Problems in Embalming: Cyanide Poisoning Rebecca J. Majus Department of Mortuary Science and Funeral Service, Southern Illinois University Carbondale

ABSTRACT WHAT IS CYANIDE? HOW CYANIDE DEATHS AFFECT EMBALMING FLUIDS TO USE

“Cyanide is used as a suicidal agent but also as a homicidal agent, particularly [8] Cyanide is a rapidly acting, fatal chemical Unnatural conditions caused by cyanide include: Multi-fluid Formula: among healthcare and laboratory workers, and it can potentially be used in a compound that consists of a carbon atom • Bright pink color of the blood C x V = C’ x V’ terrorist attack. It is also still used in cases of illegal euthanasia” (Musshoff, triple-bonded to a nitrogen atom • Intense livor mortis (intravascular blood discoloration) 24 (fluid index) x 40 (oz) = 2.5% (TDS/total diluted solution) x 384 (oz) Kirschbaum, & Madea, 2011, p. 1). Although cyanide poisoning deaths are (Department of Health, 2006). rare in the United States today, there are still people who have ready access to • Low blood viscosity • It will take 40 ozs (2.5 bottles) of a 24 index fluid to make three gallons of a the poison through their occupations. These occupations include chemists, • Rapid postmortem staining 2.5% injection solution. jewelers, those involved in pest control, mineral refining, photography, • Autopsies are often performed electroplating, dyeing, printing, and salmon poaching (Gill, Marker, & Stajic, (Mayer, 2012). Pre-Injection 2004). The purpose of this research is to inform funeral professionals, or • 16 oz. of Proflow (1 bottle) anyone interested, what cyanide poisoning is, how death from it occurs, how Livor mortis (Intravascular blood discoloration) to detect it in postmortem remains, how it poses a problem for embalmers, and what embalming techniques can be used to treat it. Being able to determine Numerous forms of cyanide exist: • Can be distinguished by pressing on the discoloration. If discoloration Arterial Fluids postmortem identifying factors of cyanide poisoning without autopsy lightens and the imprint of the fingers can be seen, this is a good test it’s • 40 oz. of Metasyn Accelerated (2.5 bottles) • Gaseous hydrogen cyanide (HCN) intravascular and can be cleared confirmation can be beneficial toward treating it correctly. With this • Water-soluble potassium and sodium cyanide salts • 6 oz. of Coloro #2 knowledge, embalmers can then treat the decedent to look how the deceased's • Livor can be removed by arterial injection or by elevating the affected • 20 oz. of Metaflow • Poorly water-soluble mercury, copper, gold, and silver cyanide salts tissues family remembered them. • 16 oz. of Rectifiant (1 bottle) (Department of Health, 2006). • Livor and stain can appear in the same tissues but livor precedes stain. • 302 oz. of Water (To fill to 3 Gallons) • Refrigeration can speed hypostasis of the blood and the resulting livor mortis OBJECTIVES An individual can be exposed to cyanide through: and post mortem stain Cavity Fluids • Inform funeral professionals, or anyone interested, what cyanide poisoning is • Inhalation of hydrogen cyanide gas • Brought about by gravitation of blood into the dependent capillaries. • 32 oz. of undiluted Cavity-N (28 Index) • Ingestion of cyanide salts • First observed 20-30 minutes after death. (Mayer, 2012). • (2 bottles: 1 up, 1 down) (thoracic, abdominal, pelvic). • Inform how death from cyanide biologically occurs. • Subcutaneous and intravenous injection (Department of Health, 2006). CASE STUDY A 40 year old, 5’5” and 130 pound housewife of a chemist was found lying in [3] [2] [4] • Inform how to detect cyanide in postmortem remains. bed at her residence, no longer than 24 hours, with a suspicious beverage and letter on the beside table. She has bright pink lividity, oral purge, and smells of • Describe how cyanide poses a problem for embalmers. HOW CYANIDE KILLS “bitter almonds.” The coroner determines suicide by cyanide poisoning to be the cause of death and does not require an autopsy to be performed. Refrigeration is • Suggest embalming techniques which can be used to treat cyanide poisoned • According to the Indian Journal of Pharmacology, cyanide poisoning is not needed. remains. associated with a 95% mortality rate. It is one of the deadliest poisons EMBALMING STEPS because it kills the enzymes that transport oxygen throughout the body. Death occurs within minutes, literally starving the body of oxygen. 