As the frequency of accidents caused by electricity is rapidly increasing, we have of late years been enabled to generalize in a manner never before possible in regard to their results, and although our present conclusions must be recognized as provisional and perhaps temporary—to be changed or modified in accordance with future knowledge—yet we have obtained a basis of fact on which we can securely rely. The general laws of injury and accident through electricity have been fairly well determined, although many of the details are not yet thoroughly worked out or understood. The advances of knowledge in this direction are so rapid that an article on this subject, if it deals too closely with details, is liable to become out of date almost before it has left the press. Like all large subjects when first made objects of general interest and investigation, and in regard to which we are on the threshold only of knowledge, the facts discoverable may lead us at any time in unexpected directions and open out new fields of thought and inquiry. We shall try to limit ourselves here, as far as possible, to proved facts, and leave questions doubtful or in dispute to be settled later; contenting ourselves merely with pointing them out and, perhaps, in some cases giving the facts on either side.

Electrical accidents and injuries may be divided into those which are caused by the atmospheric electricity—lightning proper, globes of fire, St. Elmo’s fire—and those produced through the agency of mechanical or artificial electricity—electrical machines, batteries, dynamos, etc. The effects caused by these different agents probably vary only in degree: the atmospheric electricity in the form of lightning, etc., being so much more powerful than the charges usually produced artificially as to cause some difference in the results.

RESULTS OF ACCIDENTS AND INJURIES FROM ELECTRICAL MACHINES AND CONDUCTORS.

Medical Electricity.—In the ordinary use of the mild forms of electricity employed for medical purposes, certain phenomena may at times occur, which, although not of any serious import or of long duration, may yet cause considerable inconvenience, pain, or discomfort to the patient or others, and may even be of some importance from a medico-legal point of view. We shall not enter here into the discussion of the proper methods of application of medical electricity, nor do more than point out that if these be not followed with care the patient may be not only not benefited, but made worse, and may even suffer considerable injury. The increase of pain caused by the improper application of certain currents is usually temporary and of minor consequence. But serious and lasting inflammations may be caused by the careless, ignorant, or injudicious use of the stronger currents internally, and metritis and peri-uterine inflammations have been not infrequently reported from the unskilled practice of the methods of Apostoli. These subjects, however, scarcely come under the scope of this article.

In addition, however, to these troubles we may have external injuries produced. Even in cases where the current amounts to not more than a few milliamperes burns may be caused by the ordinary electrodes of the galvanic battery. The faradic current when medically used does not, as a rule, produce any external injuries. Such might be caused by a spark from a static machine, but it would be due to gross carelessness, and is very unusual. Burns, however, from the use of the galvanic current are not very uncommon. They usually occur under the electrode after it has been for a few moments stationary in contact with the skin. They occur in certain patients with extraordinary readiness, especially in those with organic spinal lesions, and where the sensation is somewhat diminished, and where also some trophic lesion might be supposed to exist. They are not confined, however, to this class of cases, but may occur in any one if the electrode be retained too long in any one place, and especially if it be allowed to become dry. These burns are peculiar in appearance and can usually be recognized at once. They are circular, as if punched out, about the size of a common pencil or a little smaller, comparatively deep, gray with perhaps a dark ring at the circumference, and frequently surrounded by a reddened area. The edges are sharp. Their peculiarity consists (1) in their painlessness and (2) in their size, regular form, their depth in comparison to their extent, and the sharp limitation of the area of tissue destroyed. One or more may occur under a broad electrode, and they are probably produced at those points where the contact is imperfect or the conduction in some other way impeded. They heal without much difficulty and leave no serious results.

Other unpleasant symptoms produced by currents in medical use may be mentioned for the sake of completeness, and also as an introduction to the more serious symptoms caused by stronger currents. Dizziness, vertigo, tinnitus, nausea, vomiting, and syncope are readily caused by even slight currents. The sensation of light in the eyes and the metallic taste in the mouth are the results of medical currents of ordinary strength when applied to the head or in its neighborhood, and stronger currents applied at greater distances cause these sensations. All the above symptoms may be readily caused by even slight currents, whether galvanic or faradic, passed through the head. The syncope thus produced is to be carefully differentiated from the syncope caused psychically by excitement or fear of the application of electricity. Hysterical women, and even persons who show no special signs of nervous instability, may faint at the suggestion of the application of electricity. I have seen a large, strong, well-built Italian man, perfectly sound physically, so far as could be detected, except some slight local neuralgia, faint from pure fright when the electricity was to be applied. But even the application of moderately severe shocks from the ordinary medical battery are not likely to produce serious results. These shocks are ordinarily caused by the opening or closing of the galvanic current, and are most severe when the current passes through some portion of the head. A still more powerful shock may be given by reversing the current in a galvanic battery by means of the commutator.

Currents of High Tension—Strong Artificial Currents.

Passing on now to the consideration of the stronger currents, we come to those used for mechanical purposes, for electric lighting, electric railways, and other analogous objects. These currents start from dynamos or from storage batteries, and accidents are caused by them whenever they are diverted from their proper course and are caused to come in contact with or to pass through any portion of the human body in any considerable strength. Accidents not infrequently occur from direct contact with the batteries or dynamos, but still more frequently they are produced in their circuit along the wires or transmitters. They may also be caused, as some of the most fatal have been, by contact with metallic or other readily conducting objects which have themselves accidentally come in contact with some portion of an electric circuit (usually wires) and have diverted the whole, or more usually a portion, of the current to themselves. Thus was killed a young man in New York, the clerk in a store, who while lifting the metal-edged cover of a show-case brought it in contact with the charged wires of an electric light and received an immediately fatal shock. As a rule, those meeting with accidents from dynamos or electric machines directly are employees of electric companies, who are presumed to have more or less knowledge of the risk of carelessness, or they may be workers in institutions or factories in which such machines are in use. Many of the accidents due to wires also occur to linemen and other employees of electric, telephone, or telegraph companies or of electric railway companies in charge of wires or electric outfit. So long as the current transmitters and terminals (wires, etc.) are properly insulated and in their proper position in relation to other conductors, it is unusual for accidents to occur, except in cases of gross ignorance or carelessness. Unfortunately, however, proper insulation is not always accomplished, and frequently wires and other transmitters are removed from their proper positions by accidents and otherwise. So long as and wherever the system of overhead wires exists, if there be among these wires any which are the transmitters of strong electric currents, there is always a risk, and often a very serious one, that at some time or other one of these current-bearing wires will come into contact with some other non-current-bearing and ordinarily harmless wire in such a manner that the current of the first should be diverted, in whole or in part, on to the ordinarily innocuous wire, which thereby becomes at once charged and dangerous. Such an accident may be due to the displacement of either wire or to any other cause which brings the two in contact, either direct or indirect, at a point where the current-bearing wire is not sufficiently insulated. The current having once passed out of its proper circuit will, of course, follow the paths of best conduction, and may hence suddenly appear in unexpected quarters and produce the most dangerous and even fatal effects. It is accidents of this character which most frequently occur among the people who are neither employees of electric companies nor engaged in factories or buildings where electrical machines are employed.

Insulation of Wires and Other Electrical Transmitters.—We cannot mention here the various methods employed to insulate wires, as the general principles of insulation are well known. Electric wires even with very strong currents can be insulated and can be kept insulated if sufficient pains be taken and sufficient money be expended. But this is very expensive and in many cases is not done. Only partial insulation is attempted, and even this is not always carried to the degree intended or stipulated. Hence so long as overhead wires of various kinds exist, accidents from the transmission of strong electric currents along ordinarily harmless wires are liable at any time to occur, as practically little or no attempt at keeping the current-bearing wires covered with a thoroughly insulating material is in most cases made. It is usually deemed sufficient that glass or other insulators should be so placed that under ordinary conditions the wire will not come into contact with any conductor which may cause any essential part of its current to diverge. In most cases a so-called insulating material is placed over the wire itself, but this usually is insufficient at the outset or becomes so before very long and is then not renewed.

It must not be supposed, however, that underground electric wires or transmitters cannot produce accidents. On the contrary, the current may be diverted from them to the gas or water pipes or to any other conductors which come into contact with them or can attract to themselves a portion of their current. Severe shocks have been experienced by persons attempting to draw water at their faucet from causes of this character. At the same time, so far as mere safety is concerned and freedom from electrical accidents, it would seem that underground wires are preferable to overhead wires.

Electrical wires have not infrequently come in contact with telegraph and telephone wires causing unpleasant results. Telephone boxes have been set on fire, and also telegraph boards and tables, and in certain cases what might have been serious conflagrations have been started in this manner. By means of proper arrangements on the telegraph and telephone circuits these dangers can be at least partially avoided, but there is always the risk that the automatic alarms and other contrivances do not act, and the still greater one that persons or things may come into contact with these charged wires and receive dangerous or serious injuries.

