ET–18 will cover decomposition, the processes involved and conditions associated with it.

  Decomposition is the sum total of a number of processes.

  These processes are:
•     Lipolysis – the breakdown of fats
•     Fermentation – breakdown of carbohydrates
•     Saccharolysis – breakdown of sugars
•     Putrefaction – breakdown of protein
•     Autolysis is the self-digestion by bodies own enzymes.
•     Saponification is the breakdown and transformation of fatty tissue in a wet environment into a grave wax or adipocere (greasy soapy substances).
•     Maceration is the breakdown in a liquid medium.

  Early unseen signs of decomposition begin in the region of the larynx and trachea. First external sign is a green area about the size of a dime in the right inguinal region (ileocecal junction).

  Predisposing conditions associated with decomposition:

• Hydrocephalus  
• Edematous bodies 
• Peritonitis
• Burns                
• Gangrene              
• Mutilations
• Pregnancy         
• Febrile diseases      
• Septicemia
• Purge

  All predisposing conditions are not associated with decomposition but may be contributing factors if the body is not treated, for example dehydration.

  Dehydration may be due to physiological, pathological or environmental conditions. It is a major concern of the practitioner/embalmer in creating a natural appearance. In nature dehydration is a natural process of preservation. Dehydration can be caused by heat or cold.

  Dehydration is in many cases a predisposing consideration associated with:

• Hemorrhage        
• Emaciation        
• Refrigeration
• Burns                  
• Pyrexia              
• Malaria
• AIDS*

  *AIDS may cause fever, dehydration, emaciation, jaundice, edema, connective tissue tumors and/or hemorrhages in the body and this creates a number of different approaches to the embalming process.

  Emaciation has many physiological and pathological causes which include:
Moisture and tissue loss – Numerous low resistance areas
Shrinking of tissue cells – Common with diabetes
Increase in size of intercellular spaces – Common with diseases associated with the cranium

  Edema in its many forms may be a major predisposing consideration in the treatment of bodies where death was associated with:

Renal Failure                                       
Congestive heart failure Cirrhosis of the liver
Phlebitis      
Trauma                           
Alcoholism
Burns          
Carbon monoxide poisoning         
Cancer
Parasites       
Lymph vessel obstructions Drugs (steroids)
Allergic Reactions                                 
Pulmonary       
Cytotoxic

  Edema is classified according to its area of involvement (location).
•     Dropsy – an old term for edema
•     Ascites – fluid in the peritoneal cavity
•     Hydrothorax – fluid in the thoracic cavity
•     Hydropericardium – fluid in the pericardial cavity
•     Hydroperitoneum – fluid in the peritoneum
•     Hydrocephalus – fluid in the cranial vault
•     Hydrocele – fluid in the testes
•     Hydrops – gross edema in whole body (fetal)
•     Extravasation – accumulated liquid (water/fluid) in tissues 

  Four types of edema:
• Cardiac         
• Renal
• Inflammatory
• Obstructive

  Primary concerns when dealing with edema:
•     Distention of tissues
•     Increased dilution factor (tertiary dilution)
•     Desquamation (skin slip) (hydrolysis of the ret mucosum)
•     Leakage
•     Bullae on dependent parts (clear)
•     Capillary-venous congestion
•     Increase in permeability of capillary walls
•     Decrease in osmotic pressure of the blood

  ET–19 will continue with decomposition and the minimal treatment of conditions caused by certain diseases.