- Email: [email protected]
ELECTRIC SHOCKS.
357
disagreeable symptoms. I had several other similar lucky experiences and the same is the case with other operators. Indeed, I am of opinion, on the ground of this experience, due in many such cases to some factor of which the same may be said in explanation of Professor Cameron’s brilliant results. A fibroid is capricious in its course and may cease to grow and to bleed spontaneously. I am speaking, be it understood, solely of cases said to be suitable for oophorectomy, cases where the fibroid grows near the fundus, nourished by the ovarian artery. Yet I have had good results in several cases where even the cervix was involved, though with that condition failure is the rule. My good, or, rather, lucky, results can hardly have been due to the removal of the ovaries alone. Indeed, the majority of patients did well for a year or so, then the bleeding returned In one case in my own or the tumour continued to grow. practice 39 a strange result ensued : great and permanent reduction in the size of the tumour occurred, yet the sup" pression of the catamenia was but partial. The show" was accompanied by all the disagreeable symptoms of the menopause, and last autumn (10 years after the operation) the patient, then 48 years of age, saw the period three or four times yearly and suffered from occasional flushings. A return and advance both of the bleeding and of the growth of the tumour seem, however, to have been the rule The reason when oophorectomy for fibroid was popular. seems to be evident : the ovarian tissue on the distal side of the pedicle resumed its functions, for a time in abeyance owing to the organisation of lymph thrown across the groove formed by the ligature, a condition well known in the pedicle after ovariotomy. 40 In performing a hysterectomy in a case where oophorectomy had failed I detected a small, fiat button of ovarian tissue lying on the stump of the The operation tube against the cornu of the uterus itself was not without dangers-slipping of the ligature of the pedicle and thrombosis of a pelvic vessel or of one of the big veins of the lower extremity being not unknown. In anaemic cases the shock was often quite as great as after the removal of a big fibroid and I reported a fatal case in the address to which I recently referred. Again, the ovaries may be so placed in relation to a big tumour as to render their removal impossible. The haemorrhage in some instances proved to be due to a polypus high up in the distorted uterine cavity and thus easily
that
cure was we are
ELECTRIC
SHOCKS.
BY DR. S. JELLINEK.
ignorant ;
IN a very remarkable article which appeared in THE LANCET in 19021 Mr. F. B. Aspinall gave his views regarding the action of the electrical current on the human body. His reasons are strengthened by observation upon a large number of accident cases and by experiments carried out on the human body. There is a boundary between the technical and the medical knowledge of electricity, and the physician wishing to treat the subject satisfactorily must understand the technical working of electricity as well as the scientific, otherwise the solving of certain questions is impossible. As I myself have been studying atmospheric and technical electricity concerning their effects on animals I wish to add a few remarks to the article published in THE LANCET.2 While I agree with Mr. Aspinall on a great many points, As to on some important questions I am of another opinion. his first question: "Is everyone equally susceptible to an electric shock ?" I agree with him that susceptibility depends upon the individual. I would add to the above that women and children show less resistance and are therefore more endangered by a current than are males ; also that the point of entrance is of importance, mucous surfaces being much more dangerous than the skin. Secondly, Mr. Aspinall asks: ,Is a person suffering from disease more likely to be fatally injured by an electric shock than a person in good health ?"and states that the question is difficult to answer. I believe, however, that all diseases which lower skin resistance-e. g., Basedow’s disease, diseases of the heart and kidneys, and some skin diseases-predispose to accident from electric I shock. The effect of an electric current is, as Mr. Aspinall observed, dependent upon the resistance of the skin. Cæteris paribus, the skin offers the chief resistance ; for example, we find that on measuring the resistance of the hand when dry the galvanometer (Universalgalvanometer von Siemens) indicates 50,000 