Electric Cars.—The danger from the overhead wires in the trolley system of electric cars would not be great were these wires properly supported, properly insulated, and properly protected. Each of these terms must be explained. Wires which fall for any cause whatever short of being intentionally removed cannot be deemed properly supported in the sense in which we use the term. Any one of these electric wires which falls is liable to produce serious injury to persons or animals (many horses have been killed by them), or to set fire to objects with which it comes into immediate or indirect contact, the amount of injury being in part dependent upon the nature and the condition (wet or dry) of the object and its position in relation to other conductors. Wires as dangerous as these car wires should be so supported that no ordinary accident, no condition of the weather, strong winds, or heavy falls of snow should be capable of wrenching them from their supports, and they should be placed in such positions and with such protection as not to receive blows from passing or falling objects.

Secondly, these wires should be properly insulated. This is to be understood to mean that all the wires which carry the electric current, or are liable to carry it, should be attached to their poles or other support in such a manner that no appreciable quantity of electricity is under any circumstances liable to be diverted to the poles or supports, and in this way cause destruction or injury. In addition to this the side wires should be so covered that if any accident occurs, it will be difficult or impossible for the current to pass away from them to other objects. The middle wire on which the trolley runs cannot be thus covered, but must be left bare, and hence, if knocked down or brought into contact with properly conducting objects, must be the most dangerous; but on the other hand from its position it is less liable to accidents.

When we say that these wires should be properly protected we mean that such arrangements and contrivances should be used as will prevent them while in their usual position from coming into contact with dangerous objects, particularly with other wires. This may be accomplished by guard wires or in other ways. It is plainly of great importance that this should be specially cared for, and particularly in a city where there are many overhead wires, and perhaps a considerable number of dead or non-used wires. If the electricity comes into contact with one of these no one can tell where it may be transmitted or what harm it may do.

The principles which apply to these overhead wires of course apply ceteris paribus to all other electric overhead wires, and in like manner the statements made in regard to the diffusion or spreading of currents in underground wires are applicable to all methods of transmitting electricity mechanically through the ground so far as the conditions are similar. An electric current will always follow the path of best conduction, and where several paths are opened it will follow them proportionally according to the excellence of their conduction or inversely to the amount of their electric resistance.

We shall not enter here into any questions in regard to the diffusion of electricity, its transmission through fluids, water, air or other gases, nor shall we discuss the relations of good or bad conductors to electricity except so far as this relates to certain portions of the human body. An elementary knowledge of physics and electricity must be presupposed.

We can now enter more directly upon the immediate subject of this article, that is, the effect upon the human body of severe or moderately strong currents of electricity derived from artificial sources. The accidents produced by these currents may be divided into two classes, the direct and the indirect. Under the direct we place all those conditions which are apparently produced by the action of the electricity itself, such as the general shock, the loss of consciousness, the burns, etc. On the other hand, all those accidents are to be considered indirect which are not primarily due to the action of the electric current, but are only secondary results thereof. These are largely determined by the immediate surroundings and conditions at the time. Such, for example, are the surgical injuries due to falls caused by the loss of consciousness produced by the electric shock.

Indirect Accidents.

These will be considered first, as they do not demand so detailed a description as the direct. They are traumatic in character and are the result either of loss of consciousness, momentary or lasting, or of the involuntary muscular contraction which may be occasioned by the electric shock. They are among the most frequent effects of severe electric shocks. These accidents consist in contusions, fractures, dislocations, wounds, and any other injuries which may be produced from sudden loss of consciousness while in a dangerous position. Death may readily occur either immediately or as the more or less delayed result of such injuries. If the person shocked falls into the water he may be drowned, or if into the fire he will be burnt. The varieties of such accidents dependent on the sudden loss of consciousness produced by the electricity are, of course, innumerable, and their occurrence must largely depend upon the position of the victim at the moment of the shock. We see, perhaps, most of these accidents in linemen on the tops of poles or houses or in other exposed places, but persons who receive shocks when simply standing on the ground or when sitting are not exempt from severe surgical injuries other than burns. They are often cast to the ground with great violence, and not infrequently are thrown to a distance of several feet. This is caused by the violent muscular contraction produced by the electric shock, and it may occasion, like any violent push or fall, severe injuries from contact with the various objects against which they may be forced. Although much rarer, it is also possible that the violence of these muscular contractions may be such as of themselves to cause injury, as rupture of a muscle or tendon. As practically all these indirect accidents are traumatic and surgical in character, they do not differ from other accidents similar in kind, but otherwise caused, and are to be treated on the same general principles as these.

Direct Accidents.

Quite different from the indirect are the direct accidents; those produced by the immediate (direct) action of the electricity. These are of various kinds, which we shall consider separately. They may be divided into immediate and late symptoms, and they vary much according to the severity of the shock and the constitution of the patient, and the part of the body through which the electricity passes. The character of the current which gives the shock, whether constant or interrupted, also naturally has an influence on the effect.

General Principles.—A shock may be given in three ways with an ordinary galvanic battery. If the current be sufficiently strong, a distinct shock will be produced when the circuit is closed and again when the circuit is opened, while with a current of the usual strength for medical purposes, the sensation while the current is passing through the body steadily is much less and is often limited to a sensation of burning at the seat of the electrode. A shock may also (thirdly) be produced by a reversal of the current, and the shock thus caused is stronger for the same current than that produced in either of the other ways.

The strength of these shocks is shown both by the sensation produced and by the amount of muscular contraction caused. When now a shock is caused by a continuous or constant current which starts from an ordinary dynamo or other electric generator or storer, it is practically always caused by the opening or closing of the circuit, or, what is essentially the same, the diversion of a part or the whole of the current from its proper path to and through some portion of the human body causes a shock at the time of the entrance of the body into the circuit and another at the time of its exit therefrom. Shocks from reversal of current when such current arises from a constant machine might occur, but only through some peculiar accident. Hence the shocks (distinguished from any other effects of electricity) which are received by the person coming into contact with a constant current are felt only at the moment of entering the circuit (closure) and of leaving it (opening). If a person introduces himself between the two wires of an electric circuit in which a constant current is used, in such a manner as to cause the current to pass through his body, he will feel the shock only at the moment when he touches the second wire and completes the circuit, and at the moment when he lets go one of the wires and opens the circuit (unless the current be so strong or be so placed that he can divert to himself sufficient electricity to cause a shock, or, in other words, close a secondary circuit in some other way). While the current is passing through the body, although it may burn and cause tingling and other unpleasant symptoms, there is no proper shock. In other words, an electric shock is caused only by a change in the amount of electricity passing through the body or a portion thereof.

If we now consider the effects of alternating currents, we find that we have another factor to deal with. The general principles are exactly the same, but inasmuch as the reversal shock is stronger than the closure or opening shocks, other things being equal, we are likely to receive a stronger shock from a current of the same force, and in addition to this, as in alternating machines the reversals occur with considerable rapidity, the person who becomes connected with this circuit receives a number of strong shocks within a short space of time. This is a much more serious matter than to permit a current of equal strength to flow through the body without change.

—The effect of this form of electricity on the human body is first stimulating and then tetanizing to the muscles. It consists in a very rapidly interrupted current, the shocks being at times so frequent that they are not singly perceptible. There is probably also a distinct difference in the action of this current from that of the galvanic current aside from its rapid interruption. This is not, however, of so defined a character as to enable us at the present time to distinguish in man the results of severe injuries and deaths caused by this form from those caused by other strong currents. Practically this form of current is but little used, except in medical batteries and for the purposes of experimentation in laboratories.

Static electricity has, so far as we know, rarely or never caused serious injuries or death. The sparks produced in this way have sometimes caused burns, and it is conceivable that a strong electric current produced in this way might be dangerous. The symptoms could not be distinguished from those caused by other forms of electricity.

Summary.—The greatest source of danger from electric currents is the shock produced by them. In ordinary constant or continuous currents this is produced only at the moment of the opening and the closure of the circuit. In alternating currents a shock is also produced at each reversal of the machine. Faradic and static currents are rarely or never used mechanically or in the arts.

Resistance.—The resistance of the human body to electric currents has been very variously estimated.

The reasons for these variations are: (1) that the different tissues present different resistances; (2) that the resistance in the same tissue varies greatly under different circumstances.

