was that of ancient Egypt, who developed the process of mummification. They believed that preservation of the mummy empowered the soul after death, which would return to the preserved corpse.
Other cultures that had developed embalming processes include the Incas and other cultures of Peru, whose climate also favoured a form of mummification.
Embalming in Europe had a much more sporadic existence. It was attempted from time to time, especially during the Crusades, when crusading noblemen wished to have their bodies preserved for burial closer to home.
Contemporary embalming methods advanced markedly during the American Civil War, which once again involved many servicemen dying far from home, and their families wishing them returned for local burial. Dr. Thomas N. Holmes received a commission from the Army Medical Corps to embalm the corpses of dead Union servicemen to return to their families. Military authorities also permitted private embalmers to work in military-controlled areas.
In 1867, the German chemist August Wilhelm von Hofmann discovered formaldehyde, whose preservative properties were soon discovered and which became the foundation for modern methods of embalming.
In the 19th and early 20th centuries arsenic was frequently used as an embalming fluid but has since been supplanted by other more effective and less toxic chemicals. There were questions about the possibility of arsenic from embalmed bodies later contaminating ground water supplies. There were also legal concerns as people suspected of murder by arsenic poisoning could claim that the levels of poison in the deceased's body were a result of embalming post mortem rather than evidence of homicide.

Modern Embalming

Embalming as practiced in the funeral homes of the Western World uses several 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 on techniques is very common.
The first thing an embalmer should do is verify the identity of the deceased (normally via wrist or leg tags) and perform basic tests for signs of death, such as clouded-over corneas, lividity and rigor mortis. While people awakening on the mortuary table is largely the province of horror fiction and urban myth , testing for death is still a final additional precaution. Any clothing on the corpse is removed and set aside; jewelry, also, is inventoried. A modesty cloth is then placed over the deceased's genitalia for dignity. Following this the corpse is washed in disinfecting and germicidal solutions, shaved, and groomed. The embalmer bends, flexes and massages the arms and legs to relieve rigor mortis. The eyes are closed and kept closed with an eyecap that keeps them shut and in the proper expression. The mouth may be sewn shut, and a device is also employed to allow the embalmer to set the facial expression of the corpse. The process of closing the mouth, eyes, shaving etc is collectively known as setting the features.
The actual embalming process usually involves four parts:

• arterial embalming, which involves the injection of embalming chemicals into the blood vessels, usually via the right common carotid artery. Blood is drained from the right jugular vein. The embalming solution is injected using an embalming machine and the embalmer massages the corpse to ensure a proper distribution of the embalming fluid. In case of poor circulation, other injection points are used;

• cavity embalming, the suction of the internal fluids of the corpse and the injection of embalming chemicals into body cavities, using an aspirator and trocar. The embalmer makes a small incision just above the navel and pushes the trocar in the chest and stomach cavities to puncture the hollow organs and aspirate their contents. He then fills the cavities with concentrated chemicals. The incision is either sutured closed or a "trocar button" is screwed into place.

• hypodermic embalming, the injection of embalming chemicals under the skin as needed; and

• surface embalming, which supplements the other methods, especially for visible, injured body parts.

Most good embalmings are completed in two or three hours, although an easy case may take less and complicated cases can take days.
After the deceased is rewashed and dried, cosmetics are then applied to make it appear more living and create a "memory picture" for the deceased's friends and relatives. In the United States an oily foundation is placed on the visible areas of the skin, and theatrical or mortuary cosmetics are placed on the corpse. Mortuary cosmetizing is not done for the same reason as make-up for living people. Rather it is designed to the add depth and dimension to a person's features that the lack of blood circulation removes. 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 palpabrae (eyelids) to add depth, especially important as viewing in a coffin creates an unusual perspective rarely seen in everyday life.
A photograph of the dead person in good health is often sought, in order to guide the embalmer's hand in restoring the corpse to a more lifelike appearance. Blemishes and discolorations (such as bruises, in which the discolouration is not in the circulatory system and cannot be removed is arterial injection) occasioned by the last illness, the settling of blood, or the embalming process itself are also dealt with at this time. Various funeral homes have different practices as to whether the corpse will be clothed during the time of application of the cosmetics, or whether the cosmetics will be applied first and the corpse clothed afterwards.
As for clothing the body, tradition has been for the decedant to wear semi-formal clothing (a suit jacket and tie for men; a dress for women); however, in more recent years, the family often chooses to dress the decedant in more casual wear (such as a T-shirt and blue jeans), especially if the deceased was young.
In many areas of Europe, the custom of dressing the body in an especially designed shroud rather than in clothing used by the living is preferred.
After the corpse has been dressed, it is placed in the coffin for the various funeral rites. It is common for photographs, notes, cards and favourite personal items to be placed in the coffin with the deceased. Even bulky and expensive items, such as electric guitars, are occasionally interred with a body.
The foregoing describes the usual process for "cosmetic" embalming, wherein long-term preservation is not the goal; rather the natural appearance of the body is paramount.

Embalming Chemicals

Simply explained, embalming fluid acts to "fix" (technically denature) cellular proteins which means that they cannot act as a nutrient source for bacteria and it also kills the bacteria themselves. Modern embalming is not done with a single fluid. Rather various different chemicals are used to create a mixture called an arterial solution which is generated specifically for the needs of each case. For example a body needing to be repatriated overseas needs a higher index (percentage of diluted preservative chemical) than one simply viewing (known in the United States and Canada as a funeral visitation) at a funeral home before cremation.
Potential ingredients in an arterial solution include:

• Preservative (Arterial) Chemical. These are commonly a percentage (18%-35%) based mixture of formaldehyde, glutaraldehyde or in some cases phenol which are then diluted to gain the final index of the arterial solution. Formalin refers specifically to 40% aqueous formaldehyde and is not commonly used in funeral embalming but rather in the preservation of anatomical specimens.

• Water Conditioner. These are designed to balance the "hardness" of water (the presence of other trace chemicals that changes the water's pH or neutrality) and to help reduce the deceased's acidity, a by-product of decomposition, as formaldehyde works best in an alkaline environment.

• Cell Conditioner. These chemicals act to prepare cells for absorption of arterial fluid and help break up clots in the bloodstream.

• Dyes. These are use to restore someone's natural colouration and counterstain against conditions such as jaundice.

• Humectants. These are added to dehydrated and emaciated bodies to help restore tissue to a more natural and hydrated appearance.

• Anti-Edemic Chemicals. The opposite of humectants these are designed to draw excessive fluid (edema) from a body.

• Additional Disinfectants. For certain cases, such as tissue gas, specialist chemicals normally used topically such as Dis-Spray are added to an arterial solution.

• Water. Most arterial solutions are a mix of some of the preceding chemicals with tepid water. Cases done without the addition of water are referred to specifically as waterless. Waterless embalming is very effective but not economically viable for everyday cases.

• Cavity Fluid. This is a generally a very high index formaldehyde or glutaraldehyde solution injected undiluted directly via the trocar incision into the body cavities to treat the viscera. In cases of tissue gas phenol based products are often used instead.