1) Elevate the head and shoulders to help drain blood from upper tissues. • Being able to determine postmortem identifying factors of cyanide poisoning without autopsy confirmation can be beneficial toward • The natural history of severe acute cyanide poisoning is a lactic acidosis 2) Wash and shave remains. Disinfect orifices and set the features. treating it correctly. leading to respiratory failure, coma and death. Cyanide inhibits mitochondrial CONCLUSION 3) By palpating the discoloration and seeing a fingerprint appear, it known that the cytochrome oxidase, an enzyme system responsible for aerobic cellular pink lividity is an intravascular blood discoloration which should clear during Being educated on how to determine postmortem identifying factors of cyanide respiration. It causes inhibition of aerobic and activation of anaerobic respiration arterial injection and subsequent blood drainage. poisoning, without autopsy confirmation, will help embalmers consider cyanide leading to accumulation of lactate, producing metabolic acidosis. poisoning as being a possible cause of death when they see certain postmortem CYANIDE IN OUR HISTORY (Weerasinghe, D. S., MBBS, Perera, H. J., MD, & Abeyasinghe, N. L., MD., 4) Close the mouth using a needle injector and brads. discolorations or smell a certain “bitter almond” scent that is associated with 2011). cyanide (Gill et al., 2004). With this knowledge, embalmers can create a World War II: Holocaust 5) Cover the face with massage cream. memory picture of the decedent that their loved ones can cherish. • January 30, 1933 – May 8, 1945 • Cyanide leads to histotoxic hypoxia by poisoning the systems that utilize • Hydrogen cyanide gas (Zyklon-B) oxygen to create energy and preventing them from using the oxygen. Even 6) Select the right common carotid artery for injection and right internal jugular REFERENCES vein for drainage. • Millions of innocent civilians were killed by the Nazis with though there is plenty of oxygen there, the cells experience a lack of oxygen and [1] Department of Health. (2006, April). Retrieved September 09, 2017, from are affected as if there was too little/no oxygen available (Karius, 2017). https://www.health.ny.gov/environmental/emergency/chemical_terrorism/cyanide_general.htm Zyklon-B gas during World War II. Zyklon-B pellets would 7) Drainage should be continuous until the livor mortis clears. Then, [2] Dodge. (n.d.). Metaflow. Retrieved October 10, 2017, from https://shop.dodgeco.com/en/chemicals vaporize when exposed to air. Originally intended for commercial intermittent/alternate methods of drainage can be employed. Manual massage [3] Dodge. (n.d.). Metasyn Accelerated. Retrieved October 19, 2017, from https://shop.dodgeco.com/en/chemicals use as a disinfectant and an insecticide, the Nazis discovered and mechanical raising/flexing of a body limb may assist in distribution [4] Dodge. (n.d.). Rectifiant. Firming. Retrieved October 10, 2017, from https://shop.dodgeco.com/en/chemicals through experimentation the gas could be used to kill humans HOW CAN YOU DETECT A CYANIDE DEATH? and diffusion of the fluid. (Personal photo) [5] Everything you need, all in one place. (n.d.). Retrieved September 09, 2017, from (Ganesan, Raza, & Vijayaraghavan, 2010). The classic descriptions of the autopsy detection of cyanide ingestion include: http://www.thechampioncompany.com/product-catalog.html • Pink lividity 8) Use sufficient pressure and rate of flow to uniformly distribute arterial solution. [6] Ganesan, K., Raza, S. K., & Vijayaraghavan, R. (2010). Chemical warfare agents. Journal of Pharmacy & Begin