The tissue which offers the greatest resistance and also practically the greatest variation is the skin, or, more properly speaking, the epidermis. The resistance of this is many times as great as that of the rest of the body, and when perfectly dry it is impervious to currents of great strength. Witz states that in using a Ruhmkorf coil with an estimated force of 250,000 volts in Guinea-pigs and rabbits, it is advisable to cut through the skin in order to apply the electrodes directly to the flesh, or, at least, to wet the skin thoroughly, otherwise the shock caused by the full strength of the battery (six jars charged from the coil) would not cause death. Various animals offer rates of resistance which vary somewhat apparently according to the nature of the animal, but are probably largely dependent on the conducting power of its tissues, that is, of its skin. The variations between the resistance of similar animals, according to the condition of the skin at the time of the experiment, are much greater than those which are found between animals of different species under similar conditions, or which are referable to specific susceptibility. Mr. Harold P. Brown testified in the Kemmler case (Court of Appeals, State of New York—State of New York ex rel. William Kemmler against Charles F. Durston, agent and warden) that he had in the course of his experiments seen a horse weighing 1,320 pounds, with a resistance of 11,000 ohms, killed by an alternating current at 700 volts.

The resistance of the different cutaneous surfaces of the human body as measured by Jolly in Siemens’ units was from 400,000 down to 15,000 in the male and to 8,000 in the female (Siemens’ unit is to the ohm as 1.06 to 1.00).

Tschirfew and Watteville made the resistance from 80,000 to 3,000 ohms.

Experiments made at the Edison Phonograph Factory and Edison Laboratory in July, 1889, on 259 males between the ages of eleven and fifty-one, showed a resistance, measured between the hands immersed to the wrists in a solution of caustic potash independent of polarization, averaging 986 ohms and varying from 1,970 to 550 ohms.

The resistance of 236 men employed at Messrs. Bergmann & Co.’s Electrical Works in New York appears to have averaged 1,184 ohms and to have varied from 1,870 to 610 ohms. These measurements were also taken between the hands, which were washed with soap and water and then dipped in jars containing a solution of caustic potash. The battery consisted of four chromic-acid cells each having an E. M. F. of 2 volts.

As shown in all the experiments on animals and more especially in the cases of electrocution, the continuance or duration of the current has much effect on the resistance. As the current continues the resistance diminishes. Thus in the case of McElvaine the resistance between the immersed hands was at the beginning 800 ohms and at the end of the contact of fifty seconds had decreased to 516 ohms. In this case, when the current of 1,500 volts was applied from the forehead to the leg, the resistance was practically steady at only 214 ohms. Of course the small resistance in these cases (electrocutions) depends largely on the perfect contact secured.

According to the amount of resistance offered do the effects of severe shocks of electricity differ. This is shown especially well in the action of lightning, but is also true of powerful currents produced mechanically. If the resistance of the skin be slight at the moment of entering the circuit of a strong current, the current will pass through it with comparative ease and without causing much injury; but if on the other hand the resistance is great, the current will be, as it were, momentarily retarded or stored, heat will be developed, and there will ensue a burning and charring of the tissue of a special kind. These burns occur principally at the places where the current is specially resisted, that is, at the point of entrance of the current to the body and at its point of exit. This is the cause of the frequent burns in the heel or sole of the foot in the case of those struck by lightning while standing, as the electricity passes away from the body into the ground and finds a strong resistance at the point of leaving the body. This is also the cause of the burns where the current leaves the body from any other cause, as from the contact or proximity of a metallic object. The greater the resistance so long as the current passes, other things being equal, the more severe is the burn. It is for this reason that in medical electricity we usually use wet sponges on the skin or electrodes moistened with salt and water or with other fluids which will assist in rendering the passage of the electricity through the skin more easy. Solutions of chlorid of sodium and of certain other salts do this.

The mechanical effects of currents vary thus according to the resistance encountered. They also vary according to the intensity or concentration of the current. If a current of moderate force be applied through a small metallic point, it will burn, pain, and produce active irritative symptoms, while if the same amount be applied over a large surface simultaneously, it may have little or no irritating effect. We have, therefore, three factors in determining the mechanical effect of any electric current on the body: (1) the condition of the body, that is, the amount of resistance which the current will encounter at its entrance and exit; (2) the amount and intensity of the current; and (3) the character of the current. For practical purposes of the more severe currents we have only to deal with the continuous and alternating.

SYMPTOMS.

Direct Symptoms.

The direct symptoms produced by powerful mechanical currents of electricity may be divided into three classes: I. The mechanical; II. The essential or internal; III. The mental or psychical.

These classes are fairly distinct, but they are not absolute, and certain symptoms are on the borders.

The most important mechanical symptoms produced by these currents are burns. These occur at all points of strong resistance externally, hence especially at the points of entrance and departure of the current. They vary from all grades, from the lightest possible, where only the fine hairs on the skin are singed, to those of extraordinary depth and severity. The characteristic burn from powerful currents is, however, well distinguished. It consists in a deep hole of various shapes with clear-cut edges surrounded by an inflamed area and containing in its cavity a mass of blackened tissue which only separates from the portions below after several days, and causes a wound which, though not very painful, heals very slowly. The severity of electric burns is often at first sight underrated, and their duration, when severe, is unexpectedly long. It occasionally happens that after a burn of this character appears nearly healed, the surrounding and, in appearance, healthy tissue breaks down, perhaps under a healthy skin, and a destructive process occurs which much retards recovery. This is evidently due to tissue destruction from a strong electric current of such a character as to produce necrobiosis without the external appearances of a burn. These burns are, perhaps, oftenest seen on the hands, but this is only because these parts are more likely to come into contact with the current. They may occur in any portion of the body.

Eyes.—The injurious effect of electric light upon the eyes has been carefully studied by several competent observers. So far as known it has been caused solely by the arc light. The symptoms produced by exposure of the eyes for a considerable period to the electric light may be slight or severe. In the slighter cases we find merely an acute conjunctivitis with a slight central scotoma which passes off within twenty-four to forty-eight hours. The symptoms are those usual in acute conjunctivitis—photophobia, lachrymation, sensation of a foreign body under the lids, discomfort in the eyes, and swelling of the lids. In the more severe cases all these symptoms are increased; the photophobia and lachrymation may be intense. There is sometimes severe pain in the supra-orbital nerve, and occasionally a tendency to somnolence. In these cases we find an intense conjunctivitis with chymosis, a central scotoma which may render the patient for the time practically blind, and on ophthalmoscopic examination a congestion of the vessels of the retina and choroid, a neuro-retinitis, and sometimes even hemorrhages into the retina. There is sometimes peripapillary oedema and infiltration around the optic nerve. The pupil of the eye in these cases is usually much contracted. There is sometimes loss of epithelium from the cornea.

In certain severe cases there is produced in addition to the eye symptoms an erythema of the face. Bresse states that this erythema can be produced on the face, arm, or hand by exposure to the voltaic arc at a distance of thirty to forty centimetres. The blush grows deeper for three or four hours, then remains stationary for a time, and ends in desquamation leaving a very durable pigmentation. The erythema is accompanied by a sensation of smarting.

The strength of the light and the length of time required to produce these effects probably vary somewhat according to the color of the light. Emrys Jones states that he is informed that either excess or defect of current gives a less injurious light than the normal current; the excess gives a more violet, the defect a more orange light. On the other hand, Charcot considered that the harmfulness of the electric light was due at any rate in considerable part to the chemical or violet rays, and Bresse found that when violet rays were added to an electric light as by aluminium it was more injurious than before to animals. What part the brilliancy of the light plays in determining the pathological results is not yet fully settled. The heat, however, does not, as a rule, seem to have much effect unless in extraordinary instances where the cornea is burned.

Muscular Contractions.—Another effect of electricity which is externally visible on the human system is muscular contraction. Slight muscular contractions are produced purposely in many cases in medical treatment therapeutically or for the sake of diagnosis. When the stimuli are sufficiently strong and follow each other with great rapidity, or when a strong continuous current is passed through the muscles, they are brought into a state of continuous contraction or tetanus, and in this condition they will remain for a long period or until the electric stimulus is removed. In cases where a severe electric shock is received as from an electric wire, the muscles which come in contact with the wire immediately contract and remain contracted while the current continues to pass through them. As a result of this we often find that when a severe electric shock has been received through the hands by means of a wire or other conductor the sufferer’s hands are involuntarily closed upon the wire or conductor, and cannot be unclosed by any voluntary effort until the current is stopped. While thus holding the conductor the hands are often very severely burnt. Under these circumstances a strong force is required to remove a person from a charged wire if the current be not turned off, and it can only be done at a considerable risk unless by those expert and provided with special means.