ohms, but after wetting the hand with a solution of sodium chloride that the number of overlooked. ohms is reduced to 500-100 times less than in the first Mr. Jordan believes that a hysterectomy always involves condition. The importance of this becomes clear to us when more shock and takes up more time than an oophorectomy E for fibroid disease.41 If so uncertain, however, for reasons we remember Ohm’s law : C = shows that in the which I have explained, hysterectomy must be a far better operation. Mr. Jordan’s teaching may, I admit, be above case the person in the fir6t condition would receive less amperes than in the second. A person advantageously followed under exceptional conditions. Thus 100 timesfrom heart disease is much more sensitive to in 1897 I removed the ovaries of a woman, aged 44 years, suffering who was under Dr. Travers Smith’s treatment for hasmat- the electric current than when the heart is normal. emesis which had greatly reduced her health. There was a Here I will remark that in my opinion the lesions of small bleeding fibroid and I found the appendages spring- the central nervous system produced by electricity are of speak later. ing from the uterus well below the tumour which was in the greatest importanceand; of these lesions I willare the cases Very interesting the fundus. Above all, the ovarian ligaments were long. highly important I speedily removed the ovaries and the " showat once described by Mr. Aspinall with reference to his third : "Does the physiological condition which a person" began to abate, ceasing altogether seven months after question the operation. The patient’s strength steadily in- is in at the time a shock is received make any difference ? creased, but unfortunately three months after the artificial With regard to the first case which he mentions I believe that the greater part of the current was carried away by the heavy menopause she died suddenly from perforation of the stomach. As far as the oophorectomy is concerned this flannel shirt, which was drenched with perspiration, and that only a small part of the current passed through the case was satisfactory, but a previous experience to which I have referred taught me that the operation may be followed body. His description of the effect of the electric current, deserves special consideration, Mr. by fatal shock without any clinical or post-mortem evidence on sleeping persons Aspinall being the first to observe that otherwise dangerous of internal bleeding or sepsis. currents are harmless to sleeping persons. In the cases which he mentions it is certain that the persons suffered an 39 Loc. cit., Case 5 and Fig. 4. 40 For the literature of the subject see " On Ligature of the electric shock from the fact that severe burns were found Pedicle in Ovariotomy," Transactions of the Obstetrical Society of London, vol. xxxv., 1893. 1 THE LANCET, March 8th, 1902, p. 660. 41 "However skilfully and by whatever method a hysterectomy may 2 A part of my observations and experiments have appeared in the be done and however favourable the conditions are it takes longer and inflicts more shock on the patient than removal of the appendages." following publications : Beobachtungen an Elektricitätsarbeiten, Wiener Klinische Wochenschrift. No. li., 1900 ; Blitzschlag und ElekLoc. cit. trische Hochspannung, Wiener Klinische Wochenschrift, Nos. xxviii. and xxix., 1901 ; Vorrichtungen zur Verhütung von Unglücksfällen durch Elektrischen Oberleitungen, eine neue Isolirzange, Oesterreich. FALMOUTH DRAINAGE.-At the meeting of the die Sanitätswes., No. xxxvii., 1901 ; Elektrizität und Chloroformnarkose, Falmouth Corporation held on Jan. 29th the general purposes Wiener Klinische Wochenschrift, No. xlv., 1901 ; Animalische Effecte committee reported that it was of opinion that the council der Elektrizität, Wiener Klinische Wochenschrift. Nos. xvi. and xvii., Histologische Veränderungen im Menschlichen und Thierischen could not carry out the contemplated drainage scheme owing 1902; Gehirn und Rückenmark theils als Blitz theils als Elektrizität to its cost. It was stated that the committee was unani- Hoorkstrom-wirkung, Virchow’s Archiv, Band clxx., 1902 ; Zur Klinik der durch Atmospherische und Technische Electrizität verurmous in considering that the action of the Local Government Gesundheitsstorungen, Vortrag am Elektrischen Congress in Board in requiring the outfall to be carried considerably sachten Bern, 1902; and Elektrisches Unfallwesen, Zeitschrift für Klinische farther toward the east made the cost prohibitive. Medizin zu erscheinen).