Specialist Embalming

Decomposing bodies, trauma cases, frozen and drowned bodies, and those to be transported for long distances also require special treatment beyond that for the "normal" case. The recreation of bodies and features damaged by accident or disease is commonly called restorative art and is a sub-speciality inside embalming, although all qualified embalmers have some degree of training and practise in it. It is on these cases that the benefit of embalming is startlingly apparent. Many people have unreal expectation of what a dead body should look like due to seeing many "dead" bodies on television shows and the work of a skilled embalmer often results in the deceased looking like they have done nothing at all as the deceased appears so lifelike.
Embalming autopsy cases differs from standard embalming as the nature of the post mortem irrevocably disrupts the circulatory system with the removal of organs for examination. In these cases a six point injection is made via the two femoral arteries, axillary vessels and common carotids, with the viscera treated separately with cavity fluid in a viscera bag. In many mortuaries in the United States (such as the Los Angeles County Coroners Office) and New Zealand these necessary vessels are carefully preserved in the autopsy process while in other countries such as Australia, where embalming has been less common historically, they are routinely excised. This lead to an inability to properly embalm the deceased for the family and is a common source of conflict between government pathologists and embalmers there.
Long-term preservation requires different techniques, such as using stronger preservative chemicals, multiple injection sites to ensure thorough saturation of body tissues, and -in the case of a body to be used for anatomical dissection- taking no blood drainage and doing no treatment of the internal organs.
It should be remembered that embalming is only meant to temporarily preserve the body of a deceased person. Regardless of whether or not embalming is performed, the type of burial or entombment, and the materials used - such as wood or metal caskets and vaults - the body of the deceased will eventually decompose. Modern embalming is done to delay decomposition so that funeral services may take place.

Brain death

Brain death is defined as a complete and irreversible cessation of brain activity. Absence of apparent brain function is not enough. Evidence of irreversibility is also required. Brain-death is often confused with the state of vegetation.
Traditionally, death has been defined as the cessation of all body functions, including respiration and heartbeat. Since it became possible to revive some people after a period without respiration, heartbeat, or other visible signs of life, as well as to maintain respiration and blood flow artificially using life support treatments, an alternative definition for death was needed. In recent decades, the concept of "brain death" has emerged. By brain-death criteria, a person can be pronounced clinically dead even if the heart continues to beat due to life support measures.
A brain-dead individual has no electrical activity and no clinical evidence of brain function on neurologic examination (no response to pain, no cranial nerve reflexes (pupillary response (fixed pupils), oculocephalic reflex, corneal reflexes), and no spontaneous respirations). It is important to distinguish between brain death and states that mimic brain death (eg. barbiturate intoxication, alcohol intoxication, sedative overdose, hypothermia, hypoglycemia, coma or chronic vegetative states). Some comatose patients can recover, and some patients with severe irreversible neurologic dysfunction will nonetheless retain some lower brain functions such as spontaneous respiration. loss of both cortex and brainstem function. Thus anencephaly, in which there is no higher brain present, is generally not considered brain death, although it is certainly an irreversible condition in which it may be appropriate to withdraw life support..
Note that brain electrical activity can stop completely, or apparently completely (a "flat EEG") for some time in deep anaesthesia or during cardiac arrest before being restored. Brain death refers only to the permanent cessation of electrical activity. Numerous people who have experienced such "flat line" experiences have reported near-death experiences, the nature of which is controversial.
It is presumed that a permanent cessation of electrical activity indicates the end of consciousness. Those who view the neo-cortex of the brain as solely responsible for consciousness, however, argue that only electrical activity there should be considered when defining death. In many cases, especially when elevated intracranial pressure prevents blood flow into the skull, the entire brain is nonfunctional; however, some injuries may affect only the neo-cortex.
The diagnosis of brain death needs to be made quite rigorously to be certain the condition is truly irreversible. Legal criteria vary from place to place, but generally require neurologic exams by two independent physicians showing complete absence of brain function, and may include two isoelectric (flat-line) EEGs 24 hours apart. The proposed Uniform Determination Of Death Act in the United States is an attempt to standardize criteria. The patient should have a normal temperature and be free of drugs that can suppress brain activity if the diagnosis is to be made on EEG criteria. Alternatively, a radionuclide cerebral blood flow scan that shows complete absence of intracranial blood flow can be used to confirm the diagnosis without performing EEGs.
Most organ donation for organ transplantation is done in the setting of brain death. In some nations (for instance, Belgium, Poland and Portugal) everyone is automatically an organ donor, unless you get a special attest stating that you are not an organ donor. In others, consent from family members or next-of-kin is required. The non-living donor is kept on ventilator support until the organs have been surgically removed. If a brain-dead individual is not an organ donor, ventilator and drug support is discontinued and cardiac death is allowed to occur.

Body

With regard to living things, a body is the integral physical material of an individual, and contrasts with soul, personality and behavior. In some contexts, a superficial element of a body, such as hair may be regarded as not a part of it, even while attached. The same is true of excretable substances, such as stool, both while residing in the body and afterwards.
"Body" often is used in connection with appearance, health issues and death. The body of a dead person is also called a corpse (human) or cadaver. The dead bodies of vertebrate animals are sometimes called carcasses.
Cadavers may be used by physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue to repair a defect in a living human being. Students in medical schools study and dissect cadavers as part of their education.
Others who study cadavers include archaeologists and artists. It is said that the great Renaissance artist Michelangelo (1475-1564) studied cadavers by candlelight in a dark morgue -- enduring the smell of rotting flesh -- in order to better understand bone and sinew and muscle. The fruits of his efforts are evident in his painting "The Creation of Adam" on the ceiling of the Sistine Chapel in Rome and in his marble sculpture "David" in the Galleria dell' Accademia in Florence.
Courts of law sometimes use the term cadaver to refer to a dead body, as do recovery teams searching for bodies after a natural disaster such as an earthquake or a flood. A dead body is usually a corpse in a mystery story. The term cadaver also apparently has a more deathly ring in medicine.
"Cadaver" comes from the Latin word "cadere" (to fall). Related terms include "cadaverous" (resembling a cadaver) and "cadaveric spasm" (a muscle spasm that causes a dead body to twitch or jerk). A "cadaver graft" (also called "postmortem graft") refers to the grafting of tissue from a dead body onto a living human to repair a defect.
The human body consists of a head, neck, trunk, two arms, two legs and the genitals of the groin, which differ between males and females.
The study of the working of a body is anatomy.

Bleeding

Bleeding is the loss of blood from the body. Children are put more in danger by bleeding as they have less blood to lose. The average adult human will be in medical danger after 2 liters (2 quarts) and could die of hypovolemic shock if more blood is lost.

Table of contents

1 Types of bleeding 2 First aid 2.1 Minor traumatic bleeding 2.2 Severe traumatic bleeding 2.3 Externalised bleeding 2.4 Internal bleeding 2.5 Risk of blood contamination 3 Medical care

Types of bleeding

• minor traumatic bleeding: bleeding from small and superficial wounds; the loss of blood is not dangerous and the bleeding will stop spontaneously; the main risk is the wound itself (dysfunction of the organs involved and infection);
• severe traumatic bleeding: the flow of blood can soak a paper or cloth hankerchief in a few seconds; in such a situation, the bleeding will cause the death of the casualty in a few minutes;
• externalised bleeding: the blood flow through a natural orifice, such as the nose, the ears, the mouth (spitting and vomitting blood), the vagina (except for the natural menstruation), the urethra and the anus; the blood comes from the interior of the body and reveals a hidden trauma or a disease;
• internal bleeding: the blood flows inside the body; it cannot be seen, but can be suspected by shock symptoms.

Further, bleeding can be categorized by the type of the damaged blood vessel:

• arterial bleeding occurs from arteries, the major blood vessels which carry oxygen-rich blood from the heart throughout the body. This type of bleeding is characterized by spurts with each beat of the heart, is bright red in color (although blood darkens when it meets the air) and is usually severe and hard to control. Arterial bleeding requires immediate attention!
• veinous bleeding occurs from veins, vessels which return the blood to the heart. Veinous bleeding is characterized by a steady flow and the blood is dark, almost maroon in shade. Veinous bleeding is easier to control than arterial bleeding.
• capillary bleeding occurs from cappilaries, the smallest of our body’s blood vessels. It is usually slow, oozing in nature and this type of bleeding usually has a higher risk of infection than other types of bleeding. It is much easier to control than other types of bleeding.