Not only the muscles immediately in contact with the conductor, but nearly all the voluntary muscles of the body may be thus affected by a powerful current. Another effect of this involuntary muscular contraction is the forcible muscular movements produced by the shock. As previously stated, when a sufficiently strong shock occurs, the voluntary muscles of the trunk and limbs may be thrown into sudden contraction in such a manner as to throw the person violently and forcibly on to the ground, or against some object or objects in the neighborhood. In this way one may be propelled several feet, and many varieties of surgical injury may be caused. Rarely the force of the contraction is such as of itself to rupture muscles or tendons, and it might even fracture bones or dislocate joints already predisposed.

Essential or Internal Symptoms.

We pass now to what we may consider the internal or essential conditions of electric shock, leaving the mental or psychical results for examination later.

When a person receives a severe electric shock, the symptoms are usually as follows: In the first place there may be little or nothing except a burn or burns, though usually there is some sensation at the moment of the shock. This may be a simple dizziness, and is often accompanied by the sensation of a brilliant flash of light before the eyes, and sometimes by a sense of impending danger. Usually, however, there is a loss of consciousness more or less complete and more or less lasting according to the severity of the shock and the character and course of the current. In the less severe cases this gradually passes away, and in many cases the patient, although weak and feeling shaken and tired, suffers no further ill effects beyond those of the burns and mechanical injuries. Sometimes there follows a general tremor which may last a few hours or for days, and occasionally a clonic rhythmical spasm of one or more extremities. The loss of consciousness may, however, be accompanied or followed by a condition of collapse, in which the pale face, profuse perspiration, cold extremities, and feeble pulse all suggest the administration of stimulants and restoratives. As a rule, in the stage of unconsciousness the face is reddened and rather cyanotic. The pupils are dilated as a rule and the respiration stertorous or absent; the pulse may be full or feeble, sometimes imperceptible for a time. The unconsciousness sometimes lasts for hours, and all means of stimulation, electricity, artificial respiration, rubbing, have to be applied before the patient can be restored. Sometimes this condition is succeeded by delirium (Moyer). In a certain number of cases the shock is immediately fatal, and in others the patients cannot be recalled from their unconsciousness.

The secondary results of the shock, aside from the injuries, may be very slight or again may be serious and lasting. They are far more apt to be of the first class, and when long or continued motor or sensory changes unconnected with injuries follow, we are justified in suspecting mental or psychical phenomena. One class of secondary results is the motor. In addition to weakness, unsteadiness and tremor of the limbs and trunk, it is not uncommon for the patient to suffer from grand rhythmical movements, at first, perhaps, of all extremities, but soon limited to the extremity or extremities which were most exposed or injured by the current. We have personally seen these movements, and feel convinced that they can be distinguished from most of the ordinary forms of convulsive motions and tremors. The whole limb is moved at once and not separate muscles, and the movement is a large, rhythmical one, slow and co-ordinated, not at all suggestive of tremor. Movements of this character are sometimes seen in so-called functional disease (hysteria and allied conditions). They more nearly resemble the movements seen in some forms of Jacksonian epilepsy than any others known to me as occurring in organic disease, but I believe them in these cases to be always strongly suggestive, if not absolutely significant, of functional affections. A case reported by Dr. Robert, of El Paso, well illustrates this condition. The patient, a male, twenty-eight years old, received a shock through a telephone wire. When seen first, reaction was slowly taking place, the entire muscular system was in clonic convulsions. Temperature 97°; pulse rapid and of low tension; respiration 50; no cerebral symptoms. An hour later the movements were limited to the left upper and the right lower extremities, and there was pain running from the region of the spine down the left arm. Twenty-four hours after the shock, temperature 99.5°; respiration 40; pulse 100. Had slept well, but the movements in the left arm had never ceased. The next day these motions were limited to the muscles of the forearm, and on the fourth day they had wholly ceased. These convulsions consisted in extensive motions of the whole extremity or of muscles or muscle-groups, and not of simple tremor. If the movements were forcibly controlled, severe pain ensued.

Next to the motor symptoms the sensory are the most important. Pain not infrequently occurs after the recovery of consciousness in the affected limb; it is apt to be sharp, severe, darting and neuralgic in character. This may last at intervals for some days, a dull ache occurring at first between the intermissions. It disappears of itself in time without lasting effects.

HyperÆsthesia may exist at first. Should this continue, or if anÆsthesia not due to secondary traumatic conditions should appear later, we should be inclined to place these symptoms in the third class.

Of other symptoms occurring in accidents from currents of high potential, those which seem to be due to the direct action of the electricity are not serious. Buzzing in the ears and a metallic taste in the mouth often occur at the very beginning before the consciousness is involved. Nausea and vomiting frequently occur later. There is often considerable dizziness and vertigo. Patients sometimes complain of sensations as of an electric shock running through the body which occur without cause some hours or even days after the real shock. Some of these sensations are certainly to be reckoned under the mental or psychical symptoms. Susceptibility to the effects of electricity, of lightning, and of thunder-storms, though undoubtedly in many cases psychical, has probably in some cases an actual foundation. This is certainly the case in lightning stroke. On the other hand, in the large majority of cases of electric accidents no such result follows, and in many we are expressly told that such a result was looked for but not found.

The temperature, as affected by the electricity alone and not as secondary result of injuries, is not always easy to determine. It seems to be in most cases lowered at first, being in that of Moyer 97.5° and in that of Robert 97°. Later it may rise to a certain extent, usually to not more than 101°, but here again the influence of traumata is difficult to separate.

The pulse may be full and soft or weak and compressible. It is frequently very feeble, sometimes almost imperceptible, and often rapid. It is apt to remain rapid and somewhat soft for days in severe cases.

The respiration is at first rapid in severe cases unless the shock be so great as to cause its cessation. This rapidity remains for a varying period and then disappears.

As a typical case of the results of shock from an electric wire, we will mention the one reported by Dr. F. W. Jackson. The patient, a man twenty-two years old, came in contact with a live electric-light wire, touching it with his hands. He was thrown a distance of about ten feet and then back again, “swinging back and forth two or three times.” His hands were in contact with the wire about three minutes, when the current broke and he fell to the ground unconscious. Was seen two hours later by physician. Temperature 100°; pulse 100, strong and bounding; pupils dilated; headache; nervous and irritable; reflexes increased. The headache was accompanied by insomnia which continued for three days, after which it disappeared, and he resumed work apparently none the worse for his accident. The palmar surfaces of both hands and the anterior surfaces of the forearms were blackened from the tips of the fingers to a point midway between the wrists and the elbows, and these parts were exceedingly sensitive to the touch. The least irritation of the muscles would cause them to contract violently. This condition ceased on the second day. The current was from a fifty-light arc circuit of about 2,100 volts; 6.8 amperes. The accident took place out-of-doors on a very rainy night. The amount of electricity which the patient received was, as in all such cases, very uncertain.

FATAL CURRENT.

The amount of current which will produce a fatal effect varies with the character of the current and with the points of contact. Currents passing through the head or those which affect the pneumogastric nerves are much more dangerous than others of the same character and equal strength passing through one extremity, for example.

The same current will, of course, also produce different effects, according to the facility of its conduction into and through the body, and this depends again on the completeness of the contact and whether the body or the portion thereof concerned enters directly into the circuit or only forms, as it were, a partial conductor and diverts a certain portion only of the current to itself. Again, the condition of the epidermis, whether dry or wet, and the position of the person in relation to good conductors, metallic or otherwise, has much effect.

If the skin and clothes be wet, the resistance to the current is lessened and it passes more readily into the body. In the same way, if a person stands in close relation to a good conductor and places his hand on one wire of a high-tension electric circuit, he will receive a much more severe shock than if not connected with such conductor. Thus a person standing in a pool of water (water is a good conductor), and more strongly if standing on the metallic rail of a railway track, and touching one wire of an electric circuit with one hand, receives a much stronger shock than if he were standing on dry land, or if his boots were rubber or he was otherwise insulated.

The accidents most frequent in practice are those in which the current has been partially diverted from its original course and the person has not entered fully into the circuit. In such cases it is not usually possible to estimate accurately or even approximately the amount of current which the person has received. No calculations can, therefore, be based on these accidents. Again, we find that a person may be seriously or even fatally injured by a current which another person seems to bear with impunity.

D’Arsonval in 1887, in France, advised 500 volts as the maximum for the continuous current and 60 volts as the maximum for the alternating current which might be employed without special permission.

Our only accurate knowledge in regard to fatal currents comes from the experience derived from electrocutions. From these it appears that an alternating current of 1,500 volts is deadly if it passes through the body for more than a few seconds and if the contact is perfect.

Death.—Death may ensue immediately as the result of an electric shock without any evident preliminary symptoms, or it may occur later, either as the direct result of the shock or as the consequence of the exhaustion produced by the burns and other injuries, or directly from the injuries themselves. If death does not occur immediately and if appropriate means of aid are at hand, the sufferer usually survives and the effect of the electric shock gradually passes away. The danger after this arises from the burns and other injuries, and almost all the deaths not immediate are the results of these.