-;, which
358 the bodies. Unfortunately, I have never had the oppor- tlbus preventing the current passing," I must protest, as I of observing the effect of electricity on sleeping hhave found by repeated experiments that the resistance is persons. I wish to call attention to the similarity which kowered after burns of the body. In my publication "Animalexists between the above-mentioned cases and the following hsche Effecte der Elektrizitat" I have fully explained three dlifferent methods of measuring the resistance, by which experiments3 which I have carried out on animals. If a rabbit be subjected to a high-tension interrupted I can prove that the longer the tissue is exposed to currents current, with one pole in the mouth and the other in the rom the main the less the resistance becomes. I have rectum, it will be either immediately killed or paralysed for dlemonstrated the above on a portion of the sciatic nerve by several hours in all four extremities, or a spasmus nutans fiirst measuring the resistance which proved to be 120,000 I then subjected it to a current from the main of 300 may be present, or it may cease to eat and soon die from o)hms. starvation, &c. If, however, a rabbit be deeply chloroformed vvolts. I immediately again measured the resistance and f,’ound that it had sunk to 70,000 ohms and was reduced by so that it does not react to the severest mechanical irritations-for example, the insertion of a needle into the spinal 1.000 ohms for every second of time that it was exposed. cord-and while in this condition be subjected to the sameAAfter the experiments the resistance began to increase. The high-tension interrupted current as in the previously de- aanatomical alteration of the tissue appears to be the cause of scribed case for only a fraction of a second a remarkable tthe reduction of the resistance. This fact of reduction of resistance through currents from change takes place: the rabbit assumes a position of opisthotonos, then tries to rise, falls down again, cries out, tthe main, which is sometimes very great, is of great importopens its mouth, and in a few minute, the animal appears aance to the physicians of accident insurance companies. In to have perfectly recovered. The control animal that was eexplanation of the above I would refer to the technical narcotised at the same time but not subjected to the current f’ormula for the work performed by a current : A (ampere), died. The high-tension interrupted current thereby proves X This formula is true only in esti, V (volt) X t (time). itself to be not only harmless for rabbits during narcosis bitt nating the power of a current in driving machinery ; in is even life-saving. I have not yet finished my experiments rmen, however, it does not hold true, as resistance constantly with the other narcotics. I mention the above experiment ciecreases through every second of contact, thereby inour observations to only because appear agree ; that is, an c
on
tunity
the haemorrhage and alteration of killed by ganglion cells from the spinal cord of electric current of 1000-volt Represents tension. a, Haemorrhage. b, Unaltered cell. Destroyed cell. C’, Nucleus and nucleolus from destroyed cell lying in the a man
hæmorrhage.
otherwise fatal current has no injurious effect on animals in an insensible condition (sleep or narcosis). I agree with Mr. Aspinall in the statement that "the path"which the current takes through the body is important. The left side seems to be more sensitive than the right, but this fact is not due, in my opinion, to any injury to the valves of the heart but rather to the effect on the ganglia of the heart. Owing to the necessity of brevity I cannot further discuss this important question. I will only remark that the current is most dangerous when it is brought to bear on the heart and nervous system in greatest density. I have made pathological sections from the hearts of both discovered anything men and animals but have never abnormal. Another question on which I differ from Mr. Aspinall is the following: "Does the question of contact made, and whether burning takes place or not, have any effect upon a " person’s chance of being killed ?" I have made similar experiments to measure the resistance and I agree with Mr. Aspinall that the area and completeness of the contact bear
exact relation to the resistance. When, however, Mr. asserts that the burning " is a wonderful provision of nature to protect us against fatal shocks, as the burning not only numbs the nerves and thus prevents us from feeling, but will also be found to increase the resistance, an
Aspinall
3 Electrizität
und
schrift,No.xlv.,1901.
an
c,
Chloroformnarkose, Wiener Klinische Wochen-
simple algebraic expression. In consideration of the above changes which my experiments have proved we must admit that the time (t) during which a person is exposed to the current is important for two reasons : first, that t has the same value as in the above formula ; secondly, owing to the decrease of resistance and increase of amperage the effect is in five seconds not only five times greater but considerably more.
In regard to the sixth question : Can a person receive a fatal shock without giving thecry,’ and also can he speak " after receiving a fatal shock ?" I quite agree with Mr. " that the is a cry rapid drawing in of the breath," Aspinall that it does not occur in every case, and that this cry is due to sudden contraction of the diaphragm. In those cases, however, where the current is not dangerous and the victim is not rendered insensible, but is held to the machine by muscular contraction, the cry is not involuntary. Mr. Aspinall has discussed very fully the seventh question: Is an alternating or a direct current shock more likely to prove fatal?" From my experiments and observations
359 the blood pressure is changed. After exposure to the direct current it increases from 10 to 20 millimetres ; while, fol1)f lowing the alternating current, a reduction of pressure of FiG. 2.