First aid

Minor traumatic bleeding

The minor traumatic bleeding stops spontaneously, the loss of blood is not dangerous in itself. But the wound can still endanger the life of the casualty. See Wound.

Severe traumatic bleeding

The general behaviour is:

• protect: remove the cause of wound so nobody else gets hurt, or lead the casualty away and mark out the dangerous area; when the casualty cannot walk, do not move him unless the danger is deadly and real;
• stop the bleeding;
• let the casualty in the position he feels comfortable;
• ask someone to call for help, or do it yourself if you are alone; describe the general state of the casualty (alert or unalert, breathing or not) and the wound itself;
• follow the instructions given by the EMS.

A major technique of first aid is to control bleeding through direct pressure with the hand (possibly protected by a plastic bag, a glove or a piece of stuff); it can be replaced when necessary by the application of a bandage over the wound. When the casualty is concious and alert, he can press himself on the wound for a short time (e.g. the time the bystander makes the protection, get a protection for the hands, or get something to make a bandage).
When the direct pressure is not possible (e.g. there is a foreign body inside the wound, or a broken bone comes outside, or the wound is too large for the hand), then it is possible to compress the artery against a bone, between the wound and the heart (see Pressure point).
In extreme cases of an injured limb, a tourniquet may be used. If the medical care are delayed (after a few hours), the injured limb must generally be amputated afterwards, just below the level the tourniquet is applied; this is "losing a limb to save a life". This risk is very low in the urban environment of a developed country (the delay before a rescue team arrives is a few minutes after the call), but must be taken into account in wilderness or in countries that do not have organised prehospital medical services. Some first aid instruction no longer teaches the use of the tourniquet because the risk may be greater than the benefit; some other consider that saving a life is above the rest. However, this should always be the last choice.

Externalised bleeding

The only minor situation is a spontaneous nosebleed, or a nosebleed caused by a slight trauma (such as a child putting his finger in the nose). Just sit down, blow through the bleeding nostril to evacuate the forming clot (this first clot is usually not efficient), and press the nostril with a finger, the head bowed downwards, during ten minutes, the time the clot forms correctly (a shorter compression is not efficient). Consult a doctor when the bleeding does not stop or starts again.
Any other situation (including nosebleed due to a severe nose trauma or to a head trauma) must be considered as an emergency: place the person in a comfortable situation (lying or seated), call for help and follow the instructions.

Internal bleeding

Main article: Internal bleeding

The shock symptoms are not specific to an internal bleeding, but are always a medical emergency. In such a situation, the role of a bystander is to lay the person down, and call for help.

Risk of blood contamination

Concerning the direct exposure of the first-aider's skin to the blood: the skin is watertight, so if the skin is not wounded (skin disease or very recent wound), there is no risk of contamination by a disease of the casualty. Before any further activity (especially eating, drinking, touching the eyes, the mouth or the nose), the hand must be carefully and softly washed with clear water, then bathed five minutes in diluted bleach (sodium hypochlorite).
However, to avoid any risk, it is highly recommended to protect the hands, e.g. by a plastic bag or a cloth, before pressing the wound. If there is nothing to protect the hands, watch your hand to be sure it is not wounded, or use a distant compression of the artery (pressure point with your hand if you know the anatomic references, or a tourniquet).
In case of blood exposure, even on safe skin, the first-aider should go to the emergency service, where an anti-retroviral therapy will be started just in case.

Medical care

Blood lost by bleeding can be replaced by blood transfusion. The human body also generates blood at a rate of about 2 quarts (2 liters) per week.
The practise of causing bleeding intentionally to remove excess or "bad" blood from a person's body is called bloodletting or phlebotomy.

Dehydration

Dehydration is the removal of water -hydor in ancient Greek- from an object. Medically, dehydration is a serious and potentially life-threatening condition in which the body contains an insufficient volume of water for normal functioning.
The term "volume depletion" is similar to dehydration, but it refers to the loss of salts as well as water. Also see Hypovolemia.

Table of contents

1 Medical causes of dehydration 2 Symptoms and prognosis 3 Treatment 4 Avoiding dehydration 5 Ethical concerns

Medical causes of dehydration

In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These include:

• External or stress-related causes
  • Blood loss or hypotension due to physical trauma
  • Diarrhea
  • Hyperthermia
  • Shock
  • Prolonged physical activity without consuming adequate water, especially in a hot environment
  • Survival situations, especially desert survival conditions
  • Vomiting
• Infectious diseases
  • Cholera
  • Gastroenteritis
  • Shigellosis
  • Yellow fever
• Malnutrition
  • Electrolyte imbalance
    • Hypernatremia (also caused by dehydration)
    • Hyponatremia, especially from restricted salt diets
  • excessive consumption of alcohol
  • Fasting
  • Patient refusal of nutrition and hydration
• Other causes of obligate water loss
  • Severe hyperglycemia, especially in Diabetes mellitus
    • Glycosuria

Symptoms and prognosis

Symptoms may include headaches similar to what is experienced as a hangover, a sudden episode of visual snow, decreased blood pressure (hypotension), and dizziness or fainting when standing up due to orthostatic hypotension. Untreated dehydration generally results in delirium, unconsciousness, and death.
Dehydration symptoms generally become noticeable after 2% of one's normal water volume has been lost. Initially, one experiences thirst and discomfort, possibly along with loss of appetite and dry skin. Athletes may suffer a loss of performance of up to 50%, and experience flushing, low endurance, rapid heart rates, elevated body temperatures, and rapid onset of fatigue.
The symptoms become increasingly severe with greater water loss. One's heart and respiration rates will increase to compensate for decreased plasma volume and blood pressure, while body temperature may rise due to decreased sweating. Around 5% to 6% water loss, one may become groggy or sleepy, experience headaches or nausea, and may feel tingling in one's limbs (paresthesia). With 10% to 15% fluid loss, muscles may become spastic, skin may shrivel and wrinkle, vision may dim, urination will be greatly reduced and may become painful, and delirium may begin. Losses of greater than 15% are usually fatal.

Treatment

Correction of a dehydrated state is accomplished by the replenishment of necessary water and electrolytes (rehydration). Even in the case of serious lack of fresh water (e.g. at sea or in a desert), drinking seawater or urine does not help, nor does the consumption of alcohol.
When dehydrated, unnecessary sweating should be avoided, as it wastes water. If there is only dry food, it is better not to eat, as water is necessary for digestion. The best treatment for minor dehydration is consumption of an electrolyte-balanced fluid like a sports drink. For severe cases of dehydration where fainting, unconsciousness, or any other severely inhibiting symptom is present (the patient is incapable of standing or thinking clearly), emergency attention is required. Fluids will be given through an IV, and within a few hours, the patient will return to normal unless a complication occurred.

Avoiding dehydration

A person's body loses, during an average day in a temperate climate such as the United Kingdom, approximately 2.5 litres of water. This can be through the lungs as water vapor, through the skin as sweat, or through the kidneys as urine. Some (a less significant amount, in the absence of diarrhea) is also lost through the bowels.
During vigorous exercise or in a hot environment, it is easy to lose several times this amount. Heavy exercise in high temperatures could cause the loss of over 2.5 litres of fluid per hour, which exceeds the body's absorptive capacity.