ELECTROCUTION.

Electricity has been adopted in the State of New York as the agent for the execution of condemned criminals. This has given rise to much discussion as to what form of current were the best adapted for this purpose and as to what amount were required to produce death at once and painlessly. These questions may now be regarded as practically settled, at least so far as regards the purposes mentioned, and we shall only refer incidentally to the discussions and their results.

Early in 1890 a committee consisting of Dr. Carlos F. MacDonald, Dr. A. D. Rockwell, and Prof. L. H. Landy made a report to the superintendent of prisons at Albany in regard to the efficiency of the electrical appliances and dynamos placed in the State prisons of Sing Sing, Auburn, and Clinton. This report gave details of various experiments made on animals to determine the amount of current and the time required to produce a fatal result.

On the 6th of August, 1890, occurred the first electrocution, that of William Kemmler, alias John Hart, at Auburn Prison. Dr. MacDonald in his official report to the governor in relation to this says: “It is confidently believed that when all the facts in the case are rightly understood the first execution by electricity will be regarded as a successful experiment. As might have been expected at the first execution by this method, there were certain defects of a minor character in the arrangement and operation of the apparatus. But in spite of these defects the important fact remains that unconsciousness was instantly effected and death was painless.”

The efficiency, rapidity, and painlessness of this form of execution have been confirmed by the later experiences. Up to the present date (May 26th, 1892) eight condemned criminals have been executed in the State of New York. Apparently all the officials who are intrusted with the care and inspection of this subject seem satisfied that this is, on the whole, the wisest, easiest, and most effective form of death thus far practised among civilized nations. The Medico-Legal Journal of New York, in printing the official report of the recent executions of four men made by Drs. C. F. MacDonald and S. B. Ward to the warden of Sing Sing Prison, states that it furnishes “indisputable evidence of the fact (1) that the deaths were painless and the victims unconscious from the instant of contact; (2) that they were certain and unattended with any of the revolting scenes so frequently witnessed at the scaffold; (3) that the method is humane so far as inflicting physical pain or suffering, and from all sides considered infinitely preferable to the death by hanging; and that so long as capital punishment for murder exists in New York, we need not desire to change the method of punishment.” These claims would seem to be thus far substantiated.

The value of this method of execution is now beyond doubt. When properly performed it is rapid, painless, and not repulsive. The criminal has probably no physical sensation of pain or discomfort due to the mode of death from the moment the first shock occurs. Since the rapidity of the transmission of the electric current through the body is in these cases much greater than the rapidity of the transmission of sensation, it seems just to conclude that no sensation from the electricity reaches the consciousness. The only distress suffered by the criminal is the unavoidable mental suffering natural to his position.

The mechanical means employed in electrocution are practically the same at Sing Sing, Clinton, and Auburn prisons. A special room is provided for the purpose, which should be, if possible, in the basement with a concrete floor: this room must be of sufficient size to admit readily the criminal with the attendant officers, the warden and other officials in charge or on duty at the execution, and the witnesses for whom seats are usually provided at a little distance from the criminal’s chair, and also to allow of plenty of room for the management of the electrical apparatus, and a good space around the chair in which the criminal is placed. The electrical plant consists of an alternating-current dynamo and its accessories, placed wherever may be convenient, according to the arrangements of the buildings of the institution, but connected by means of wires with the switch-board in the execution-room. In the execution-room also should be the voltmeter, the ammeter, and such other instruments of measurement or precision as may be required. In charge of these and of the switch-board during the execution is the electrical expert, an official paid by the State of New York. Means of communication by electric bells or otherwise are, of course, arranged between the execution-room and the engineer in charge of the dynamo, so that the current can be produced as desired.

The chair in which the criminal is placed is made of stout beams of oak and is securely fastened to the floor and insulated. It is perfectly plain, with broad arms and an upright back, which latter can be tilted backward a little by means of a special arrangement and firmly fixed in the desired position. This is accomplished by means of a bar of wood which is firmly attached at one end to the lower portion of the back and runs forward thence parallel to the seat of the chair and alongside of it; to the anterior end of this is fastened a perpendicular bar running downward, which can be raised or lowered at will, and securely fastened at any height. As this is raised or lowered, it raises or lowers the anterior end of the horizontal beam and correspondingly lowers or raises the opposite end to which the back of the chair is attached, thus moving the latter. When the anterior end of the horizontal bar is raised the posterior end is lowered and the back of the chair is straightened. Attached to the upper portion of the back of the chair is a head-rest, which can be raised or lowered as desired: it may, as in the case of Kemmler, have a horizontal arm which projects forward and from which the head-electrode may be suspended. The chair is also furnished with broad leather straps firmly attached, two of which pass around the body, one around each upper arm, one around each lower arm, and one around each leg. There is also a broad conjoined or compound strap which passes over the head, encircling the forehead and the chin and securing the head firmly to the head-rest. When these straps are properly adjusted and fastened, any marked degree of movement is impossible. The adjustment and fastening of these straps can be performed very rapidly, in practiced hands taking not more than forty seconds.

The electrodes used have varied slightly in different cases. In the case of Kemmler they each consisted of a bell-shaped rubber cup about four inches in diameter, with a wooden handle through which passed the wires into the bell to end in a metallic disk about three inches in diameter, faced with sponge. The upper electrode was so arranged as to rest firmly on the top of the head, where it was held closely by means of a spiral spring: it was attached to the horizontal arm of the head-rest, a sliding arrangement shaped like a figure 4. The lower electrode was in this case attached to the lower part of the back of the chair, and projected forward at a level with the hollow of the sacrum. There was also connected with it a sliding arrangement, and a spiral spring which in connection with a broad strap around the prisoner’s lower abdomen rendered contact secure.

In the later executions these electrodes have been somewhat modified and differently applied. The head-electrode is now so formed as to cover the forehead and temples, and can be easily fastened in this position without a spring. The lower electrodes have been applied to the leg in each case, sometimes apparently to the calf and sometimes more to the outer side, where they are securely strapped. They are made of such a shape as to cover a considerable portion of the surface in this region. It is not a matter of importance to which leg the indifferent electrode is attached, but they have actually been applied in most cases to the right leg, though in some they were attached to the left. They are thoroughly moistened, usually with a solution of salt and water, and a drip may be arranged so as to keep them wet during the passage of the current or other means employed to this effect.

The electromotive pressure, as shown by readings of the voltmeter by Professor Laudy, in the cases of Slocum, Smiler, Hood, Jugigo, and Loppy, varied from 1,458 to 1,716 volts. The ammeter showed a variation of from two to seven amperes.

The alternating current in the case of McElvaine made roughly 150 periods per second.

The number of contacts made in each case and the duration of each contact were as follows:

In the case of McElvaine, the first contact of fifty seconds was made through the hands, the second contact of thirty-six seconds from the head to the leg. The hands were immersed in cells containing tepid salt water, connected respectively with the opposite poles of the dynamo. Kennelly states that in this case, with the hands immersed and the electromotive force at 1,600 volts, the current began at 2.0 amperes, and in fifty seconds had increased to 3.1 amperes, indicating a resistance between the electrodes of from 800 ohms at the beginning to 516 ohms at the end. In the second application from the forehead to the leg with an electromotive force of 1,500 volts, the current amounted to 7.0 amperes during the thirty-six seconds contact, indicating a resistance practically steady at 214 ohms.

Alternating currents of from 1,600 to 1,700 volts and upward may be considered fatal currents, and as capable of producing death when contact is perfect. Dr. MacDonald goes so far as to say: No human being could survive the passage through his body of an alternating current of more than 1,500 volts for a period of even twenty seconds, contact being perfect.”

The physical phenomena caused in the body by electrocution as at present conducted are comparatively simple, and such as we should logically expect. The instant the body of the patient enters into the circuit of the current, all the voluntary muscles appear to be thrown into a condition of violent contraction which continues so long as the current lasts, and on cessation of the current is replaced by a condition of extreme muscular relaxation. All consciousness is apparently lost immediately on the application of the current. This probably has never returned in any case, but on the removal of the body from the circuit of the current the relaxation of the muscles causes movement, and sometimes, as in the case of Kemmler, slight spasmodic movements of the chest have occurred. The pupils in this case were dilated. The condition of contraction and rigidity is renewed at each new application of the current, to cease immediately when the current is removed.

In Kemmler chest movements and possibly heart-beat occurred after the first contact, the former perhaps half a minute after the cessation of the current.