)
Shows haemorrhage and destruction of the vessel wall from the brain of a girl killed by lightning. a, Haemorrhage. b, Tortuous and destroyed vessel wall.
FIG. 3.
a
direct
current
of
VVlUtf
iJVV
tension
auu
vYaa
immediately
I have also observed and read of cases where the contact was made with the whole hand gripping the wire, and in these cases the person is always held fast. The most peculiar phenomenon is the pushing away of the Professor S. Exner of Vienna thinks that it is persons. caused possibly by the sudden strong contraction of the entire musculature. Mr. Aspinall’s eighth question is : Cannot medical men give us a more certain method of ascertaining whether a man is dead or not ?As to whether the heart function is entirely lost it is difficult even for the physician to decide. In my experiments on animals I have observed that several hours after apparent death they show signs of life. For this reason I believe that the attempts at restoration after shock should be continued for hours or until some certain sign of death appears. I wish to call special attention to the importance of the ninth question : "Cannot something more be done to help those who receive a shock ?"" Mr. Aspinall asks if it would be advantageous to "I hold the body for a few seconds head downwards at an angle of 45°, thus flushing the brain and stimulating its action ?" "Flushing the brain" in particular I would warn against. The method of reasoning by which Mr. Aspinall arrives at this conclusion is very plausible, but the fact is that there are direct contra-indications to this treatment. During the microscopical examination of pathological preparations taken from three men and six animals that were killed by electricity I was successful in finding that the capillaries of the central nervous system were torn and that blood had escaped and permeated the surrounding nervous substance. These hasmorrhages were found almost without exception in the grey substance of the brain and cord. I also discovered an alteration of the ganglion-cells.5 These changes are illustrated by Figs. Such a haemorrhage is not necessarily 1, 2, and 3. fatal, but it is very probable that the above method of flushing the brain would lead to secondary haemorrhage and therefore result fatally. In my opinion it would be better to perform venesection. Artificial respiration should be continued for hours ; massage of the abdomen and of the region of the heart, placing the patient in a hot bath, subcutaneous injections of ether, camphor, or strychnine, should also be carried out. I believe that many of those victims who are pronounced dead could be revived by taking the necessary time and trouble. In conclusion, I wish to remark that Mr. Aspinall’s observations are of the greatest interest to physicians and that these very difficult problems regarding the action of electricity in the human body can only be solved through the combined and harmonious efforts of both physicians and
repulsed.
,
engineers. Vienna. 5 The etiology and character of the above described pathological alterations I have fully described in Virchow’s Archiv, October, 1902, Band clxx., Heft 1, p. 44.
LENGTH
OF
STAY
OF
SCARLET FEVER
PATIENTS IN THE METROPOLITAN ASYLUMS BOARD’S HOSPITALS.-At a meeting of the Metropolitan Asylums Board on Jan. 24th the
committee reported that it had had under consideration a letter from the Metropolitan Branch of the Incorporated Society of Medical Officers of Health, drawing attention to the length of stay of scarlet fever patients in the Shows hemorrhage and destruction of the vessel wall from the brain hospitals of the Board as compared with that of a guinea-pig killed by an electric current of 300-volt tension, a, of patients in some of the provincial hospitals, Haemorrhage with small particles of brain substance. b, Destroyed and suggesting that a conference should be vessel wall. arranged on that subject between the Board’s from 10 to 15 millimetres is present, thereby proving that the medical and the medical officers of health. direct current has an action different from the alternating rhe committee stated that it had discussed that suggestion current, when using a current of a tension of from 100 to and as a result of its consideration had informed the 200 volts. With higher tensions I have not experimented. society that it saw no objection to such a conference but Mr. Aspinall is of the opinion that a direct current seems to that it did not appear to it that for the holding of such paralyse the victim at once, "whilst an alternating current a conference there was any necessity for the official sanction shock seems to draw him closer and to tie his body as far )f the Board or of the hospitals committee, adding that, as possible into a knot." My experiments and observations so far as it could see, there was nothing to prevent two on men and animals show that the effect of both currents is bodies of medical men meeting together to discuss a purely to produce a severe spasm of all the muscles during the medical question. The Board agreed with the action of the action of the current. I myself have touched a wire carrying committee.