Ethical concerns

Judge Lynch of the Massachusetts Supreme Judicial Court argued that death by dehydration symptoms was "cruel and violent" in his opinion on the 1986 Brophy case:

• The mouth would dry out and become caked or coated with thick material.
• The lips would become parched and cracked.
• The tongue would swell, and might crack.
• The eyes would recede back into their orbits and the cheeks would become hollow.
• The lining of the nose might crack and cause the nose to bleed.
• The skin would hang loose on the body and become dry and scaly.
• The urine would become highly concentrated, leading to burning of the bladder.
• The lining of the stomach would dry out and the sufferer would experience dry heaves and vomiting.
• The body temperature would become very high.
• The brain cells would dry out, causing convulsions.
• The respiratory tract would dry out, and the thick secretions that would result could plug the lungs and cause death.
• At some point within five days to three weeks, the major organs, including the lungs, heart, and brain, would give out and the patient would die.

Be advised the death due to dehydration can occur in 3 days (or less in hot weather) and no one normally lives more than about 5-6 days

Death by natural causes

In medicine, death by natural causes is a loosely-defined term used by coroners describing death when the cause of death was a naturally occurring disease process, or is not apparent given medical history or circumstances. Thus, deaths where the death was caused by active human intervention (as opposed to the failure of medical intervention to prevent death) are excluded from this definition, and are described as unnatural deaths.
The majority of deaths in the US are due to natural causes, and the majority of those deaths occur in old age.
As of the year 2000, the most common natural cause of death in the US is heart disease, accounting for 30% of all deaths. Cancer causes an additional 25% of all US deaths. Other common natural cases are stroke, Alzheimer's Disease, congenital anomalies, genetic disorders (such as cystic fibrosis), serious infections, and respiratory disorders.

Dead on arrival

Dead on arrival or DOA is a notation that a patient was brought to a hospital and immediately pronounced dead by a physician. The term arises because first responders such as emergency medical technicians (a.k.a. paramedics or ambulance drivers) do not have the authority to pronounce a patient dead (in the U.S. at least), and they are obliged, in the absence of a do not resuscitate order, to attempt resuscitation if there is any possibility of life and to continue resuscitation until the patient has been examined by a physician, which usually occurs only after the patient has been brought to a hospital.
Colloquially, anything which is received in a non-operational (broken) state can be called DOA or dead on arrival. If a new product, such as a computer, arrives "DOA" then it is likely that the recipient will call the supplier to get a Return Merchandise Authorization (RMA), a transaction that acknowledges that (apparently defective) goods will be returned to the supplier for refund, replacement or credit. Sometimes it is difficult to actually detect a defective or DOA product. With computers, for instance, it might require a boot image to be installed and run through a test suite to detect any failed parts.
When, as with computers, product complexity is high and diagnostics are involved, the medical metaphor is perhaps appropriate, as complex diagnostics might be required to determine if the product "is really dead".

Dead bodies and health risks

After disasters with extensive loss of life due to trauma, much resource is often expended on burying the dead quickly, and applying disinfectant to bodies, to prevent disease.
According to health professionals, the fear of spread of disease by bodies killed by trauma rather than disease is not justified. Amongst others, Steven Rottman, director of the UCLA Center for Public Health and Disasters, said that no scientific evidence existed that bodies of disaster victims increased the risk of epidemics, adding that cadavers in fact posed less risk of contagion than living people.
Obviously this does not apply in the case of a health disaster such as an epidemic where the victims are affected by diseases which can be communicated by dead bodies. And sanitary measures for the survivors of any disaster are necessary to prevent the spread of diseases which affect concentrations of people in bad conditions.
In disasters involving trauma where there is competition for resources, more effort should be spent caring for survivors (improving sanitation, providing clean water or facilities for boiling or otherwise disinfecting water, providing food, clothing and shelter), and less disinfecting and disposing urgently of the dead. Religious and cultural practices, the stench, and the effect on morale must of course also be taken into consideration.
The incorrect notion that dead bodies inherently spread diseases is probably a combination of (a) the incorrect miasma theory of disease: diseases are spread by foul air — you get malaria from breathing marsh air, cholera from breathing foul air from untreated sewage, and diseases from the stench of decomposing corpses; (b) a confusion between normal decay processes and the signs of disease; and (c) the true fact that corpses of those who died from certain contagious diseases do, indeed, spread disease.
While, of course, research and evidence must override any commonsensical arguments, there is no logical reason for non-diseased corpses to generate and spread disease: micro-organisms do not come into being by spontaneous generation, any more than flies are generated spontaneously by rotting rubbish, rather than hatching eggs. Disease micro-organisms are not the same as those causing decay.

Poison

In the context of biology, poisons are substances that cause injury, illness, or death to organisms, usually by chemical reaction or other activity on the molecular scale. Some poisons are also toxins, usually referring to naturally produced substances that kill rapidly in small quantities, such as the bacterial proteins that cause tetanus and botulism. A distinction between the two terms is not always observed, even among scientists. Animal toxins that are delivered subcutaneously (e.g. by sting or bite) are also called venom. In normal usage, a poisonous organism is one that is harmful to consume, but a venomous organism uses poison to defend itself while still alive. A single organism can be both venomous and poisonous.The derivative forms "toxic" and "poisonous" are synonymous. Within chemistry and physics, a poison is a substance that obstructs or inhibits a reaction, for example by binding to a catalyst. Poisons have been known to be symbolized by the skull and crossbones, although since this attracts children (being linked to pirates) it is gradually being replaced by Mr. Yuk in the United States.

Table of contents [hide]

1 Biological poisoning 2 Classification of biological poisons by mechanism 2.1 Corrosives 2.1.1 Acids 2.1.2 Bases 2.1.3 Oxidizers 2.1.4 Reducing agents 2.2 Metabolic poisons (energy) 2.2.1 Specific biochemical inhibitors 2.2.2 Heavy metals 2.3 Neurotoxins 2.3.1 Anticholinesterases 2.3.2 Acetylcholine antagonists 2.3.3 Cell membrane disrupters 2.4 Others 2.4.1 Teratogens (birth defects) 2.4.2 Mutagens (DNA damage) 2.4.3 Carcinogens (cancer) 3 Examples of biological poisons by source 3.1 Non-radioactive inorganic poisons 3.2 Organic poisons 3.3 Naturally produced poisons and toxins 4 Famous poisonings 4.1 Confirmed poisonings 4.2 Suspected or rumoured poisonings

Biological poisoning

Contact or absorption of poisons can cause rapid death or impairment. Agents that act on the nervous system can paralyze in seconds or less, and include both biologically derived neurotoxins and so-called nerve gases, which may be synthesized for warfare or industry. Inhaled or ingested cyanide almost instantly starves the body of energy by poisoning mitochondria and the synthesis of ATP. Intravenous injection of an unnaturally high concentration of potassium chloride, such as in the execution of prisoners in parts of the United States, quickly stops the heart by eliminating the cell potential necessary for muscle contraction. Such rapid reactions are often called acute poisoning.
Most (but not all) pesticides are created to act as poisons to target organisms, although acute or less observable chronic poisoning can also occur to non-target organism, including the humans who apply the pesticides and other beneficial organisms.
A poison may also act slowly. This is known as chronic poisoning and is most common for poisons that bioaccumulate. Examples of these types of poisons are mercury and lead.
Many substances regarded as poisons are toxic only indirectly. An example is "wood alcohol" or methanol, which is not poisonous itself, but is chemically converted to toxic formaldehyde in the liver. Many drug molecules are made toxic in the liver, and the genetic variability of certain liver enzymes makes the toxicity of many compounds differ between one individual and the next.
The study of the symptoms, mechanisms, treatment and diagnosis of biological poisoning is known as toxicology.
Exposure to radioactive substances can produce radiation poisoning, an unrelated phenomenon.