In Slocum there were chest movements and radial pulsation after the first contact. In Smiler no movement of the chest, but radial pulsation after the third contact. In Jugigo a slight fluttering of the radial pulse when final contact was broken, which rapidly ceased. In Hood no movement or pulse-beat.

In some of the patients superficial burns have been caused by imperfect contact of the electrodes, either on the head or at the position of the lower electrode. In Kemmler’s case the cerebral cortex was somewhat affected under the head-electrode.

The practical effect of the application of the current to the criminal fastened in the death-chair, as seen by the bystander, is that immediately on its reaching him the whole body is straightened and rendered rigid in extension, the extremities tend to straighten out, and the face may grow red and turgid. There is reported at times swelling and turgidity of the neck. The whole body remains in this tetanic, stiffened condition until the removal of the current, when all the muscles relax and the body sinks back into the chair in a state of complete muscular collapse.

MENTAL OR PSYCHICAL SYMPTOMS.

The third class of results which are found after electrical shocks from high-tension currents are the mental or psychical. By the use of these terms we do not wish to imply that they are voluntary. They are, however, so far as our present knowledge of pathology reaches, largely functional. This is precisely the class of cases which, when resulting from railway accidents, are placed under the head of railway-brain or railway-spine. They may be considered in the present state of our knowledge as traumatic functional neuroses, though it is probable that when our means of examination and investigation are more complete we may succeed in discovering a visible or perceptible lesion. The symptoms affecting motion and sensation in these cases are frequently accompanied by others of an emotional character, and in many cases there seem to be partially or wholly voluntary conditions and symptoms with the involuntary. There is in many cases a characteristic loss or diminution of the force and power of volition, but in others this is not perceptible.

These conditions are so well known when produced by other causes that we do not consider it proper to enter into a full consideration of them here, but we cannot leave this important subject without a few general remarks.

No form of affection or disease has caused more discussion among the medical profession or figured more prominently in the courts than this, and even now there are many questions in relation to these conditions still under dispute. Our own view, confirmed both by observation and experience, is that the tendency in New England, at least, has been on the whole to underrate the severity, the duration, and the amount of suffering caused by these conditions. That because there have been cases of malingering, of deception, and of rapid cure after the receipt of damages, and because in addition to this a certain visible emotional and at times apparently controllable element exists, the profession, and above all the laity, are led to conclude that this forms the essential condition and basis of the disease. On the contrary, in a very large proportion of cases the symptoms are such as cannot possibly be voluntarily assumed; they produce extreme discomfort and often much suffering for the patient, and frequently last for years, rendering their victims incapable of carrying on their former occupations.

Fortunately in the patients suffering from electric shock the severer forms of these affections are not so common. In most of the cases reported recovery has been more or less rapid. Cases in which previous hysteria or neurasthenia have existed are more liable to these manifestations than persons of a previously equable nervous constitution, but these latter are by no means wholly exempt. To consider these conditions, as is sometimes done, as the fault of the patient seems to us both unwarrantable and unjust.

LIGHTNING.

We now come to the consideration of the action of electricity in another form, that of natural electricity or lightning. The effects of this are practically the same as those of the forms previously described, except such differences as seem to be fairly accounted for by the vastly greater force of the currents with which we have to deal. Injuries and deaths from lightning stroke have been recognized and described for many centuries, and we have now a large collection of careful observations on them. They occur in most temperate regions with comparative frequency. In France the number of deaths from 1835 to 1852 inclusive (eighteen years) was 1,308. In England, including Wales, there were in twenty years, 1865 to 1884 inclusive, 416 deaths. In 1846 Mr. Eben Merriam, of Brookline, wrote to Mr. Arago that in the three last years about 150 persons had been killed by lightning in the United States. In thirty years, from 1855 to 1884 inclusive, we find 101 deaths in Massachusetts from this cause.

Exposure.—Injuries and deaths from lightning may occur in various places and under various conditions. The severe lightning strokes are popularly supposed to occur only during thunder-storms, and in this latitude this is undoubtedly, as a rule, true, but lightning strokes are reported to have occurred, particularly in the South, from a clear sky, and there seems no reason to doubt that this may happen. It is said also that dangerous discharges from the earth to the atmosphere may take place at a considerable distance from an atmospheric storm. As a rule, the lightning is more likely to strike some tall object, as a tree or a tower or steeple, and for this reason, and to avoid injury from falling branches, the shelter of trees should not be sought during thunder-storms if lightning stroke be dreaded. Ships at sea are frequently struck by lightning, partly perhaps on account of the height of the masts and partly on account of the metal in or on them.

Lightning obeys the same general laws as the other forms of electricity and naturally follows the paths of least resistance. Persons, therefore, who are in the neighborhood of or in contact with good conductors are in more danger of injury by lightning than when surrounded by or in contact with poor conductors. The proximity or contact of a large metallic object exposed in a thunder-storm is consequently more or less dangerous. On the other hand, the absence of tall objects or of specially good conductors of any kind does not insure safety. In many cases persons in fields are struck, and cases are related of persons struck on the prairies in the West. In Fredet’s case a shepherd was found dead in the midst of the barren moors (landes) in Southern France.

More accidents appear to occur directly to persons out-of-doors than to those in houses or other buildings. When inside buildings, persons struck are usually near an open door or window through which the lightning enters, and they are more exposed to danger from this source if there be some metal object or good conductor in the vicinity. Persons carrying or wearing metallic objects render themselves thereby more liable to be injured in this way.

Not only does the liability to injury from lightning vary somewhat according to the exposure or position of the person, both in relation to the free access of the atmospheric air and to the contact with or neighborhood of metallic objects or other good conductors, but also the severity of the injuries may be largely dependent upon what they are wearing or carrying and the condition of their clothing at the time. If the clothing be wet it will act as a good conductor, as will also any metallic object about the person. We have already referred to the action of metallic objects upon the passage of the electricity to and from the body and to the condition of the skin in relation thereto. The laws of conduction and resistance are precisely the same for the electricity of lightning as for the other forms. Hence the greater the resistance to the electricity at the points where it enters or leaves the body, the deeper will be the burn. Thus we find not infrequently that the lightning, in its course from the head to the feet, meets with a chain or a truss, and almost invariably at least a portion of the current follows this, causing a deep burn where it again passes into the skin. All the external burns of the lightning, except the initial one, are determined by the position and conditions of the body, the clothing, and the conductors near. All electricity obeys the same law and, roughly speaking, follows the path or paths of least resistance.

The clothing worn by a person when struck by lightning may be acted upon in the most various ways. Sometimes it is wholly stripped off the unfortunate sufferer, who, as in a case reported by Cook and Boulting, may have to be protected with sacks or other hastily improvised coverings. In a case reported by Nason, a girl of thirteen was struck while in the street and most of her clothes stripped off and torn to shreds, and the top of her hat, which contained steel wires, was torn from the brim. In the case of Wilks the body was stripped entirely naked and absolutely nothing left on except a portion of the left arm of the man’s flannel shirt. The clothing is sometimes torn to the finest shreds, like those of a mouse’s nest, as described by Van Horn, and in another case (Claes), where the patient was struck while on board ship, his woollen jacket was torn into fine bits, which stuck to the ropes, and the deck was covered with fibres of wool as fine as those of cotton-wool. In this case the woof of the trousers was said to have been wholly destroyed, while the web was untouched.

The clothing is also often burnt. Not only are holes burnt in it as is usually the case at the point where the lightning strikes and at the point where it leaves the body, but it may be set on fire. It may be found smoking or in flames.

Of all portions of the clothing injured, perhaps the coverings of the feet are the most frequently so, as the electricity is very apt to leave the body through the feet, and the resistance opposed is great. Hence the boot or shoe is frequently injured. Sometimes it is pierced as by a bullet, or a large hole is torn in it, or it may be torn to pieces or reduced almost to lint, while the foot remains uninjured. It may be torn, shrivelled, and burnt. In one case the soles of the shoes had disappeared; in another the leg of the boot was clearly divided from the sole and both straps were torn out; while again in another the shoe was carried wholly off.

The amount of injury to the clothing does not necessarily correspond to the amount done to the body. A person may be killed by lightning while the clothing is uninjured. On the other hand, the clothing may be torn to pieces, carried away, or even partially burnt, while the portion of the body underneath remains unhurt.

Symptomatology.—The symptoms of stroke by lightning resemble, in a general way, those due to high-tension currents of electricity. As in the case of the latter, they can be divided into the direct, produced immediately by the lightning itself, and the indirect, or secondary, produced through the medium of other factors.