hospitals
superintendents
.
disagreeable symptoms. I had several other similar lucky experiences and the same is the case with other operators. Indeed, I am of opinion, on the ground of this experience, due in many such cases to some factor of which the same may be said in explanation of Professor Cameron’s brilliant results. A fibroid is capricious in its course and may cease to grow and to bleed spontaneously. I am speaking, be it understood, solely of cases said to be suitable for oophorectomy, cases where the fibroid grows near the fundus, nourished by the ovarian artery. Yet I have had good results in several cases where even the cervix was involved, though with that condition failure is the rule. My good, or, rather, lucky, results can hardly have been due to the removal of the ovaries alone. Indeed, the majority of patients did well for a year or so, then the bleeding returned In one case in my own or the tumour continued to grow. practice 39 a strange result ensued : great and permanent reduction in the size of the tumour occurred, yet the sup" pression of the catamenia was but partial. The show" was accompanied by all the disagreeable symptoms of the menopause, and last autumn (10 years after the operation) the patient, then 48 years of age, saw the period three or four times yearly and suffered from occasional flushings. A return and advance both of the bleeding and of the growth of the tumour seem, however, to have been the rule The reason when oophorectomy for fibroid was popular. seems to be evident : the ovarian tissue on the distal side of the pedicle resumed its functions, for a time in abeyance owing to the organisation of lymph thrown across the groove formed by the ligature, a condition well known in the pedicle after ovariotomy. 40 In performing a hysterectomy in a case where oophorectomy had failed I detected a small, fiat button of ovarian tissue lying on the stump of the The operation tube against the cornu of the uterus itself was not without dangers-slipping of the ligature of the pedicle and thrombosis of a pelvic vessel or of one of the big veins of the lower extremity being not unknown. In anaemic cases the shock was often quite as great as after the removal of a big fibroid and I reported a fatal case in the address to which I recently referred. Again, the ovaries may be so placed in relation to a big tumour as to render their removal impossible. The haemorrhage in some instances proved to be due to a polypus high up in the distorted uterine cavity and thus easily
that
cure was we are
ELECTRIC
SHOCKS.
BY DR. S. JELLINEK.
ignorant ;
IN a very remarkable article which appeared in THE LANCET in 19021 Mr. F. B. Aspinall gave his views regarding the action of the electrical current on the human body. His reasons are strengthened by observation upon a large number of accident cases and by experiments carried out on the human body. There is a boundary between the technical and the medical knowledge of electricity, and the physician wishing to treat the subject satisfactorily must understand the technical working of electricity as well as the scientific, otherwise the solving of certain questions is impossible. As I myself have been studying atmospheric and technical electricity concerning their effects on animals I wish to add a few remarks to the article published in THE LANCET.2 While I agree with Mr. Aspinall on a great many points, As to on some important questions I am of another opinion. his first question: "Is everyone equally susceptible to an electric shock ?" I agree with him that susceptibility depends upon the individual. I would add to the above that women and children show less resistance and are therefore more endangered by a current than are males ; also that the point of entrance is of importance, mucous surfaces being much more dangerous than the skin. Secondly, Mr. Aspinall asks: ,Is a person suffering from disease more likely to be fatally injured by an electric shock than a person in good health ?"and states that the question is difficult to answer. I believe, however, that all diseases which lower skin resistance-e. g., Basedow’s disease, diseases of the heart and kidneys, and some skin diseases-predispose to accident from electric I shock. The effect of an electric current is, as Mr. Aspinall observed, dependent upon the resistance of the skin. Cæteris paribus, the skin offers the chief resistance ; for example, we find that on measuring the resistance of the hand when dry the galvanometer (Universalgalvanometer von Siemens) indicates 50,000 ohms, but