or timbers may cause death immediately, and burning the body occur
subsequently.
Immediate death may result from _syncope_ or _collapse_ from the
violence of the shock to the nervous system by the pain resulting from
the burns.
The SECOND DIVISION includes those conditions where death may result
early, from a series of causes less immediate than those just mentioned.
_Cerebral congestion_ and _effusion_, resulting in death from coma,
is not unusual (Case 15). In this connection Taylor[705] cites a case
of alleged poisoning by opium, in the treatment of a burn, in a child
dying comatose, and emphasizes the undesirability of administering
opium or its preparations to children in cases of burns of any
severity. The danger claimed to exist is hardly to be considered.
In the case referred to, Abernethy, who was a witness in the case,
ascribed death to coma induced by the effect of the burn. The
powerfully depressing influence of the pain in sensitive organizations
and liability to death from shock therefrom must be remembered.
_Inflammatory conditions_ of the _respiratory tract_ or organs are
common results; _pneumonia_, _bronchitis_, and sudden congestion or
œdema of the lungs are frequent (Cases 11, 15, 16).
_Inflammation of the intestines_, inducing _peritonitis_ and
_ulcerations_ of the intestines with or without resulting hemorrhage,
occurs as a frequent lesion (Case 10).
_Gangrene_ or _septicæmia_ causes death in other instances.
_Exhaustion_, from extensive and prolonged suppuration or from severe
and long-continued pain and other conditions, terminates other cases
(Case 12).
Legally, burns and scalds are included among injuries endangering life,
but are not described as wounds. They may be considered dangerous
according to the extent of surface which they cover, rather than the
depth to which they involve the tissues.
The extensive injury to the sensory nerve structures and the
suspension of function or destruction of a considerable portion of the
perspiratory tracts render large superficial burns far more fatal than
those confined to a small part of a limb, for example, which may be
deeply burned. From a medico-legal point it is desirable to establish
the fact of how large a surface must be injured to prove fatal. The
effort to reduce the subject to a statement of an exact minimum area of
square inches seems very objectionable and liable to lead to erroneous
conclusions.
It is possible to make a general statement, subject to some
qualifications, which may serve as a basis of conclusion, as each
individual case must be considered in its own circumstances.
A burn involving two-thirds of the body may be regarded as necessarily
fatal; but the injury of a much less proportion, even one-fourth of
the surface, has resulted in death. The qualifications to be made
in burns of less extent are pronounced. The _part affected_ is of
much importance. Burns of the trunk are more fatal than those of the
extremities; and those of the genital organs[706] and lower part of the
abdomen are especially so (Case 7).
The character of the burn, whether single and continuous or multiple
and scattered over various portions of the body, is a very important
modifying circumstance, involving the questions of excessive pain and
the difficulty in insuring necessary treatment for all parts injured.
The physical condition of the patient and sensitiveness of the nervous
system to pain exert a powerfully determining influence. Burns in
children and sensitive, nervous females are specially serious and call
for an unfavorable prognosis.
=Spontaneous Combustion.=—Spontaneous combustion of the human body
has been seriously discussed in this connection, and explanations of
popularly reported cases have been attempted. The writer refers to
the subject here for the sole purpose of stating that no trustworthy
evidence of the possibility of any such condition or result exists.
TREATMENT.
In cases of severe burns the constitutional as well as the local
conditions demand attention. Locally, a great variety of applications
has been employed: starch, gum, oxide of zinc, solution of caoutchou,
collodion, cotton wadding, a mixture of linseed oil and lime-water
on cotton or lint, and many other agents are used. The important
consideration is to exclude the air from and to afford a protective
covering for the injured surface. The constitutional treatment varies
in different cases; but its main object is to relieve pain, induce
reaction from the shock, and support the depressed nervous system.
For the first opium or its preparations in proper doses is indicated.
Alcoholic stimulants in some cases are demanded in addition. After
the stage of reaction has occurred the therapeutics must be governed
by inflammatory conditions; or later by the exhaustion from continued
pain, suppuration, etc.
POST-MORTEM APPEARANCES.