In the milder cases the person struck feels dazed and benumbed and may or may not lose consciousness for a short time. At the moment struck they may have the sensation of a blow, and they often see a blinding flash. On recovery of their faculties there may be a temporary anÆsthesia or weakness of one or more extremities, which rarely lasts more than twenty-four hours. There is a general shock to the system, sometimes slight loss of memory for a time, and occasionally nausea and vomiting. There are often discolorations of the skin of medium extent, and frequently burns and blisters. These persons have usually received the stroke on one extremity or have escaped the full force. In the more severe cases the patient loses consciousness immediately and may continue unconscious for some hours. He passes into a condition of collapse with rapid, feeble pulse and cold extremities, and the pupils are dilated. On recovery of his senses the same symptoms as in the less severe cases, only more pronounced, are found. The loss of memory may be marked and the intellect temporarily weakened, while the weakness and anÆsthesia of the extremities persist longer. The external injuries, burns, and wounds are liable to be more severe.

In the fatal cases where death is directly due to the electricity it is usually instantaneous or at least without recovery of consciousness. It may be caused by shock or by apoplexy, i.e., intracranial hemorrhage or by the direct effect of the electricity on the brain. Of course death is often due to burns or to indirect traumatic injuries.

The indirect traumatic injuries caused by lightning are due either to the loss of consciousness of the patient, which causes him to fall and thus sustain injury, or to the direct action of the electricity upon him, knocking him down or throwing him to some distance, sometimes with great violence, or lastly, and perhaps the most frequent cause, to the impact or pressure of objects which are torn or cast down by the electricity and by striking or falling on a person produce great injury. Thus persons have been killed by the fall of buildings, sheds, or trees which were struck by the lightning, or their branches. Of course all kinds of traumata may be produced thus.

The direct external injuries caused by lightning are burns, subcutaneous hemorrhages, discolorations and markings of the skin either dendritic or metallic, lacerations or wounds.

Burns occur in nearly all, perhaps all, severe cases of lightning stroke. They may be of any or all degrees, and may extend over very small points or over the whole or nearly the whole body. They may consist in a simple singeing of the hair, or they may be very deep and extend to the bone. As before stated, the deep burns are found at the points of resistance to the current, at its points of entrance and exit from the body, and, to a lesser degree, at all points where its course is impeded. This occurs wherever the clothes are fastened tightly or pressed against the body, hence especially at the neck, waist, knees, and sometimes at the ankles. The position of the burns is determined, therefore, by the point at which the lightning strikes the person, the position at the moment, and by the arrangement of the dress and the presence of metallic substances. In the large majority of cases the upper portion of the body is the part first touched by the lightning, and thence it descends along the body to the ground. We are apt, therefore, to find a severe burn about the upper portion of the body, the head, neck, or shoulders; then a scorching, singeing, or burning, more or less severe, in the form of a stripe or stripes more or less broad down the body: the burns being deeper where the clothes are tighter or where metallic objects come into contact with or are near the body; and finally a deep burn at the nearest point of contact with the ground, usually the heel or some portion of the foot.

The burns, however, vary greatly. The eyes may be burnt and severely injured or destroyed. The lightning has been known to enter the mouth and burn the mucous membrane within. The deeper burns not infrequently assume the form of holes. In Heusner’s cases about twenty whitish-gray spots, varying from the size of a lentil to that of a pea, were found on the soles of the feet. The hair is usually singed and may be burnt off in large areas, or wholly as in a case reported by Bernard.

Wounds.—These may be direct or indirect. We shall speak here only of the first. Like burns they occur usually at the points of greatest resistance, that is, the places of entrance and exit, but they may be found in any part of the body. They may be clean-cut, as if made by a sharp knife, or they may be lacerated and ragged with the edges contused or burnt. They may consist of holes which look as if they had been punched out.

Contusions or ecchymoses. These may also be produced directly by the lightning, and like burns and wounds are most apt to occur where the resistance is greatest. They may be of considerable importance in a medico-legal sense, as in Fredet’s case, where there were ecchymoses on the neck similar to those produced by the fingers of a hand applied for strangulation. In the case related by Cook and Boulting the right side of the body appeared like an exaggerated example of post-mortem staining. There are sometimes found also dark-brown spots, small or large, which may be soft and, when cut, containing fluid blood, or they may be hard and like parchment, dry, and bloodless on section.

Closely connected with these are the so-called dendroid or dendritic marks, which are dark-colored reddish bands or stripes, often more or less dichotomously branched, not disappearing under pressure, found on the bodies of those struck by lightning. Though usually of the form mentioned, they may assume other shapes, as that of an irregular star with zig-zag rays. Balfour has figured an excellent example of these.

Metallic staining of the skin has been known to occur where metals were in contact with it at the time of the lightning stroke. These stains may be permanent and are due to the introduction of the finely divided metal. Richardson has succeeded in producing this artificially in animals. He found two conditions required, that the metallic conductor should be sufficiently fine to offer resistance to the current and that the current itself should be an electric discharge of low tension.

Loss of hair is said to have occurred from lightning, though the hair was not burnt. One case has been reported where after a severe stroke all the hair on the body is said to have fallen out.

Symptoms.

Under this heading we shall consider only such symptoms as are, so far as can be ascertained, the direct result of the electricity and not those secondary to injuries.

We will consider first those relating to the nervous system.

Loss of Consciousness.—This occurs to a greater or less extent in all but the very mildest cases. It varies throughout all degrees from a slight momentary benumbing of the faculties to the most profound stupor or coma. It may then last hours or even days. On recovery the patient is apt to have some loss of memory, to be dazed and confused for some time, and a certain obtuseness or blunting of the intellectual faculties may persist for a considerable period. This loss of consciousness is often accompanied by flushing of the face and dilatation of the pupils, or on the other hand the patient may present all the symptoms of collapse.

Loss of memory in regard to the lightning stroke after recovery of consciousness is not rare. It is frequently complete so far as any recollection of the lightning goes, and there may be no remembrance of the thunder-storm. Sometimes a defective memory persists together with general mental impairment (James).

Mental Disease.—A condition of mental impairment lasting at least weeks or months may occur. Mania and the delirium of terror are said to have occurred.

Various symptoms of the disturbance of the nervous equilibrium are not uncommon. Among these we may mention tremor, insomnia, and nervous dread of thunder-storms and of electricity. There is no doubt that some persons who have been exposed to lightning stroke do, at least for a time, become unusually susceptible to the influences of atmospheric electricity.

Loss of Motion—Paralysis.—This is a very frequent result of a stroke from lightning. Hemiplegia is not uncommon. In Bonnet’s case the patient was struck on the head by the lightning, which caused a lacerated wound in the left temple, but did not injure the aponeurosis. On recovery of consciousness the patient was found to have a left hemiplegia involving the face and both extremities accompanied by a diminution of sensation over the left half of the body. The sensation became normal in two days, but a partial hemiplegia remained permanently. In the case of Durand there was a nearly complete right hemiplegia with accompanying hyperÆsthesia and some affection of speech. Deglutition and mastication were difficult, and there was persistent hiccough. There was photophobia and hyperÆsthesia. The patient improved in two weeks and finally recovered. There is often a temporary hemiplegia.

Nearly all forms of paralyses of the extremities may occur. We may have paralysis of all the extremities or of both arms or legs, or monoplegias. Paraplegia occurs not very rarely. It is usually of short duration. It may be accompanied by paralysis of the bladder. Single muscles or muscle groups only may be affected.

Ptosis may occur with paralysis of other branches of the third nerve, causing diplopia. Facial paralysis occurs also alone; in one case it lasted only twenty-four hours, in another one month.

Difficulty in mastication is sometimes found, but much more frequently difficulty in deglutition is reported.

Retention of urine, dysuria, or incontinentia urinÆ may all occur, and there is sometimes a paralysis of the rectum, usually temporary, and sometimes obstinate constipation, which in one case was combined with paralysis of the bladder and monoplegia.

Aphasia in various degrees and various forms of dysphasia or difficulty in speech are not uncommon. They are apt to be temporary.

Loss of co-ordination in the lower extremities with partial paralysis of bladder and rectum is reported.

Convulsions.—Epilepsy may be brought on by lightning: this would be more likely to occur in a person previously subject to epileptic attacks. Hysterical convulsions and spasms may also be produced, both immediately and as a more remote result, usually in persons predisposed. Tetany and catalepsy are said to occur.

Clonic spasms of the whole body and convulsive movements of the limbs are not very infrequent. In some cases a marked sensitiveness remains for a time in the limbs struck, so that if touched they are immediately thrown into clonic spasms.