at a slow rate of flow with high pressure. Once distribution is established, Bioallied Sciences, 2(3). Retrieved September 8, 2017. • Odor of “bitter almonds” Jonestown Massacre then a small increase in flow can better ensure distribution to distal body areas. [7] Gill, J. R., M.D., Marker, E., Ph. D., & Stajic, M., Ph. D. (2004). Suicide by cyanide: 17 deaths. Journal of • November 18, 1978 • Gastritis Forensic Sciences, 49(4). Retrieved September 8, 2017. • Oral/perioral erosions [8] Jcwf. (n.d.). Lewis-structuur van het cyanide ion [Photograph]. (Originally photographed 2009, December 21) • Potassium cyanide 9) Pre-inject with a large enough volume to help clear livor mortis. [9] Judge, J. (1985). The black hole of Guyana the untold story of the Jonestown massacre . Retrieved September • A community of mostly Blacks and women drank cyanide from paper cups of (Gill et al., 2004). 8, 2017, from https://www.ratical.org/ratville/JFK/JohnJudge/Jonestown.pdf. Kool-Aid as part of a mass suicide pact of the Jonestown camp. Adults and 10) Arterial Embalm. [10] Know the threat you can't see. (n.d.). Retrieved September 09, 2017, from Occupation of the deceased should be taken into account. This is because the http://www.cyanideinsight.com/cyanide-poisoning/where-cyanide-is-found children died and fell around the main pavilion. Jones himself was shot in the use of cyanide to commit suicide by people who have easy access to it is [11] Lindsay, A. (2006, April 19). Cyanide poisoning. Retrieved September 09, 2017, from head, an apparent suicide. For days, the body count mounted, from 400 to nearly 11) Aspirate - immediately after arterial injection using a trocar. https://www.thenakedscientists.com/articles/features/cyanide-poisoning predictable and could help solidify your suspicions. 1,000. The bodies were flown to the United States and later cremated or buried [12] Mayer, J. S. (1986). Color and cosmetics: the consummation of restorative art. Dallas, Tex. (P.O. Box 4495, in mass graves (Judge, 1985). 12) Cavity Embalm. Dallas 75208): Professional Training Schools. Specific occupations that use cyanide are: [13] Mayer, R. G., & Reed, J. D. (2012). Embalming: History, theory, and practice. New York: Mcgraw-Hill Medical. • Jewelers - use cyanide to rid gold of tarnish. 13) Pack the trachea with cotton using the purge preventative method to Chicago Tylenol Murders [14] Musshoff, F., Kirschbaum, K. M., & Madea, B. (2011). An uncommon case of a suicide with inhalation of • Salmon Poachers - poison salmon with a cyanide compound called Cymag. prevent any possible expulsion from the lungs/stomach. hydrogen cyanide. Forensic Science International, 204(1-3). Retrieved September 8, 2017. • September 1982 • Miners - use cyanide to separate various precious metals from ores. [15] Weerasinghe, D. S., MBBS, Perera, H. J., MD, & Abeyasinghe, N. L., MD. (2011). Case report – Death by • Potassium cyanide • Healthcare and laboratory workers (chemists) can also be suspected. 14) Realign the features. subcutaneous injection of cyanide in Sri Lanka. Journal of Forensic and Legal Medicine, 18(4). Retrieved • “Seven people from suburban Chicago died after taking Extra Strength (Mayer, 2012). September 8, 2017. (Gill et al., 2004). [16] Wolnik, K. A., Fricke, F. L., Bonnin, E., Gaston, C. M., & Satzger, R. D. (1984). The tylenol tampering Tylenol capsules that had been maliciously adulterated with cyanide” incident - tracing the source. Analytical Chemistry, 56(3). doi:10.1021/ac00267a003 (Wolnik et al., 1984, p. 1). 15) Remove massage cream and cosmetize with a transparent liquid or cream cosmetic. These may be clear or translucent (cloudy) as they appear in the ACKNOWLEDGEMENTS container: applied thinly, they appear transparent and the skin is visible through Special thanks to Dr. Thomas Shaw and the SIUC Mortuary Science and RESEARCH POSTER PRESENTATION DESIGN © 2015 them. Apply finishing powder last. www.PosterPresentations.com Funeral Service department for guidance in my research. (Mayer, 1986).