after wetting the hand with a solution of sodium chloride that the number of overlooked. ohms is reduced to 500-100 times less than in the first Mr. Jordan believes that a hysterectomy always involves condition. The importance of this becomes clear to us when more shock and takes up more time than an oophorectomy E for fibroid disease.41 If so uncertain, however, for reasons we remember Ohm’s law : C = shows that in the which I have explained, hysterectomy must be a far better operation. Mr. Jordan’s teaching may, I admit, be above case the person in the fir6t condition would receive less amperes than in the second. A person advantageously followed under exceptional conditions. Thus 100 timesfrom heart disease is much more sensitive to in 1897 I removed the ovaries of a woman, aged 44 years, suffering who was under Dr. Travers Smith’s treatment for hasmat- the electric current than when the heart is normal. emesis which had greatly reduced her health. There was a Here I will remark that in my opinion the lesions of small bleeding fibroid and I found the appendages spring- the central nervous system produced by electricity are of speak later. ing from the uterus well below the tumour which was in the greatest importanceand; of these lesions I willare the cases Very interesting the fundus. Above all, the ovarian ligaments were long. highly important I speedily removed the ovaries and the " showat once described by Mr. Aspinall with reference to his third : "Does the physiological condition which a person" began to abate, ceasing altogether seven months after question the operation. The patient’s strength steadily in- is in at the time a shock is received make any difference ? creased, but unfortunately three months after the artificial With regard to the first case which he mentions I believe that the greater part of the current was carried away by the heavy menopause she died suddenly from perforation of the stomach. As far as the oophorectomy is concerned this flannel shirt, which was drenched with perspiration, and that only a small part of the current passed through the case was satisfactory, but a previous experience to which I have referred taught me that the operation may be followed body. His description of the effect of the electric current, deserves special consideration, Mr. by fatal shock without any clinical or post-mortem evidence on sleeping persons Aspinall being the first to observe that otherwise dangerous of internal bleeding or sepsis. currents are harmless to sleeping persons. In the cases which he mentions it is certain that the persons suffered an 39 Loc. cit., Case 5 and Fig. 4. 40 For the literature of the subject see " On Ligature of the electric shock from the fact that severe burns were found Pedicle in Ovariotomy," Transactions of the Obstetrical Society of London, vol. xxxv., 1893. 1 THE LANCET, March 8th, 1902, p. 660. 41 "However skilfully and by whatever method a hysterectomy may 2 A part of my observations and experiments have appeared in the be done and however favourable the conditions are it takes longer and inflicts more shock on the patient than removal of the appendages." following publications : Beobachtungen an Elektricitätsarbeiten, Wiener Klinische Wochenschrift. No. li., 1900 ; Blitzschlag und ElekLoc. cit. trische Hochspannung, Wiener Klinische Wochenschrift, Nos. xxviii. and xxix., 1901 ; Vorrichtungen zur Verhütung von Unglücksfällen durch Elektrischen Oberleitungen, eine neue Isolirzange, Oesterreich. FALMOUTH DRAINAGE.-At the meeting of the die Sanitätswes., No. xxxvii., 1901 ; Elektrizität und Chloroformnarkose, Falmouth Corporation held on Jan. 29th the general purposes Wiener Klinische Wochenschrift, No. xlv., 1901 ; Animalische Effecte committee reported that it was of opinion that the council der Elektrizität, Wiener Klinische Wochenschrift. Nos. xvi. and xvii., Histologische Veränderungen im Menschlichen und Thierischen could not carry out the contemplated drainage scheme owing 1902; Gehirn und Rückenmark theils als Blitz theils als Elektrizität to its cost. It was stated that the committee was unani- Hoorkstrom-wirkung, Virchow’s Archiv, Band clxx., 1902 ; Zur Klinik der durch Atmospherische und Technische Electrizität verurmous in considering that the action of the Local Government Gesundheitsstorungen, Vortrag am Elektrischen Congress in Board in requiring the outfall to be carried considerably sachten Bern, 1902; and Elektrisches Unfallwesen, Zeitschrift für Klinische farther toward the east made the cost prohibitive. Medizin zu erscheinen).