Classification of biological poisons by mechanism

Corrosives

Corrosives mechanically damage biological systems on contact. Both the sensation and injury caused by contact with a corrosive resembles a burn injury.

Acids

Strong inorganic acids, such as concentrated sulfuric acid, nitric acid or hydrochloric acid, destroy any biological tissue with which they come in contact within seconds.

Bases

Strong inorganic bases, such as lye, gradually dissolve skin on contact but can cause serious damage to eyes or mucous membranes much more rapidly. Ammonia is a far weaker base than lye, but has the distinction of being a gas and thus may more easily come into contact with the sensitive mucous membranes of the respiratory system. Quicklime, which has household uses, is a particularly common cause of poisoning. Some of the light metals, if handled carelessly, can not only cause thermal burns, but also produce very strong basic solutions in sweat.

Oxidizers

Poisons of this class are generally not very harmful to higher life forms such as humans (for whom the outer layer of cells are more or less disposable), but lethal to microorganisms such as bacteria. Typical examples are ozone and chlorine, either of which is added to nearly every municipal water supply in order to kill any harmful microorganisms present. All halogens are strong oxidizing agents, fluorine being the strongest of all.

Reducing agents

The most notable substance in this class is phosphorus.

Metabolic poisons (energy)

Metabolic poisons act by adversely disrupting the normal metabolism of an organism.

Specific biochemical inhibitors

• By far the most notable substance in this class is carbon monoxide, which blocks the ability of red blood cells to transport oxygen.
• Fluoroacetate blocks a vital step in the citric acid cycle.
• Cyanide bonds with an enzyme involved in ATP production.
• Rotenone - disrupts electron transport in cellular respiration
• Antimycin - disrupts electron transport in cellular respiration
• Malonate - inhibits cellular respiration
• 2,4-Dinitrophenol - disrupts cellular proton gradient

Heavy metals

A common trait shared by heavy metals is the chronic nature of their toxicity (a notable exception would be bismuth, which is considered entirely non-toxic). Low levels of heavy metal salts ingested over time accumulate in the body until toxic levels are reached.
Heavy metals are generally far more toxic when ingested in the form of soluble salts than in elemental form. For example, metallic mercury passes through the human digestive tract without interaction and is commonly used in dental fillings—even though mercury salts and inhaled mercury vapor are highly toxic.
Notable examples:

• arsenic (see arsenic poisoning)
• antimony
• barium
• cadmium
• chromium
• lead
• mercury
• thallium
• uranium
• beryllium (a highly but subtly toxic light metal)

Neurotoxins

Neurotoxins interfere with nervous system functions and often lead to near-instant paralysis followed by rapid death. They include most spider and snake venoms, as well as many modern chemical weapons. One class of toxins of interest to neurochemical researchers are the various cone snail toxins known as conotoxins.

Anticholinesterases

• Fasciculin

Acetylcholine antagonists

• Curare
• Pancuronium

Cell membrane disrupters

Others

• Nicotine - not strictly a neurotoxin, but capable in large doses of causing heart attack

Teratogens (birth defects)

• Thalidomide

Mutagens (DNA damage)

• Ultraviolet Rays - Long term exposure may cause skin cancer such as Melanoma
• Other Ionizing Radiation - Causes radiation sickness and cancer
• ethidium bromide

Carcinogens (cancer)

A carcinogen is a chemical substance which is believed to cause cancer. There are an enormous variety of possible carcinogens. Some of the better known or more controversial examples are listed below.

• Some artificial sweeteners (e.g. Aspartame and Saccharin) have been alleged to be carcinogenic or neurotoxic (however these research behind these claims is highly controversial and inconclusive; the FDA believes aspartame is safe for humans in dietary doses).
• Asbestos - a widely used insulating material that causes mesothelioma and other cancers especially in the respiratory tract.
• Benzene (lab solvent, used in various chemical reactions).
• Carbon tetrachloride (formerly used in fire extinguishers).
• Dioxin - actually a group of many chemicals - has carcinogenic and other toxic effects.

Tobacco, whether chewed or smoked, is also carcinogenic.

Examples of biological poisons by source

Unfinished task: Items below should be added as examples under the appropriate poison class above.

Non-radioactive inorganic poisons

• Arsenic compounds
  • arsenic trioxide
  • Fowler's solution
• inorganic compounds
  • phosgene
  • phosphine
  • hydrogen sulfide
• Acids and bases, corrosives
  • various light metal oxides, hydroxides, superoxides
  • Bleach, some pool chemicals, other hypochlorates (acidic and oxydizing effect)
  • hydrofluoric acid

Organic poisons

• formaldehyde

Naturally produced poisons and toxins

• Microorganisms
  • ethanol
  • botulin toxin
  • Tetrodotoxin
  • domoic acid (or Amnesic Shellfish Poison, ASP)
  • Shellfish toxins (PSP, DSP, NSP, ASP )
• snake and spider venoms
• plant toxins (including many alkaloids)
  • strychnine
  • solanine
  • atropine
  • hyoscyamine
  • aconite
  • curare
  • digitoxin
  • digoxin
  • poison hemlock
  • hemlock water dropwort
  • Phytohaemagglutinin (Red kidney bean poisoning)
  • Grayanotoxin (Honey intoxication)
• fungal toxins
  • amanita toxin, see Amanita phalloides
  • muscarine
  • aflatoxins
• Ciguatera poisoning
  • Scombroid poisoning
  • Ouabain
  • Pyrrolizidine alkaloids

Famous poisonings

Confirmed poisonings

• Bhopal Disaster — An accidental release of poisonous gas from a pesticide plant in India that killed over 2,000 people and injured many more.
• Jonestown inhabitants — died from a poisoned drink in a mass suicide/murder: see Jonestown mass suicide
• Love Canal — Buried toxic waste was covered and used as a building site for housing and school in Niagara Falls, New York, resulting in claims of chronic poisoning and a massive environmental cleanup.
• Clare Boothe Luce — Fell ill but did not die; arsenic poisoning
• Georgi Markov — Assassinated in London with ricin
• Socrates — According to Plato, killed by drinking Hemlock (water hemlock, not hemlock the evergreen tree)
• Alan Turing — Apparently committed suicide by painting an apple with Cyanide and taking a bite.
• Viktor Yushchenko — poisoned with dioxin during the Ukrainan elections.

Suspected or rumoured poisonings

• Yasser Arafat — Arafat reputedly died from liver cirrhosis, which may be a consequence of chronic alcohol use or poisoning. Some Arafat supporters feel it is extremely unlikely that Arafat habitually used alcohol (forbidden by Islam), and so suspect poisoning, possibly by the Mossad. (Note that cirrhosis is not necessarily caused by alcohol use, or indeed any poison.)
• Napoleon Bonaparte — some claim he was killed by someone on his staff with arsenic. Evidence is inconclusive.
• Charles Darwin — possibly died due to self-medication with Fowler's solution, one percent potassium arsenite
• Jamestown colonists — Standard historical accounts claim deaths by starvation, but the possibility of arsenic poisoning by rat poison (or of death by Bubonic plague) has also been reported.
• Joseph Stalin — Officially cerebral hemorrhage; but, according to Vyacheslav Molotov's memoirs, Lavrenty Beria claimed to have poisoned Stalin.

Mortuary

A mortuary is a cold chamber used to keep the deceased from seriously decomposing; this practice exists for the sake of recognition of the deceased and to allow time to prepare for burial. The term also refers to the room in which a body may be prepared for a funeral or undergo an autopsy.