In the EXTERNAL post-mortem examination of a burned body careful
note should be made of the sex, probable age, and every circumstance
leading to the establishment of the identity of the individual. The
parts burned should be specially examined as to their condition,
whether exhibiting redness, vesication, or charring. The amount of
surface covered by the burns should be computed; also the relation of
the burned parts to those uninjured, whether separated by a sharply
marked line of redness or merging into the sound skin without a line
of demarcation. The condition of the blisters should be examined as
to whether they are full or empty and their contents as to whether
consisting of clear or turbid serum.
INTERNALLY.—In some cases no lesions are found on examination. These
are usually cases where death occurred from shock or severe pain (Case
12). Ordinarily the mucous membrane of the respiratory tracts is
congested. In some instances, however, no redness has been discernible.
Where death occurred by suffocation and asphyxia, the trachea and
bronchial tubes have been found to contain a dark smoky or sooty
mucus[707] (Case 9).
The serous membranes of the brain, thorax, and abdomen are in many
cases found reddened with effusions, more or less considerable,
into the ventricles of the brain and the pleural, pericardial, and
peritoneal cavities from the sudden inflow of blood from the surface,
caused by the local injuries.
When the body has been badly charred or incinerated the skeleton
usually remains, and it is possible to determine the age from the size
and development of the bones and the sex from the shape of the bones
of the pelvis. Careful search should be made for special articles of
identity. False teeth,[708] a watch and chain, buttons, etc., have
alone been sufficient to identify the incinerated remains (Case 23).
Where the whole body and even the bones have been reduced to ashes,
some portions of bone, etc., may be found on careful search. Sifting
the ashes will give some pieces of bone, etc., which may be sufficient
to disclose the presence of human remains[709] (Case 24). A chemical
analysis of the ashes also will aid in establishing this fact. In cases
where cremation of the body has been resorted to to conceal crime, the
length of time necessary to entirely consume the human body may become
an important question. A period of less than ten hours has been proven
sufficient.[710]
PERIOD OF THE OCCURRENCE OF DEATH.
As already indicated, death may occur from direct causes during the
first forty-eight hours after the infliction of the burn, or may take
place during a period extending from the second day to the fifth or
even the sixth week. In the great majority of cases the fatal result
occurs during the first five or six days. In some instances it may be
important to establish the fact as to _how long after the infliction of
the burn the person may have survived_.
Inflammation and suppuration would not ordinarily begin until about
the third day, hence the existence of this condition would indicate
that the person had probably lived two days or more; and the state of
advancement of these processes would afford some further evidence. The
existence of intestinal inflammations and ulcerations, which require
some days for their appearance and development, would also give some
indication of the probable time elapsing.
WAS THE BURN ANTE MORTEM OR POST MORTEM?
In describing the anatomical characters of a burn occurring during
life, =vesication=, the formation of blisters, is regarded as a marked
symptom.
While it is not an invariable result in a burn of the living body,
it is so constant as to become one of the most important factors in
answering the question as to the ante-or post-mortem infliction of
the burn. Where the burn has been caused by a scalding fluid, or by
burning of the clothing, or the direct application of flame, blisters
are more likely to occur than where contact with a highly heated body
has taken place. In the formation of a blister the cuticle is raised
from the derma or true skin by the effusion of a highly albuminous
serum, and the surrounding skin is of a bright or coppery red color.
The time of the appearance of such a blister is not fixed. It may occur
almost immediately or may not do so for several hours, an interval
sufficiently long for death to occur from shock. It must be remembered
that a burn inflicted in a condition of great depression of the vital
powers with insensibility may be followed by no vesication or redness,
but upon reaction and return of sensation both redness and blisters
may appear (Case 17). In the absence of blisters, therefore, it cannot
be decided that for this reason the burn was post mortem. If from a
blister formed on the living body the cuticle be carefully removed,
the site of the blister will present an intensely reddened base. In
the dead body, if the cuticle be removed, no red base appears, but the
surface of the blister becomes dry and of a grayish color.
On the other hand, if the presence of blisters is noted, can it be
concluded that the burn was ante mortem? While their presence affords
reason for an affirmative answer, careful examination of the blisters
as to their character and contents must be made in order to decide; the
presence of apparent blisters is not alone sufficient (Cases 20, 18;
Plate II.).
Elaborate experiments have been made in order to decide the possibility
of producing blisters post mortem.
