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Drinking grandma: the problem of embalming.

The Origin and Spread of Embalming in the United States

While embalming has origins going back to ancient Egypt, its roots are not as deep in the United States. The modern practice of embalming owes its origins to the American Civil War. Faced with the problem of shipping dead soldiers home, the army commissioned Dr. Thomas Holmes to develop a method of preservation (Roach, 2003). He came up with and emblaming fluid that used arsenic as the main ingredient because it was effective in killing the microorganisms responsible for decomposition (Knoefes & McGee, 2002).


After the Civil War, the practice of embalming spread and became increasingly common. The final train ride of Abraham Lincoln's embalmed body form Washington, D.C., to Illinois raised awareness even more. Open-casket funerals became the norm (Roach, 2003). The era of arsenic-based embalming lasted until the early 1900s when it was banned because of harmful health effects (Knoefes & McGee, 2002) and because it interfered with criminal investigations of cases where arsenic poisoning was suspected (Iserson, 1994).

This firs era of embalming provides a clear example of the impact of embalming on the environment. Studies in Iowa and New York found elevated levels of arsenic in the groundwater "downstream" of late-19th-century cemeteries, as well as higher levels of copper, zinc, and lead--elements associated with caskets (Knoefes & McGee, 2002).

Despite this, embalming and open-casket funerals continues to be the norm in America. A number of rationales have been given for the expansion of these practices. Urban population density prevented traditional funeral practices such as leaving the body in the parlor and holding the funeral service at home. And as life spans increased and contact with death became less common, the fear of death increased. When death did occur, people had a desire to render death more aesthetically pleasing.

The most likely reason for the continues practice of embalming is that it fueled the expansion of the funeral industry. Dempsey (1977) wrote, "Economically speaking, there is no doubt that viewing the corpse is one of the fundamentals of economy of the funeral industry." When you make the body the center-piece of the funeral, you incur costs in dressing and preparing the body a viewing room with attendant chapel, floral costs, expensive caskets, and grave vaults. Today the funeral industry in the United States takes in approximately $13 billion per year (Harrington & Krynski, 2002). The funeral industry remains the driving force behind embalming. Harrington & Krynski's 2002 study confirmed that funeral directors do induce customers into burial and embalming over cremation. This inducement is aided by state regulations that tacitly encourage embalming by linking funeral home licenses with embalming certifications.

Modern embalming entails replacing the blood with an embalming fluid. A slit is made in an artery and the embalming hose is inserted. The blood is drained and disposed of via the regular sewer. Roach (2003) notes, "Just as blood in the vessels and capillaries once delivered oxygen and nutrients to the cells, now those same vessels, emptied of blood, are delivering embalming fluid." Red coloring is added to the embalming fluid to give the bodies a natural coloring.

The primary ingredient in most modern embalming fluids is formaldehyde. It takes roughly 3.5 gallons to embalm the average adult (Cook, 1999). The National Funeral Director's Association estimates that two million Americans are embalmed each year. That translates into roughly seven million gallons of formaldehyde being deliberately placed in the soil each year.

In addition, at least 42 other federally regulated "dangerous chemicals are also commonly used in embalming and body preparation (Iserson, 1994)." All of these dangerous chemicals also end up in the ground or being burned in a crematorium. Because formaldehyde makes up the largest percentage of embalming fluid, it will be the focus of this article.

Formaldehyde breaks down first into formic acid (which is itself hazardous) and then into carbon dioxide. It is unclear how long formaldehyde remains in the soil before it degrades or what damage it does in the meantime (Cook, 1999).

Formaldehyde has a big advantage over arsenic and other alternatives in that it helps stiffen the body and helps fix the body in a desired position. The more embalming find used the longer the body lasts but in a less lifelike condition (Mitford, 1998). Undertakers attempt to find just the right balance of diluted embalming fluid to preserve the body in a lifelike condition long enough for the funeral. Embalming "is designed to keep a cadaver looking fresh and uncadaverous for the funeral service, but not much longer (Roach, 2003)."

The Dangers of Formaldehyde to Public Health and the Environment

Formaldehyde is used in the production of resins, plywood, permanent-press cotton, certain molded plastics, and a variety of other uses (U.S. Consumer Product Safety Commission, 1997). It also occurs naturally during combustion. Most studies on the effects of formaldehyde on public health and the environment focus on airborne exposure rather than groundwater or waterborne exposure. Nonetheless, the findings suggest that formaldehyde is harmful to public health and probably not a good thing to be adding to the environment.