A standard mortuary

There are two types of mortuary cold chambers:

• Positive temperature (+2/+4°C): This is the most common type, used for keeping the bodies a few days or a few weeks; however, decomposition of the corpse is still happening albeit at a reduced rate.

• Negative temperature (-15°C/-25°C): This is used for forensic institutes for bodies which have not yet been identified. Here the body is completely frozen and the decomposition totally stopped.

In some countries, the family must make the burial within 72 hours but in others countries (Africa) it is usual that the burial takes place some weeks or some months after the death. That is the reason why some corpses can stay one or two years at the hospital or in a funeral home. When the family has enough money to organise the burial ceremony, they take the corpse from the cold chamber.
In many countries the body of the deceased is embalmed which negates the requirement of keeping it refrigerated.

Morgue

Morgue is predominately used in American English, whilst mortuary is more common in British English. It originally referred to a building in Paris, France, the Morgue, where bodies were kept until identified. The term morgue is derived from French morguer, to look at solemnly, to defy. The term was first used to describe the inner wicket of a prison, where prisoners were kept for some time, that the jailers and turnkeys might view them at their leisure, so as to be able to recognize them when occasion required. Relating to dead people, the name was first given to a building in Paris which in the middle of the fifth century was part of the Châtelet and was used for the keeping and identification of unknown corpses.
Probably because it is in a sense where the "dead bodies" are kept, the term morgue is also used in the USA to refer to the room where newspaper or magazine publishers keep their back issues and other historical references.

Table of contents [hide]

1 Morgue or mortuary cold chamber 1.1 Positive temperature 1.2 Negative temperature 2 Usage

Morgue or mortuary cold chamber

There are two types of mortuary cold chambers:

Positive temperature

+2/+4 °C which is the most usual for keeping the bodies a few days or a few weeks, but does not prevent decomposition of the corpse, which continues, albeit at a slow rate.

Negative temperature

-15°C/-25 °C which is usual in forensic institutes, especially for bodies which have not yet been identified. At these temperatures, the body is completely frozen and decomposition totally halted.

Usage

The mortuary cold chamber is used to keep the deceased as long as is necessary for identification purposes, or prior to post-mortem examination, or while awaiting burial.
In many countries, the family have to make the burial within 72 hours but in some countries, (in Africa, for example), it is usual that the burial takes place some weeks or some months after the death. That is the reason why some corpses can be kept as long as one or even two years at the hospital or in a funeral home. When the family has enough money to organise the burial ceremony, they take the corpse from the cold chamber.
Morgues have been constructed in all large cities in the United States; in Boston (1851), in New York, (1866), in Chicago], (1872), etc.

Autopsy

An autopsy (also known as a post-mortem examination, necropsy or obduction) is a medical procedure that consists of a thorough examination performed on a corpse after death, to evaluate disease or injury that may be present and to determine the cause and manner of a person's death.

Table of contents

1 General information 2 Forensic autopsy 3 The process 3.1 External examination 3.2 Internal examination 4 Reconstitution of the body 5 Other information 6 Ogrish Content

General information

The term "autopsy" derives from the Greek for "to see for oneself". "Necropsy" is from the Greek for "seeing a dead body".
There are two types of autopsies:

• Forensic: This is done for medical-legal purposes and is the one that is normally seen on television or in the news.
• Clinical: This is usually performed in hospitals to determine a cause of death for research and study purposes.

Forensic autopsy

From the a perspective of the law, deaths are placed in one of five categories of causes:

• Natural
• Accident
• Homicide
• Suicide
• Undetermined

Following an in-depth examination of all the evidence, a medical examiner or coroner will assign a cause of death as one of the five listed above.

The process

The body is received at a medical examiner's office or hospital in a body bag or evidence sheet. A brand new body bag is used for each body, to ensure that only evidence from that body is contained within the bag. Evidence sheets are an alternate way to transport the body. An evidence sheet is a sterile sheet that the body is covered in when it is moved.
There are two levels of the physical examination of the body, external and internal. Toxicology, biochemical tests and/or genetic testing often supplement these and frequently assist the pathologist in assigning cause(s) of death.

External examination

The person responsible for handling, moving, cleaning the body is often called a diener (the German word for servant). After the body is received, it is first photographed. Then the examiner notes the clothes and the position of the clothes on the body before they are removed. Then evidences like gun powder residue, paint flakes etc are collected from the external surfaces of the body. Samples of hair, finger nails etc are taken at this stage. Sometimes special ultraviolet radiation is used to search the body for evidence that may not be easily visible to the naked eye. The body may also be X-rayed at this stage.
Once the evidence is collected, the body is removed from the bag, undressed and the wounds if any are examined. This is followed by cleaning the body for the actual examination. After the body is cleaned, it is weighed and measured. Often, the scale is large enough to accommodate the cart that the body is transported on. The person's weight is then determined by subtracting the weight of the cart from the total weight seen on the scale. The body is then transported to the autopsy room and placed on the autopsy table. A plastic or rubber brick called the body block is placed under the back of the corpse causing the chest to protrude forward and making it easier to cut open. Then a general description of the body with regards to race, sex, hair color and length, eye color, age, and identifying features is recorded. A handheld voice recorder or a standard exam form is normally used to record this information.

Internal examination

Autopsy Scene on Elderly Woman

After the body has been prepared for autopsy, a block is placed under the chest. This causes the chest to protrude outward and the arms and neck to fall back. This allows the prosector, a pathologist or pathologist-assistant, the maximum exposure to the trunk. After this is done, the internal examination begins. The internal examination consists of inspecting the internal organs of the body for evidence of trauma or other indications of the cause of death. For the internal examination, a large and deep Y-shaped incision is made from shoulder to shoulder meeting at the breastbone extending all the way down to the pubic bone and will make a slight deviation to the side to avoid the navel. If the body is that of a woman, the incisions are made to go around the breasts so that the arms of the "Y" have a slightly curved appearance. Bleeding from the cuts (if there even is any) is minimal, because gravity is producing the only blood pressure.
An electric saw dubbed a "Stryker saw" is most often used to open the chest cavity. The prosector uses the tool to saw through the ribs on the lateral sides of the chest cavity to allow the sternum and attached ribs to be lifted as one chest plate; this is done so that the heart and lungs can be seen in situ and that the heart, in particular the pericardial sac is not damaged or disturbed from opening. A scalpel is utilized to remove any soft tissue that is still attached to the posterior side of the chest plate. Now the lungs and the heart are exposed. The chest plate is set aside and will be eventually replaced at the end of the autopsy.

Skull Autopsy on Elderly Woman

At this stage all the organs are exposed. Then a series of cuts, along the vertebral column, are made so that the organs can be detached and pulled out in one piece for further inspection and sampling. The various organs are examined, weighed and tissue samples in the form of slices are taken. Even major blood vessels are cut open and inspected at this stage. Next the stomach and its contents are examined and weighed. This could be useful to find the cause and time of death.
The body block that was utilized earlier to elevate the chest cavity is now used to elevate the head. To examine the brain, a cut is made from behind one ear, across the forehead, to the other ear and around. These incisions are made on the back of the head so that when the autopsy is completed, the incision can be neatly sewn up and is not noticed when the head is resting on a pillow in funeral where it is open casket. The scalp is pulled away from the skull in two flaps with the front flap going over the face and the rear flap over the back of the neck. The skull is then cut with an electric saw to create a "cap" that can be pulled off, exposing the brain. The dura - the soft tissue membrane that covers the brain remains attached to the "cap". The brain's connection to the spinal cord is severed, and the brain can then be easily lifted out of the skull for examination. If the brain needs to be preserved before being inspected, it is contained in a jar of formalin (Ten percent solution of formaldehyde gas in buffered water) for at least two weeks. This not only preserves the brain, but also makes it firmer allowing easier handling without corrupting the tissue.