Leuret,[711] in experiments upon dropsical subjects twenty-four hours
after death, shows the possibility of raising a blister post-mortem,
but one which can be distinguished from one of ante-mortem production,
in that it contains a reddish serum very slightly albuminous. He urges
extreme care in deciding this question.
Christison[712] found it impossible to produce a blister a few hours
after death. In a patient unconscious from narcotic poison, heat
applied four hours before death produced a blister and a red line was
formed around the burns. In the burns produced half an hour after
death, in the same patient, blisters formed in two places only, and
these were covered by dry skin and contained air. No redness appeared
around them.
Champouillon[713] agrees with Leuret in his conclusions, from
experiments upon dropsical subjects.
Kosack[714] considers blisters with albuminous contents diagnostic of
burns during life, but states the necessity for care in deciding in the
absence of other signs of reaction.
Wright[715] was able to produce blisters three and a half hours
after death containing a small quantity of pale serum. On the same
body, similar experiments fifteen hours after death produced blisters
containing no serum.
Caspar[716] states, as a result of experiments, that blisters may be
produced by flame after death; that they result from vaporization of
the fluid beneath the cuticle by the heat employed; that they are not
found to contain serum and no line of redness is found at their base.
The presence after death of vesications containing serum and surrounded
by a reddish base is an evidence that the burn was inflicted ante
mortem. He distinctly says: “It is quite impossible to confound a burn
inflicted during life with one inflicted after death.”
Woodman and Tidy,[717] in an extended series of experiments, conclude
that while blisters can be produced post mortem, they are readily
distinguished from those formed ante mortem in containing no serum; and
even in dropsical subjects, where blisters containing some fluid were
formed, the presence of but a mere trace of albumin was shown; and, in
all, no redness about the base of the blisters was produced, nor any
appearance of redness after removal of the cuticle.
Taylor[718] has never observed vesications in post-mortem experiments
on infants. He cites a case of drowning where the person, “pulseless
and apparently dead,” was imprudently placed in a _hot_ bath. Blisters
containing bloody serum were formed over several portions of the body.
He concludes that hot water on the living and recently dead body, so
far as vesication is concerned, produces similar effects.
In experiments on the dead body immediately after death the writer has
failed to produce any blister containing serum or fluid. The so-called
blisters are produced by the rapid expansion and evaporation of the
fluid beneath the cuticle over the portion to which the heat was
applied, and differ distinctly from blisters caused during life, in the
absence of serum or any redness of adjacent or subjacent parts (Plate
II.).
Chambert[719] concludes that in living bodies and in dead bodies within
twenty-four hours after death blisters can be produced, and that less
heat will develop them in the living. He specially emphasizes the
difference, in the albuminous character of the contents, of a blister
formed ante mortem and of one formed post mortem.
Jastrowitz[720] emphasizes the difference between blisters formed
during life and those occurring in œdematous conditions.
Blisters are to be distinguished from the bullæ arising from
putrefaction. There is little danger of confounding such cases. In
conditions of putrefaction no redness or line of demarcation exists,
and the green discoloration and other conditions of the skin will
suffice to establish the diagnosis.
Schjerning[721] considers blisters containing highly albuminous serum
as diagnostic of burns produced during life. In some conditions of
depression of nutrition blisters occasionally form, but are not liable
to be confounded with those caused by burning.
A second anatomical feature of much importance, even more so than
vesication, is the condition of the skin to which the heat was applied.
It assumes a dusky red color and a dry and parchment-like condition
(Case 8). Surrounding this is an area of grayish-white skin bounded by
a sharply defined and deeply injected =red line=, which in turn shades
into the color of the surrounding skin. These features are more or less
pronounced according to the degree of heat applied and to the length of
time of contact; or, in other words, to the depth and severity of the
burn (Plate I.).
MEANS OF DISTINGUISHING ANTE-MORTEM FROM POST-MORTEM BURNS.