In June 2004, the International Agency for Research on Cancer upgraded formaldehyde from a probable human carcinogen to a known human carcinogen (International Agency for Research on Cancer, 2004). Based on animal and human reactions, they have proposed an air quality standard of 0.1 mg/[m.sup.3] (roughly .1 parts per million [ppm]) and a drinking water standard of 900 [micro]g/liter. A World Health Organization study (WHO, 2002) found that formaldehyde acts as an irritant at low levels of exposure.

The Occupational Safety and Health Administration (OSHA, 2008) has placed form aldehyde on its list of toxic chemicals with a permissible exposure limit of 0.75 ppm over the course of an eight-hour workday. If formaldehyde levels exceed this, a warning must be posted which says, part, "irritant and potential cancer hazard." A 1998 publication by the National Institute for Occupational Safety and Health states that embalmers are exposed to an average of 9 ppm while embalming. At levels between 10 ppm and 20 ppm, formaldehyde causes more severe symptoms; at levels of between 50 ppm and 100 ppm, it causes fluid on the lungs and death.

The National Cancer Institute has reported that exposure to formaldehyde increases the risks of brain cancer and leukemia and the U.S. Environmental Protection Agency (U.S.EPA) has listed formaldehyde as a probable carcinogen since 1987 (Welton, 2003). U.S. EPA also regulates formaldehyde as a hazardous waste. Embalming manufacturers also recognize the occupational danger of formaldehyde (Bedino, 2004).

High formaldehyde exposure makes embalmers more susceptible to chronic bronchitis and eye and skin irritation. A number of studies have found "that embalmers are at significantly greater risk than the general populace of getting cancers of the skin, brain, colon, sinuses, nose, throat and blood, kidney failure, arteriosclerotic heart disease, chromosomal damage, and cirrhosis of the liver (Iserson 1994)" Crematory workers were found to have slightly elevated risks for some diseases that formaldehyde is also known to cause.

A 1980s White House groundwater task force report raised the possibility that cemeteries would be a potential pollution source, but concerns were dismissed because of the lack of studies about the problem, not lack of evidence (Cook, 1999). At present, U.S. EPA guidelines don't include recommendations about testing for formaldehyde and no safety standards have been set. Cook reported that studies in Canada have turned up low concentrations of formaldehyde outside of cemeteries and that a study in Great Britain turned up extremely high concentrations in water that collected in the bottom of freshly dug gravses. A literature survey for the Institute of Occupational Medicine revealed a number of similar studies of groundwater near cemeteries from around the world (Creely, 2004). Studies of cemeteries in regions where embalming is practiced found low levels of chemicals used in embalming fluid. Creely noted that a study of an Ohio cemetery found dramatic levels of arsenic and other heavy metals associated with various embalming fluids as well as casket materials.

Embalming fluids also end up in the wastewater of funeral homes. This has been studied more because of the potential health risks of draining blood and bodily fluids into the sewer system. These studies have found that large wastewater treatment facilities can adequately handle the relatively small volume of diluted embalming fluid and blood (Green, 2003). A 2003 study by the National Funeral Directors Association (NFDA) found that a properly installed septic system can reduce formaldehyde levels to a safe level in facilities not connected to a sewer system (Green, 2003).

Formaldehyde also enters the atmosphere through cremation. Because all combustion creates some formaldehyde the contributions of cremation are assuredly de minimis. Nonetheless, cremating are assuredly de minimis. Nonetheless, cremating embalmed remains would release a larger quantity of formaldehyde into the air. Once in the air, formaldehyde can last for up to 250 hours in good weather (WHO, 2002). Because formaldehyde is highly soluble, it readily attaches to atmospheric moisture and washes out in precipitation. Embalming also renders the remaining ashes slightly carcinogenic.

The environmental impacts of formaldehyde are less known. WHO (2002) found that formaldehyde injured or killed developing marine plant life as well as the root systems of some plants. They did not find any impact on larger wild animals through waterborne exposure. Embalmed bodies buried at sea take longer to decompose because fish and other marine life are repelled by the odor of the chemicals (Iserson, 1994). Formaldehyde is on a U.S. EPA list of the top 10% worst chemicals for hazardous impact on the environment (Bedino, 2004). Fortunately, formaldehyde does not appear to be bioaccumulative (WHO, 2002).

Only a small percentage of the total formaldehyde manufactured and consumed each year finds its way into embalming fluid. Nonetheless, this small percentage is placed almost directly into the environment despite potential harm and questionable benefit.