-;, which
358 the bodies. Unfortunately, I have never had the oppor- tlbus preventing the current passing," I must protest, as I of observing the effect of electricity on sleeping hhave found by repeated experiments that the resistance is persons. I wish to call attention to the similarity which kowered after burns of the body. In my publication "Animalexists between the above-mentioned cases and the following hsche Effecte der Elektrizitat" I have fully explained three dlifferent methods of measuring the resistance, by which experiments3 which I have carried out on animals. If a rabbit be subjected to a high-tension interrupted I can prove that the longer the tissue is exposed to currents current, with one pole in the mouth and the other in the rom the main the less the resistance becomes. I have rectum, it will be either immediately killed or paralysed for dlemonstrated the above on a portion of the sciatic nerve by several hours in all four extremities, or a spasmus nutans fiirst measuring the resistance which proved to be 120,000 I then subjected it to a current from the main of 300 may be present, or it may cease to eat and soon die from o)hms. starvation, &c. If, however, a rabbit be deeply chloroformed vvolts. I immediately again measured the resistance and f,’ound that it had sunk to 70,000 ohms and was reduced by so that it does not react to the severest mechanical irritations-for example, the insertion of a needle into the spinal 1.000 ohms for every second of time that it was exposed. cord-and while in this condition be subjected to the sameAAfter the experiments the resistance began to increase. The high-tension interrupted current as in the previously de- aanatomical alteration of the tissue appears to be the cause of scribed case for only a fraction of a second a remarkable tthe reduction of the resistance. This fact of reduction of resistance through currents from change takes place: the rabbit assumes a position of opisthotonos, then tries to rise, falls down again, cries out, tthe main, which is sometimes very great, is of great importopens its mouth, and in a few minute, the animal appears aance to the physicians of accident insurance companies. In to have perfectly recovered. The control animal that was eexplanation of the above I would refer to the technical narcotised at the same time but not subjected to the current f’ormula for the work performed by a current : A (ampere), died. The high-tension interrupted current thereby proves X This formula is true only in esti, V (volt) X t (time). itself to be not only harmless for rabbits during narcosis bitt nating the power of a current in driving machinery ; in is even life-saving. I have not yet finished my experiments rmen, however, it does not hold true, as resistance constantly with the other narcotics. I mention the above experiment ciecreases through every second of contact, thereby inour observations to only because appear agree ; that is, an c
on
tunity
the haemorrhage and alteration of killed by ganglion cells from the spinal cord of electric current of 1000-volt Represents tension. a, Haemorrhage. b, Unaltered cell. Destroyed cell. C’, Nucleus and nucleolus from destroyed cell lying in the a man
hæmorrhage.
otherwise fatal current has no injurious effect on animals in an insensible condition (sleep or narcosis). I agree with Mr. Aspinall in the statement that "the path"which the current takes through the body is important. The left side seems to be more sensitive than the right, but this fact is not due, in my opinion, to any injury to the valves of the heart but rather to the effect on the ganglia of the heart. Owing to the necessity of brevity I cannot further discuss this important question. I will only remark that the current is most dangerous when it is brought to bear on the heart and nervous system in greatest density. I have made pathological sections from the hearts of both discovered anything men and animals but have never abnormal. Another question on which I differ from Mr. Aspinall is the following: "Does the question of contact made, and whether burning takes place or not, have any effect upon a " person’s chance of being killed ?" I have made similar experiments to measure the resistance and I agree with Mr. Aspinall that the area and completeness of the contact bear
exact relation to the resistance. When, however, Mr. asserts that the burning " is a wonderful provision of nature to protect us against fatal shocks, as the burning not only numbs the nerves and thus prevents us from feeling, but will also be found to increase the resistance, an
Aspinall
3 Electrizität
und
schrift,No.xlv.,1901.
an
c,
Chloroformnarkose, Wiener Klinische Wochen-
simple algebraic expression. In consideration of the above changes which my experiments have proved we must admit that the time (t) during which a person is exposed to the current is important for two reasons : first, that t has the same value as in the above formula ; secondly, owing to the decrease of resistance and increase of amperage the effect is in five seconds not only five times greater but considerably more.
In regard to the sixth question : Can a person receive a fatal shock without giving thecry,’ and also can he speak " after receiving a fatal shock ?" I quite agree with Mr. " that the is a cry rapid drawing in of the breath," Aspinall that it does not occur in every case, and that this cry is due to sudden contraction of the diaphragm. In those cases, however, where the current is not dangerous and the victim is not rendered insensible, but is held to the machine by muscular contraction, the cry is not involuntary. Mr. Aspinall has discussed very fully the seventh question: Is an alternating or a direct current shock more likely to prove fatal?" From my experiments and observations
359 the blood pressure is changed. After exposure to the direct current it increases from 10 to 20 millimetres ; while, fol1)f lowing the alternating current, a reduction of pressure of FiG. 2.