Differentially, a distinction is to be made between the surrounding
_redness_ and _the line of redness_. The redness due to capillary
distention is transient, disappears under pressure during life,
and fades after death. The line of redness is permanent, changing
but little under pressure, and remains after death. It is a vital
reactionary effort, a true line of separation between living and
dead tissue, formed in the same manner as the line of demarcation in
sphacelus or gangrene. This line of redness, developed only during life
and permanent after death, is of great significance in cases with
a medico-legal bearing. It has been already stated that in persons
in a condition of depressed vitality the appearance of redness and
vesication is sometimes very tardy and imperfect, and that death from
shock or pain may occur before their development at all. They are vital
processes and require time for their appearance in proportion to the
activity of the powers of reaction. Hence in cases of burning resulting
fatally where vesication and redness do not appear, the circumstances
must be carefully considered before deciding that the burns produced
were post mortem. With these qualifications, it may be stated that the
presence of the red line is almost uniform in burns inflicted during
life and absent in those occurring after death.
If upon a body bearing evidences of exposure to heat there be found
blisters containing highly albuminous serum, and such blisters, after
the removal of the cuticle, present a bright red base surrounded by
a bright and sharp line of demarcation, with redness of adjacent
surface, we are justified in concluding that the burns were inflicted
ante mortem or, at farthest, within a few moments of death. If, on the
contrary, the red line is absent and the blisters contain a thin watery
fluid, with a yellowish and dry condition of their base after removal
of the cuticle, the presumption is that the burning occurred post
mortem.
Where _a number of burns_ are found upon a body, the question whether
they were produced simultaneously may be raised. This can be answered
by examination as to their condition. If some show signs of recent
infliction, while others are in conditions of suppuration or other
changes which only occur after an interval, a difference of time in
production would be probable. But if all present mainly the same
conditions, the probability of their occurring at the same time may be
concluded (Plates I. and II.).
=The Condition of the Blood.=—Special examination of the blood of
persons dying from the effect of burns has been made by competent
observers. While it is not at present possible to define an exact and
constant condition, specially characteristic, some features of interest
have been recently recorded.
The color of the blood has been variously reported; in some cases as
being of a dark color and in others of a bright arterial hue. Death
by asphyxia or suffocation, by the deprivation of oxygen, and by the
products of combustion, would be accompanied by a dark or venous hue
of the blood. An atmosphere containing an excess of carbon monoxide,
resulting from combustion, would cause death by apnœa with an arterial
hue to the blood.[722] But other influences must be considered.
According to Schjerning,[723] it is difficult to deduce positive
conclusions from the condition of the blood. The changes induced by the
spleen and kidneys, as well as the varying intensity of the degree of
heat to which the body may be subjected, tend to render positive and
constant conclusions from this source difficult.
Falk[724] refers to the bright red color of the blood found in some
cases, and explains this condition in part by the influence of chemical
changes in the tissues surrounding the vessels.
Wertheim[725] describes certain conditions observed by him and mentions
an increase in the number of the leucocytes, together with the presence
of hæmoglobin and melanin.
Hoppe Seyler meets with similar results and arrives at the same
conclusions in his observations.
Ponfik,[726] on the contrary, is doubtful of the constant presence of
some of these conditions and also of their diagnostic value.
Seliger[727] confirms the conclusions of Wertheim, in that he describes
the presence of crystalline bodies and of dark discolorations (melanin).
Some spectroscopic analyses have disclosed the presence of bands
additional to those of normal blood. The lack of uniformity of
conditions described and of conclusions reached leaves the subject in a
position of uncertainty. Examination of the blood of those dying from
burns has not been so extensively and minutely followed as to enable us
to decide questions which may arise in any case.
EXPLANATION OF PLATE II.
FIGURE 1.—ANTE-MORTEM BURN.
Scald by steam from a boiler bursting, July, 1892.
From a photograph taken sixty hours after the accident. The injury
covered one-half of the surface of the body. The red line is sharply
marked; the extensive blisters formed are broken and their contents
have escaped; the serum drying has produced yellowish discolorations;
the blush of redness on adjacent parts is well marked. Death resulted
on the fifth day.
FIGURE 2.—POST-MORTEM BURN.
_Exp. 1._ (Appearances after application of a _tin can containing
boiling water_.) The cuticle was raised by expansion. The blisters
contained no serum and no red line is developed.
FIGURE 3.—POST-MORTEM BURN.
_Exp. 2._ (Appearances after the application of _iron at a dull red
heat_.) No proper blister formed; the cuticle was raised, as in
previous experiment. There was no serum and no red line or redness of
adjacent parts. The cuticle is charred at one point, where the iron was
brought into contact with it.