The Current Legal Status of Embalming

Misconceptions on the legal status of embalming abound. For instance, more than half of Americans believe that embalming is legally required or that embalming is required before cremation (Iserson, 1994). Another common misconception is that embalming is required when transporting a body across state lines. None of these claims is true. The funeral industry stood to gain from these mistaken beliefs and may have spread misrepresentations about the law. To prevent this, the Federal Trade Commission passed a rule in 1984 forbidding the practice of claiming that embalming is legally required.

Currently, embalming and embalming fluids are exempt from a number of federal environmental laws. Embalming fluids are included in the same exemption from the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) that exempts natural pesticides like cedar, peppermint, and garlic. Wastewater discharge from the manufacture of embalming fluid is specifically exempt from the Clean Water Act. A permit is required under the Clean Water Act when burying a body at sea or spreading cremated remains at sea, but other than a requirement that the burial be done more than three miles from the coast and that the body be weighted so that it doesn't rise up again, the regulation is silent on embalming.

By contrast, some environmental laws do cover key ingredients in embalming fluid. The Resource Conservation and Recovery Act (RCRA) defines formaldehyde as a hazardous substance, and as such, spills over 100 pounds by carriers and transporters must be reported under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA). In the context of wood furniture manufacturing operations, the Clean Air Act lists formaldehyde as a "volatile hazardous air pollutant."

In defining hazardous waste, U.S. EPA has devised a toxicity mixture test. If you add something toxic to something nontoxic, the whole thing becomes toxic. This becomes relevant to the embalming process twice. The mixture rule first applies during the embalming procedure where wastewater containing a mixture of embalming and bodily fluids is flushed into the sewer system. A number of hazardous chemicals are used in the process and inadvertently mixing them in too high a proportion can trigger a violation (Green, 2003).

Applying the mixture test comes up a second time with the embalmed bodies. When you add embalming fluid, which is toxic, to a dead body, which is nontoxic, the whole becomes toxic waste. Understandably, this is upsetting for mourning families and U.S. EPA seems to have modified their position. Under proposed emissions standards for crematories, U.S. EPA has come to the conclusion that the human body should; not be labeled or considered "solid waste."

The biggest government regulation of the funeral industry is a 1984 Federal Trade Commission rule designed to stop certain unfair practices used by the funeral industry. Most relevant to this discussion are rules against embalming bodies without authorization and forbidding claims that embalming preserves the body forever. In Harry and Byrant Co. v. Federal Trade Commission, which upheld the rule, the court found that even the funeral industry's own study indicated that "nearly ten percent of the funeral buyers in a given year would decline embalming if allowed to choose."

Aside from the FTC rules and federal environmental laws, most laws regulating the funeral industry come at the state level. Twenty-eight states require that funeral directors also be embalmers in order to get a license and 33 states require that funeral establishments maintain embalming facilities (Harrington & Krynski, 2002). Other licensing regulations require additional education and training. Harrington (2003) explained that these state regulations serve mostly to impair the entry of new firms into the funeral market and preserve a quasi monopoly for existing firms.

The Rationale for Embalming

Only in Canada and the United States is the practice of embalming widespread, although it is spreading to England and Australia (Welton, 2003). This immediately raises suspicions about the supposedly apparent necessity of embalming. Two main arguments have been put forth as to the necessity of embalming: embalming as a public; health measure and embalming as psychologically necessary for the mourning process.

Public Health

The first argument is that embalming is necessary as a public health matter (Mitford, 1998). Common sense would suggest that rotting corpses are indeed a public health risk. Because embalming floods the body with disinfectants, it kills any infectious organisms that may remain. While this general theory is partially accurate, it overstates the role of embalming.

The only health risk from corpses comes from communicable diseases, such as typhoid, cholera, or the plague (Mitford, 1998). In some ways, however, dead bodies are safer because, as Mitford puts it in The American Way of Death Revisited, dead bodies "don't excrete, inhale, exhale, or perspire."

Embalming alone is not foolproof; "Other infectious organisms are virtually unaffected by normal embalming practice, including those that cause anthrax, tetanus, and gas gangrene (Iserson, 1994)."

A study in the United Kingdom suggests that rather than helping the public health, embalming actually harms the public health by exposing embalmers to the bodily fluids of the deceased (Creely, 2004). The same UK study provides a list of bloodborne diseases such that any body with these diseases should not be embalmed, which further undercuts the public health rationale of embalming.

Diseased blood in a hospital would be treated as medical waste and death with accordingly, yet when that same blood is extracted during the embalming process, it is simply dumped into the sewers (Mayer, 2000). Absent embalming, neither blood nor embalming fluids would be entering the wastewater.