)
Shows haemorrhage and destruction of the vessel wall from the brain of a girl killed by lightning. a, Haemorrhage. b, Tortuous and destroyed vessel wall.
FIG. 3.
a
direct
current
of
VVlUtf
iJVV
tension
auu
vYaa
immediately
I have also observed and read of cases where the contact was made with the whole hand gripping the wire, and in these cases the person is always held fast. The most peculiar phenomenon is the pushing away of the Professor S. Exner of Vienna thinks that it is persons. caused possibly by the sudden strong contraction of the entire musculature. Mr. Aspinall’s eighth question is : Cannot medical men give us a more certain method of ascertaining whether a man is dead or not ?As to whether the heart function is entirely lost it is difficult even for the physician to decide. In my experiments on animals I have observed that several hours after apparent death they show signs of life. For this reason I believe that the attempts at restoration after shock should be continued for hours or until some certain sign of death appears. I wish to call special attention to the importance of the ninth question : "Cannot something more be done to help those who receive a shock ?"" Mr. Aspinall asks if it would be advantageous to "I hold the body for a few seconds head downwards at an angle of 45°, thus flushing the brain and stimulating its action ?" "Flushing the brain" in particular I would warn against. The method of reasoning by which Mr. Aspinall arrives at this conclusion is very plausible, but the fact is that there are direct contra-indications to this treatment. During the microscopical examination of pathological preparations taken from three men and six animals that were killed by electricity I was successful in finding that the capillaries of the central nervous system were torn and that blood had escaped and permeated the surrounding nervous substance. These hasmorrhages were found almost without exception in the grey substance of the brain and cord. I also discovered an alteration of the ganglion-cells.5 These changes are illustrated by Figs. Such a haemorrhage is not necessarily 1, 2, and 3. fatal, but it is very probable that the above method of flushing the brain would lead to secondary haemorrhage and therefore result fatally. In my opinion it would be better to perform venesection. Artificial respiration should be continued for hours ; massage of the abdomen and of the region of the heart, placing the patient in a hot bath, subcutaneous injections of ether, camphor, or strychnine, should also be carried out. I believe that many of those victims who are pronounced dead could be revived by taking the necessary time and trouble. In conclusion, I wish to remark that Mr. Aspinall’s observations are of the greatest interest to physicians and that these very difficult problems regarding the action of electricity in the human body can only be solved through the combined and harmonious efforts of both physicians and
repulsed.
,
engineers. Vienna. 5 The etiology and character of the above described pathological alterations I have fully described in Virchow’s Archiv, October, 1902, Band clxx., Heft 1, p. 44.
LENGTH
OF
STAY
OF
SCARLET FEVER
PATIENTS IN THE METROPOLITAN ASYLUMS BOARD’S HOSPITALS.-At a meeting of the Metropolitan Asylums Board on Jan. 24th the
committee reported that it had had under consideration a letter from the Metropolitan Branch of the Incorporated Society of Medical Officers of Health, drawing attention to the length of stay of scarlet fever patients in the Shows hemorrhage and destruction of the vessel wall from the brain hospitals of the Board as compared with that of a guinea-pig killed by an electric current of 300-volt tension, a, of patients in some of the provincial hospitals, Haemorrhage with small particles of brain substance. b, Destroyed and suggesting that a conference should be vessel wall. arranged on that subject between the Board’s from 10 to 15 millimetres is present, thereby proving that the medical and the medical officers of health. direct current has an action different from the alternating rhe committee stated that it had discussed that suggestion current, when using a current of a tension of from 100 to and as a result of its consideration had informed the 200 volts. With higher tensions I have not experimented. society that it saw no objection to such a conference but Mr. Aspinall is of the opinion that a direct current seems to that it did not appear to it that for the holding of such paralyse the victim at once, "whilst an alternating current a conference there was any necessity for the official sanction shock seems to draw him closer and to tie his body as far )f the Board or of the hospitals committee, adding that, as possible into a knot." My experiments and observations so far as it could see, there was nothing to prevent two on men and animals show that the effect of both currents is bodies of medical men meeting together to discuss a purely to produce a severe spasm of all the muscles during the medical question. The Board agreed with the action of the action of the current. I myself have touched a wire carrying committee.
hospitals
superintendents
.