Reconstitution of the body

An important aim of the autopsy is to reconstitute the body such that it can be viewed, if desired, by relatives of the deceased following the procedure. After the examination, the body has an open and empty chest cavity with chest flaps open on both sides, the top of the skull is missing, and the skull flaps are pulled over the face and neck. It is unusual to examine the face, arms, hands or legs internally. The organs are replaced or incinerated, the chest flaps are closed and sewn back together and the skull cap is sewed back in place. Then the body may be wrapped in a shroud and it is common for relatives of the deceased to not be able to tell the procedure has been done when the deceased is viewed in a funeral parlor.

Other information

The principal aim of an autopsy is to discover the cause of death, to determine the state of health of the person before they died, and whether any medical diagnosis and treatment before death was appropriate. Studies have shown that even in the modern era of use of high technology scanning and medical tests, the medical cause of death is wrong in about one third of instances unless an autopsy is performed. In about one in ten cases the cause of death is so wrong that had it been known in life the medical management of the patient would have been significantly different.
In the United States, and most Western countries, the number of autopsies performed in hospitals has been decreasing every year since 1955. Critics, including pathologist and former JAMA editor George Lundberg have charged that the reduction in autopsies is negatively affecting the care delivered in hospitals, because when mistakes result in death, they are often not investigated and learned from.
When a person has given permission in advance of their death, autopsies may also be carried out for the purposes of teaching or medical research.
An autopsy is frequently performed in cases of sudden death, where a doctor is not able to write a death certificate, or when death is believed to be due to an unnatural cause. These examinations are performed under a legal authority (Medical Examiner or Coroner) and do not require the consent of relatives of the deceased. The most extreme example is the examination of murder victims, especially when medical examiners are looking for signs of death or the murder method, such as bullet wounds and exit points, signs of strangulation, or traces of poison.

Abortion

An abortion is the premature termination of pregnancy resulting in the death of any or all carried embryo(s) or fetus(es). In medicine, the following terms are used to define an abortion:

• Spontaneous abortion: An abortion due to accidental trauma or natural causes. Also known as a miscarriage.
• Induced abortion: Deliberate (human induced) abortion. Induced abortions are further subcategorized into therapeutic abortions and elective abortions.
• Therapeutic abortion: An abortion perfomed because the pregnancy poses physical or mental health risk to the pregnant woman (gravida).
• Elective abortion: An abortion perfomed for any other reason.

In common parlance, the term "abortion" is used exclusively for induced abortion.
A pregnancy that terminates early, but where the fetus survives to become a live infant is instead a premature birth. A pregnancy that ends with a infant dead upon birth due to causes such as spontaneous abortion is termed a stillbirth.
The ethics and morality of induced abortion have become the subject of an intense debate in the past 50 years in various areas of the world, including the United States of America, Canada and a number of countries in Europe.
While abortions can be performed and occur in any animal that gives birth, this article focuses exclusively on abortions performed upon humans.

Table of contents [hide]

1 Spontaneous abortion 2 Induced abortions 3 Methods of inducing abortion 3.1 Medical Abortion 3.2 Surgical abortion 3.3 Other means of abortion 4 Health risks 4.1 Physical health 4.2 Mental health 5 Emergency contraception 6 History of abortion 7 Ogrish Content

Spontaneous abortion

Spontaneous abortions, known more commonly as miscarriages, occur frequently. Up to 78% of all conceptions may fail, in most cases even before pregnancy is confirmed. 15% of all confirmed pregnancies end in a miscarriage. Most miscarriages occur very early in a pregnancy. Since early embryonic development is an error prone process, the body may spontaneously abort if a fetus is not viable (i.e., due to genetic deformities, such as most cases of trisomy), or when the womb is unable to support the development of the fetus. A spontaneous abortion can be caused by accidental trauma, while trauma with the intent to cause miscarriage is considered an induced abortion. Some states have laws increasing the criminal liability of a person who causes a miscarriage during an assault or other violent crime.

Induced abortions

The term "abortion" is usually used by lay people to refer to induced abortion. Induced abortions are sought for a number of reasons, according to the Alan Guttmacher Institute, there were 1.31 million abortions in the US in 2000, and cases of rape or incest accounted for 1.0% of abortions in 2000. Women from 27 nations reported the following reasons for seeking an induced abortion:

• 25.5% – Want to postpone childbearing
• 21.3% – Cannot afford a baby
• 14.1% – Has relationship problem or partner does not want pregnancy
• 12.2% – Too young; parent(s) or other(s) object to pregnancy
• 10.8% – Having a child will disrupt education or job
• 7.9% – Want no (more) children
• 3.3% – Risk to fetal health
• 2.8% – Risk to maternal health
• 2.1% – Rape, incest, other

An abortion in China

In many areas of the world, especially the developing nations or where induced abortions are illegal, many women choose or are pushed to perform abortions on themselves. These self-induced abortions are commonly unsafe abortions as described by the World Health Organization. Furthermore, some abortions are induced because of societal pressures, such as stigma of disabled persons and similar eugenic ideals, or laws, such as under China's one-child policy. These policies and societal pressures can lead to sex-selective abortion and infanticide, which is illegal in most countries, but difficult to stop.
Some women, poor or uninformed, choose not to go to a legally approved place to get an abortion, their only other choice being to turn to untrained, and often unsafe, providers. These abortion providers levy fees based on the ability to pay, degree of guilt felt, and extent of secrecy desired. After the anxiety and expense of choosing this alternative, women are often left with serious disabilities and sometimes suffer fatal consequences from incomplete or septic procedures. Sometimes, in this case, the woman doesn't see any other way to take the baby's life right after it is born.

Methods of inducing abortion

Depending on the gestational age of the embryo or fetus, different methods of abortion can be performed to remove the embryo or fetus from the womb.

Medical Abortion

Medical Abortion, sometimes called chemical abortion, comprises 10% of all abortions in the United States and Europe. Medical abortion is a method used to induce abortion during the first trimester. Medical abortion is accomplished by administering either methotrexate or mifepristone (RU-486) followed by administration of misoprostol. Misoprostol may also be used alone to induce abortion; however the need for surgical intervention is slightly elevated (about 10%), compared to the 8% of medical abortions using a combination of medications. Surgical intervention is primarily vacuum uterine aspiration (See below). Methotrexate can also treat undiagnosed or concomitant ectopic pregnancies.

Surgical abortion

In the first fifteen weeks, suction-aspiration or vacuum abortion are the most common methods, replacing the more risky dilation and curettage (D & C). Manual vacuum aspiration, or MVA abortion, consists of removing the fetus or embryo by suction using a manual syringe, while the Electric vacuum aspiration or EVA abortion method uses suction produced by an electric pump to remove the fetus or embryo. From the fifteenth week up until around the eighteenth week, a surgical dilation and evacuation (D & E) is used. D & E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.
Dilation and suction curettage consists of emptying the uterus by suction using a different apparatus. Curettage refers to the cleaning of the walls of the uterus with a curette. Dilation and curettage (D & C) is a standard gynaecological procedure performed for a variety of reasons, such as examination.
As the fetus grows, other techniques must be used to induce abortion in the third trimester. Premature delivery of the human fetus can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. Very late abortions can be brought about by the controversial intact dilation and extraction (intact D & X) which requires the surgical decompression of the fetus's head before evacuation and is controversially termed "partial-birth abortion". A hysterotomy abortion, similar to a caesarian section but ending with a dead fetus, can also be used at late stages of pregnancy. Hysterotomy abortion can be performed vaginally, with an incision just above the cervix, in the late mid-trimester.