[Illustration: MEDICAL JURISPRUDENCE—PLATE II.
BURN, TWO HOURS AFTER DEATH, BY IRON AT A DULL RED HEAT.
BURN, TWO HOURS AFTER DEATH, BY TIN CAN CONTAINING BOILING WATER.
BURN BY STEAM, SIXTY HOURS AFTER INJURY.
POST-MORTEM AND ANTE-MORTEM BURNS.]
WAS DEATH ACCIDENTAL, SUICIDAL, OR HOMICIDAL?
Nearly all deaths occurring from burning are accidental, very few
homicidal, and hardly more than a few exceptional cases suicidal.
It is important in cases of legal investigation to note the position of
the body when found and its relation to the apparent source of fire;
the parts of the body and clothing burned, etc.; evidences of violence
should be carefully observed, such as contusions, fractures of bones,
wounds of the soft parts, evidences of strangling, etc. (Case 22).
These should be specially sought in the site of the burned portions,
as burning and cremation of the victim are sometimes a resort to
conceal homicide. In considering the character of the apparent wounds,
it must be remembered that extensive injuries, resembling wounds, may
result from the effects of fire,[728] and these must be carefully
distinguished.
Inability to detect special marks of violence need not preclude the
possibility of its commission and of its being a possible cause of
death (Case 19). The parts burned, the character and depth of the
burns, and their relation to the apparent source of burning, with
consideration of their probable simultaneous exposure, are all
circumstances of weight in forming an opinion. The position of the
body in relation to the fire should also be considered. In accidental
burning, except in cases of intoxication, epileptic seizures, or other
sources of helplessness, the victim is quite likely to be found at a
distance from the fire, owing to his efforts to escape.
CASES.
CASE 1. _Death from Cold._ _Accidental_ (Dr. Hilty in Caspar’s
_Vierteljahrschrift_, II., 1865, p. 140).—Male, æt. 52; intoxicated.
Severe winter weather; death from exposure. Post mortem: Blood
crimson; both sides of heart full; internal organs congested.
CASE 2. _Criminal Exposure to Cold_ (_Ann. d’Hygiene_, 1868, Vol. II.,
p. 173).—Girl, unmarried; sudden delivery when at stool. She stated
that she had fainted, and found the child dead when she recovered.
The child had breathed and the cord was cut. No marks of violence.
Evidence of death being caused by wilful exposure. Imprisoned.
CASE 3. _Ill-Treatment and Criminal Exposure_ (_Ann. d’ Hygiene_, Vol.
VI., p. 207, 1831).—Man and wife tried for manslaughter of a child,
æt. 11. Wife the stepmother. Starvation and ill-treatment by mother,
followed by forcing the child, in a cold December day, to get into a
barrel of cold water and remain there. Though removed by a servant,
she was again placed in the cold water by the mother, death resulting.
The woman was sentenced to life imprisonment.
CASE 4. _Sunstroke, High Temperature, etc._ (Dr. A. Flint, Jr., _New
York Med. Jour._, 1872, p. 168; Dr. Katzenbach, _New York Med. Jour._,
1873, p. 93).
CASE 5. _Scald, Drinking from a Tea-kettle._ _Accidental_ (Mr.
Sympson, _Brit. Med. Jour._, 1875, June 19th, p. 809).—Boy, æt. 2½
years, drank boiling water from spout of tea-kettle. Inflammation of
pharynx and glottis. Tracheotomy; recovered.
CASE 6. _Fatal Scald of Insane Person in a Bath_ (_Brit. Med. Jour._,
April, 1871, p. 456).—An insane patient fatally scalded in a bath,
through carelessness of an attendant. The charge of manslaughter
brought against the attendant.
CASE 7. _Fatal Burn of Genitals._ _Accidental_ (Caspar, “Forensic
Med.,” Vol. I., p. 315).—Female child, 2½ years, fell on a hot
flat-iron. Genitals burned; died in eleven days. Vagina gangrenous;
blood fluid; lungs anæmic and pale; trachea bright red, etc.
