Volume 1

A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae.

Date:: 1907-10

Credit: A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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$one case a man in good jdiysical healtli, whose flannel undershirt was thoroughly wet from jjerspiration, withstood without ill effects a shock of 2,000 volts. Lowenheim aiul Jcllinck rejjort a case of 5,500 volts which did not terminate fatally; Picon and Leblanc report a similar case. The immediate effect of electrical current may be death, shock with tempo- rary loss of consciousness, painful sensations, and, finally, burns of the skin. Death.—When an individual is stricken by a fatal current there is a violent tetanic contraction of all the muscles of the body, followed by loss of consciousness. Three or four minutes later the respiration ceases. The mechanism of death, according to Provost and Battelli, depends upon the degree of tension of the current. In high tension (1200 volts or above) there is inhibition of the nervous centres; the respiratory centre is first affected, and the heart ceases to beat only subsequently to asphyxia. Low-tension currents (not above 120 volts) produce paralysis of the heart, but the respiration continues for a certain time. The heart shows a fibrillary tremor, and as soon as the latter appears the beating is im- mediately arrested and no more blood is thrown into the circulation. Currents of average tension (240 to 600 volts) produce paralysis of the heart in a state of fibrillary tremor, and an absolute cessation of respira- tion. We therefore see that the fibrillary tremor of the heart is the most dreaded phenomenon, while the shock of the nervous centres is of no special import. The cessation of the heart-beat is independent of the extrinsic innervation of its muscles. When there is no fibrillary con- traction of the heart, there is no danger to life. The currents used in industry are either continuous or alternating. Both cause shock or death by the same mechanism. It is interesting to note that the continuous current requires a higher voltage than the alter- nating current to bring on a paralysis of the heart. On the other hand, the inhibition of the nervous system is more pronounced with continuous than with alternating currents. Other Consequences of Electrical Shock.—If death does not ensue, in ordinary conditions the sudden contact with an electrical conductor will produce syncope, which is usually of short duration. The reestablish- ment of normal functions may be complete and rapid, but sometimes the various nervous disturbances may remain very tenaciously. In the latter case there is usually a state of hebetude for several days, accompanied by weakness, headache, and sometimes palpitation of the heart. In some cases there was a state of mental confusion or delirium, tremor, and a general depression of the ner\'ous system similar to that following trauma- tism. P.sychoses were observed by Bucknill,Tuke, Sanze, Pick, Cipriano, Lahnson, and others; but the mental disturbances were all transient in character. Amnesia was reported by Heusner, Ebertz, Winiwarter, and others. Painful .sen.sations, more or less ])ronounced, in the muscles and in the thorax have been recorded in a number of cases as of frequent occurrence. Besides these immediate disturbances, there are quite a number resem- bling well-defined nerv^ous aft’ections. Functional nervous diseases, as hysteria and neurasthenia, are common occurrences after an electrical shock. Nothnagel, Gibier de Sarigny, and Charcot, contributed con- siderably to the subject. Abundant examples of either of these two$