Other means of abortion

Certain herbs are considered by some to be effective abortifacients. Using herbs in this way can cause serious side effects, including multiple organ failure and other serious injury, and are not recommended by physicians. Many herbal recipes were compiled and published in medieval times under the name of Peter of Spain.
Physical trauma to a pregnant woman's womb can cause an abortion. The severity of the impact required to cause an abortion carries high risk of injury to the pregnant woman, without necessarily inducing a miscarriage. Both accidental and deliberate abortions of this kind carry criminal liability in many countries.

Health risks

As with most surgical procedures, the most common surgical abortion methods carry the risk of serious complications. These risks include: a perforated uterus, perforated bowel or bladder, septic shock, sterility, and death.
Accurately assessing the risks of induced abortion is difficult due to a number of factors. These factors include a lack of uniform definitions of terms, and difficulties in follow-up.
Use of "traditional medicine" methods (e.g., overdoses of various drugs and inserting various objects into uterus) for abortions is also dangerous. Serious complications from abortions done outside of professional clinics may include infections and bleeding. In many cases, such abortions lead to death.

Physical health

Each phase of the abortion carries separate risks, and practitioners are not in agreement as to the best methods of mitigating those risks. The degree of risk depends upon the skill and experience of the practitioner; maternal age, health, and parity; gestational age; pre-existing conditions; methods and instruments used; medications used; the skill and experience of those assisting the practitioner; and the quality of recovery and follow-up care. A highly-skilled practitioner operating under ideal conditions will have a very low rate of complications, whereas an inexperienced practitioner in an unsanitary, ill-equipped and ill-staffed facility will typically have a high complication rate.
Some practitioners advocate using the minimal possible anesthesia, so that patient pain can alert the practitioner to possible complications. Others recommend general anesthesia in order to prevent patient movement which might cause a perforation. General anesthesia carries its own risks and most public health officials recommend against its routine use in abortion due to an increased risk of death.
Dilation of the cervix carries the risk of cervical tears or perforations, including small tears that might not be apparent and might cause cervical incompetence in future pregnancies. Most practitioners recommend using the smallest possible dilators, and using osmotic rather than mechanical dilators after the first trimester of pregnancy.
Instruments are placed within the uterus to remove the pregnancy. These can cause perforation or laceration of the uterus, and damage to structures surrounding the uterus. If the uterus is perforated, surrounding structures, especially the bowel, may be pulled through the perforation into the uterus. Partial evisceration can result, with its attendant risks, including peritonitis and the need for a colostomy.

Woman died after illegal abortion in Venezuela

Laceration or perforation of the uterus or cervix can result in amniotic fluid embolism, with the resulting risk of disseminated intravascular coagulopathy, shock, and death.
Incomplete emptying of the uterus can cause fever, hemorrhage, and infection, which if not promptly diagnosed and treated can lead to sepsis and death. Another risk is failure to diagnose ectopic pregnancy, which can lead to rupture, infection, hemorrhage, sepsis, and death. Use of ultrasound verification of the location and duration of the pregnancy prior to abortion, with immediate follow-up of patients reporting continuing pregnancy symptoms after the procedure, will virtually eliminate this risk. In some cases, the abortion will be unsuccessful and the pregnancy will continue. Most practitioners recommend a second procedure to terminate the pregnancy due to the possibility that the abortion attempt had caused injury to the fetus.
The sooner a complication is noted and properly treated, the lower the risk of permanent injury or death.

• Abortion-breast cancer (ABC) hypothesis

The controversial abortion-breast cancer (ABC) hypothesis posits an association between having an abortion and a higher risk of developing breast cancer. The proposed mechanism is based on the increased estrogen levels found during early pregnancy, which initiate cellular differentiation (growth) in the breast in preparation for lactation. The ABC hypothesis states that if the pregnancy is aborted before full differentiation in the third trimester, then more "vulnerable" undifferentiated cells would be left than prior to the pregnancy, resulting in an elevated risk of breast cancer. The majority of interview-based studies have indicated a link, and some have been demonstrated to be statistically significant, but there remains debate as to their reliability because of possible response bias.

According to the National Cancer Institute (NCI), it is "well established" that "induced abortion is not associated with an increase in breast cancer risk." Those findings have been disputed by Dr. Joel Brind, a leading scientific advocate of the ABC hypothesis. Nevertheless, gaps and inconsistencies remain in the research as the "ABC link" continues to be a politicized issue.

• A specific and undisputed complication that can arise, especially with repeated abortions by a dilatation and curettage, is the development of Asherman syndrome.

Mental health

The medical literature has not conclusively shown that abortion affects mental health.

"George Walter, an employee of then US Surgeon General C. Everett Koop, conducted a review of more than 250 studies in the literature pertaining to the psychological impact of abortion. Walter conducted the review at the request of Koop, who was being pressured by then US President Ronald W. Reagan to produce a report. Walter consulted primarily with researchers from the Alan Guttmacher Institute and the Centers for Disease Control, and used primarily studies recommended by researchers in favor of easy access to legal abortion. Walter submitted the report to Koop, who instructed Walter to shelve the report. Koop submitted a letter to Reagan indicating that the research was inconclusive. However, Walter released the report under Koop's name. Thus, public debates in the US as to the safety of legal abortion remain muddled. Opponents of abortion cite Koop's letter finding the evidence inconclusive, and those favoring the availability of legal abortion cite Walters' report, released under Koop's name, and attributed to Koop."

Research on the risk of clinical depression associated with abortion has been inconclusive:

• Another study of 2,525 women revealed that women who had an abortion were more likely to report depression or lower satisfaction with their lives. However, they also often reported rape, childhood physical and sexual abuse, and violent partners. After controlling for the history of abuse, partner characteristics, and background variables, abortion was not related to poorer mental health.
• A study in the Medical Science Monitor stated that, "Consistent with previous research, the data here suggest abortion can increase stress and decrease coping abilities, particularly for those women who have a history of adverse childhood events and prior trauma." In the study, 65% of post-abortive American women and 13.1% of Russian women experienced multiple symptoms of increased arousal, re-experiencing, or avoidance associated with posttraumatic stress disorder (PTSD). According to the study, 14.3% of American and 0.9 % of Russian women met the full diagnostic criteria for PTSD. However, in all fairness, not all PTSD is necessarily from abortion. Labor Law Talk has this commentary on the paper: "In keeping with the paper, it should however be noted that many day to day tasks cause problems for sufferers of PTSD, especially as a result of child abuse. Visits to dentists are often a problem, but women often still try to get to them and to avoid all events in life that might lead to re-traumatization."

Emergency contraception

Emergency contraception refers to forms of birth control that can be used after sexual intercourse. Birth control primarily prevents pregnancy by preventing fertilization. However, some forms of birth control, especially if used immediately prior to or after intercourse, can potentially prevent implantation of the embryo (often called a blastocyst), causing its death. If personhood starts at conception, this would be morally equivalent to an abortion. The most controversial of these forms of emergency contraception is currently the morning-after pill, which is legal in a number of countries and has recently been legalized in the United States and in Canada.

History of abortion

According to some anthropologists, (induced) abortion has occurred from ancient times forward. Abortions were induced with sharpened sticks, poisonous herbs, abdominal pressure, special exercises, and other techniques. Many ancient texts contain specific recipes for abortificants, or even descriptions of specialized medical instruments designed to remove a fetus from the womb. Along with changes in medical science, there have been changes in the societal norms and laws that govern abortion.