Disturbances of Sensation.—Pain occurs in nearly all cases. It is most frequently a secondary result of the burns and other injuries. Not rarely, however, it exists as a direct symptom in the form of a burning or stinging neuralgia in the limb or limbs affected. Sometimes the first sensation on the recovery of consciousness seems to be pain all over the body or confined to some portions only, but the amount and character of the pain, aside from that produced by the injuries, varies much. One patient had a burning pain in the back and leg lasting only half an hour after recovery of consciousness. In another case there were pains all over at the end of the first week. On the whole, severe pain in some or all of the limbs, and less commonly in the head, without paralysis and lasting some days is not rare. In one case reported by Paige the patient had intense pain in the head, neck, arms, and chest; that in the head was constant, severe, and lasted seven days, elsewhere less constant.

Pain in the arms accompanied by paralysis and anÆsthesia and lasting three months has been reported.

Headache is not rare as a later or secondary symptom.

Disturbances of sensation other than pain are not rare.

A certain amount of hyperÆsthesia almost always exists in the portion affected immediately after the stroke. This is often so marked that it cannot be wholly due to the burns or other injuries. It is usually very temporary and ceases in a few hours. In some cases a permanent or lasting sensitiveness to the action of electricity is said to remain.

AnÆsthesia, loss or diminution of sensation, occurs either with or without paralysis. In the cases reported by Balfour, one boy said he could not feel his legs and another that his arms were cut off. In a case reported by Free there was loss of sensation in the right upper extremity from the elbow to the fingers and in the left lower extremity from the knee to the toes. As a rule, the loss of sensation is temporary and quickly passes away, but it may last, in company with paralysis, for some time. In such cases either an organic lesion or a traumatic neurosis is to be suspected.

ParÆsthesiÆ are very common after lightning stroke. Most frequent, perhaps, is the subjective sensation of numbness. Tingling, formication, and the sense of “pins and needles” may occur.

Reflexes.—As a rule, the deep reflexes seem to remain normal. The superficial reflexes of the parts affected are at least temporarily increased.

Special Senses.—Sight.—Affections of the eye. The eye and the surrounding parts may be directly injured by burning. We also find many serious conditions caused by the lightning the pathology of which will be considered later. When a person is first struck he may perceive a flash of light or a ball of fire before losing consciousness. While unconscious the pupils are usually dilated, but react. Sight may be at once totally lost, but this is usually only temporary. There may be amblyopia; photophobia, lachrymation, and pain are not uncommon for a time. Cataract may be produced and other severe ocular affections may result.

Hearing.—Sudden and total deafness may be caused by lightning, as in the case of Cook, where perforation of both tympana was found. This may prove to be only temporary, as in the case of Nason, where the patient, though totally deaf at first, is reported as hearing fairly on the fifth day; on the seventeenth day, however, the hearing was still dull. The deafness may be permanent. With deafness tinnitus is apt to occur. Hyperacustia, or extreme sensitiveness to noise, has also been reported in several cases.

Smell and Taste.—The person affected sometimes has noticed a smell resembling that of sulphur, and this has also been said to have been apparent to others. A metallic taste in the mouth is not rare.

General Symptoms.—When first struck by lightning and while still unconscious, the patient has usually a flushed and reddened face, with dilated pupils. Immediately following, or perhaps without this preliminary stage, appear the symptoms of collapse. Cyanosis may occur, and the patient may appear to be asphyxiated.

Fever, not caused by injuries, may sometimes occur, but certainly not to any extreme degree. In many cases the temperature when taken was normal, and even in cases of severe stroke without serious surgical injury the temperature has not risen above 101°. In these latter cases it is hard to say how far the temperature is affected by the burns which are always present.

The pulse is sometimes slow, sometimes rapid and feeble, or almost imperceptible; at times it is irregular.

The respiration is apt to be labored. In Paige’s case there was marked dyspnoea. It may be almost imperceptible. It is sometimes slow and sometimes rapid.

Nausea and vomiting occur often after recovery of consciousness. Vertigo and reeling may exist from various causes.

It is probable that seminal emissions may occur at the moment of shock.

Menstruation, when present, may be checked or may continue. Pregnant women do not necessarily abort.

Pathology and Pathological Anatomy.

A few words must be said in regard to the pathological conditions which may be directly produced by lightning and can be detected during life. The burns, wounds, ecchymoses, dendritic marks, and other external signs have already been fully considered.

Certain pathological changes, however, have been found in the eyes which are capable of being verified during life. In addition to swelling and oedema of the lids, to the injuries from burns and to the various paralyses of the ocular muscles, changes in the tissues of the eye itself may occur. In the first place we may find corneal opacities and adhesive iritis. Iridocyclitis may occur. Cataract formation is not rare, and its causation has given rise to many theories. Optic neuritis and neuro-retinitis are sometimes found; and we have sometimes optic atrophy. Structural changes in the choroid may also be caused by lightning. Rupture of the choroid, hemorrhage from the choroid and retina, and partial detachment of the retina may occur from the shock without the patient being struck by the lightning and without rupture of the external tissues.

Ears.—Perforation of the tympanum is reported in more than one case.

Autopsies.

We shall consider here the pathological conditions found in deaths from electricity, whether due to artificial or to atmospheric sources. The results are or may be the same in either, so far as we now know, and it is probable that the action of the electricity is practically the same in either case, only varying as regards the strength and tension of the current.

Rigor Mortis.—This has generally been found in cases of death from artificial electricity. In the case of Jugigo, who was executed by electricity, it was present four and one-half hours after death. As regards its occurrence in death by lightning and the rapidity of its onset, there has been much discussion. It is certainly present in many cases, and the probability is there is nothing diagnostic in regard to it in deaths by lightning. When absent, its absence is probably due to the presence of some external factor and has no relation to the form of death. We have, on the other hand, no proof that the rapidity of its onset is increased.

Coagulation of the Blood.—It has been observed frequently that the blood of persons struck by lightning does not coagulate readily. Sullivan states that in certain cases of complete disorganization after lightning shock the blood is left fluid and incoagulable and its color changed to a deep black. In one of the cases of death from artificial electricity reported by Grange, the heart was found sixty-two hours after death to be filled with liquid blood of a rosy vermilion color, which quickly became darker on contact with the air. A spectroscopic examination of the blood showed the normal lines of oxidized blood reducible by sulphydrate of ammonium. In a case reported by Matzinger the blood as submitted was black and perfectly fluid, the corpuscles, both red and white, were normal, and no fibrin was detected. In those executed by electricity the blood seems to have been fluid and not in any way remarkable.

There seems to be no evidence that the bodies of those dying from electricity in any form suffer unusually rapid decomposition.

The only absolute sign of death from electricity is decomposition of the tissues, but the usual signs are to be relied upon to the same extent as in ordinary cases of death.

Internal Organs.—In the cases of death from mechanical electricity no changes in the internal organs other than those due to accidental traumata have been found, except a considerable degree of congestion and sometimes minute hemorrhages in the heart substance beneath the pericardium and into the pulmonary air-vesicles and pleura. In one of Grange’s cases the heart was filled with liquid blood; in the other it was completely empty, the right ventricle collapsed, the walls of the left ventricle hard and contracted.

Careful autopsies were made in the cases of the criminals executed by electricity, but no important changes caused by the electric current have been detected either macroscopically or microscopically. A few petechial spots (Tardieu’s spots) are apt to be found underneath the pericardium in the heart tissue and sometimes beneath the pleura. The organs were not extremely congested. In the case of Jugigo the vessels of the spinal cord and its membranes contained if anything less blood than usual. In this case the amount of blood found in the brain seems to have been about normal, the vessels of the dura were moderately dilated and those of the pia “in a medium state of congestion.” In the case of Kemmler the portion of the intracranial contents underneath the head-electrode was somewhat affected directly by the heat, the meningeal vessels in the dura were carbonized, and the brain cortex was sensibly hardened to one-sixth of its depth, “where there was a broken line of vascularity.” The post-mortem temperature in this case seems to have remained unusually high, being 97° F. in the fourth ventricle and 99° F. at the back of the neck three hours after death in a room where the temperature was only 83°.

In autopsies after death by lightning the results are in general analogous. The brain and its membranes may be anÆmic or congested. Effusions of blood may be found beneath the dura or in the brain substance itself, due to the laceration or injury of vessels. Rupture of the brain is said to have occurred, and Phayre reports a case in which the left hemisphere was entirely destroyed and changed into a dark gray homogeneous fluid mass, only a small portion of the corpus callosum remaining. No extravasation of blood, laceration of the vessels or membranes, or injury of the bones was detected.

Ecchymotic spots are frequently found beneath the serous membranes, pericardium, pleura, and peritoneum.

Schmitz states that parenchymatous inflammation of the internal organs may occur, and Sullivan reports a case where the stomach was found to be gangrenous over a large surface, the patient having lived several days. Cases of rupture of the heart, the liver, and the spleen are reported.