Psychological Benefit

The second argument in favor of embalming is that by preserving the body and having a viewing it enables the mourning family to form a "memory picture" that will somehow help with the grieving process (Roach, 2003). As the public health benefit claims have been criticized, more emphasis has been placed on this psychological benefit. "[W]ith great candour it is now conceded ... that the sole function of embalming is to produce a short-term, superficial but aesthetically pleasing preservative effect for the benefit of grieving relatives," says Wilkins (1990).

Some funeral industry surveys of mourning families indicate that the viewing of the body does have important positive psychological effects by allowing the grieving families to grasp the finality of death (Dempsey, 1977). By allowing the mourning family to see their loved one, they can be assured that their loved one is truly dead and that there hasn't been any mix-up in the morgue (Roach, 2003).

Alternatives to Embalming

"A body will keep, under normal conditions, for twenty-four hours," according to Jessica Mitford (1998). Two exceptions to this general rule are if the body is opened or has been floating in the ocean, it keeps for less time.

Freezing is the most viable alternative for preventing decomposition in the short term. It preserves the body in a way that does not require toxic chemicals. At present many funeral homes and hospitals are already equipped with refrigeration facilities (Funeral Consumers Alliance, 2003).

Other alternatives that preserve the body and prevent odors include packing the body with dry ice and placing the body in a waterproof pouch with lime (Iserson, 1994).

Another alternative to the open-casket funeral is known as green burial. The goal of green burial is to respect the natural course of decay and minimize the impact of the body on the environment. One of the rules of green burial is that the body can not be embalmed. The reason for this, as Joshua Slocum, executive director of the Funeral Consumers Alliance, puts it, is "from a common-sense standpoint, putting a chemical that the Occupational Safety and Health Administration deems toxic into the ground certainly can't be beneficial to the environment."

Cremation is making great advances, being used in approximately 25% of all deaths in America (Iserson, 1994). These percentages have risen dramatically in recent years and the reasons given are illuminative. The lower cost of cremation is the single largest reason given, followed by what can be broadly called environmental reasons (Horton, 2003). It can be inferred that the increased use of cremation is a direct consumer choice away from embalming. This inference is given more weight in the study by Harrington and Krynski (2002), which demonstrated that in states which require funeral directors to be embalmers or have embalming facilities, cremation rates decrease due to funeral director inducement.

If preservation is truly the goal sought by embalming, two alternatives reported by Iserson offer much more practical promise. The first is by completely encasing the body in plastic and the second is mummification by dehydration. Both will preserve the body for a much longer time than the current embalming practice.

Situations Where Embalming Is Still Useful

Some cases exist where the benefits of embalming outweigh the health and environmental risks. Every first-year medical student must come face-to-face with a human cadaver for purposes of medical education. Because the bodies need to last longer than the length of a funeral service, anatomy departments use a much higher concentration of embalming fluid. The corresponding increase in health risks for anatomy students can be dealt with by increased ventilation and greater diligence.

A need still exists for embalming in cases where the mourning family desires an open-casket funeral or viewing and the body needs to be transported over a long distance, such as when dead soldiers are shipped home from overseas. Another case is when the viewing lasts over a longer period of time, such as President Reagan lying in state in the Capital or Pope John Paul II lying in the Sistine Chapel.


The costs of embalming to the public health and environment are at best mild, and the benefits of embalming are cosmetic or illusory. Severely curtailing embalming would have a number of immediate benefits for the public at large. It would remove a minor, yet blatant, source of pollution. Cemeteries would become less of a nuisance to live next to. Potential long-term health consequences can be avoided. The inclusion of an embalming requirement in the licensing of funeral establishments has served as a large impediment to any person desiring to start a funeral home. By removing embalming from the equation, it allows easier entry into the funeral market and the consumer benefit of lower prices and more options.

"[Formaldehyde] is going to show up, but it's going to take a while. We're probably drinking great-grandmother Maude right now more than we are someone who died last Saturday night," says Julie Weatherington-Rice, an environmental consultant who has studied arsenic in groundwater (Cook, 1999). Frankly, that should be enough.

Corresponding Author: Dr. Ted Chiappelli, Associate Professor of Health Sciences, Western Carolina University, G-05 Moore, Cullo-whee, NC 28723. E-mail:


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Jermiah Chiappelli, J.D.

Ted Chiappelli, Dr.P.H., M.H.A., M.S.S.M.
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Title Annotation:SPECIAL REPORT
Author:Chiappelli, Jermiah
Publication:Journal of Environmental Health
Geographic Code:1USA
Date:Dec 1, 2008
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