CASE 8. _Red, Parchmenty Skin, Cracks, etc._ (Caspar, “Forensic Med.,”
Vol. I., p. 307).—While a chimney-sweep was cleaning a chimney a fire
was lighted below. Death. The entire skin was of a coppery red color,
with yellow patches. No carbonization. Skin parchmenty, with fissures
upon the edges of which the fat had melted and flowed out.
CASE 9. _Asphyxia. Sooty Mucus, etc._ (Caspar, “Forensic Med.,” Vol.
I., p. 314).—Two children, æt. 3 and 7, burned; death from asphyxia.
The youngest, the girl, burned externally; the boy was not. Post
mortem in both showed the trachea to contain frothy and sooty mucus.
Lungs and vessels of thorax and abdomen distended with dark and fluid
blood. Brain congested, etc.
CASE 10. _Burn of Body._ _Inflammation of Stomach_ (_Amer. Jour. Med.
Sciences_, Jan., 1861, p. 137).—Superficial burn of lower part of
body. Death on the thirteenth day. Post-mortem examination showed the
stomach inflamed and the intestines also.
CASE 11. _Accidental Scald._ _Pleurisy_ (Caspar, “Forensic Med.,”
Vol. I., p. 312).—Female child, æt. 6; scalded with a pot of boiling
coffee overturned upon the side of neck, right axilla, thorax, and
right arm. Death on the eighth day. Post-mortem examination revealed
inflammation of right pleura, pericardial effusion, etc. Body anæmic.
CASE 12. _No Internal Lesion Found_ (Guy’s Hospital Reports, 1860,
Vol. VI., p. 146).—Female, æt. 9. Burn of upper part of chest and
arms by clothing taking fire. Death on the ninth day. Post-mortem
examination revealed no lesion of the internal organs.
CASE 13. _Cracks and Fissures of Skin_ (Caspar, “Forensic Med.,”
Vol. I., p. 314).—Male, æt. 83. Clothing caught fire; death. Body
carbonized. On right side were fissures opening into the abdomen; the
viscera could be seen, etc.
CASE 14. _Fissures, Vessels Crossing, etc._ (Taylor, “Med.
Jurisprudence,” Vol. I., p. 696).—Boy, æt. 2; death in three-quarters
of an hour. On legs were fissures and lacerations near each knee. On
right thigh a laceration 2¾ inches long, 1/6 inch deep and 1/4 inch
wide; fatty tissue seen beneath. No blood effused; small vessels could
be seen stretching across the fissures.
CASE 15. _Brain Congested, etc._ (Caspar, “Forensic Med.,” p.
316, Vol. I.).—Boy, æt. 1-1/2 years, set fire to his clothing.
Death in 1½ days. Post-mortem examination showed congestion of the
brain, inflammation of the trachea, engorgement of the lungs with
hepatization of the lower part of the right lung.
CASE 16. _Burn of Lower Part of Body._ _Death_ (same
reference).—Woman, æt. 81; burn of lower part of body, including the
gluteal region, the perineum and genital organs (external). Death
after several days. Post-mortem examination showed the upper lobe of
left lung in a stage of red hepatization, etc.
CASE 17. _Tardy Appearance of Redness and Vesication_ (Tidy, “Legal
Med.,” Vol. II., p. 124, Case 15).—Woman, insensible from cold, had
hot water applied in tins to her sides and feet. The flannel coverings
became displaced and the hot tins came in contact with the body. No
redness or vesication could be detected two hours afterward. The next
day, when consciousness had returned and recovery from insensibility
had taken place, the parts had become reddened and vesicated.
CASE 18. _Were the Burns Ante Mortem or Post Mortem?_ (Caspar,
“Forensic Med.,” Vol. I., p. 317).—Woman intoxicated; clothing caught
fire; death due to asphyxia. Some burns apparently caused during life
and some after death. The case was decided upon the _character_ of the
vesications and their _contents_. Lungs and other organs normal. Right
side of heart engorged with dark blood.
CASE 19. _Murder._ _Body Burned_ (Dr. Duncan, _Med. Gazette_, Lond.,
Vol. VIII., p. 170).—Man charged with the murder of his wife and
attempting to burn the body afterward. The body was so extensively
burned as to remove all means of deciding the cause of death. The man
claimed that her clothing took fire when she was intoxicated. Persons
in the same house had heard sounds of a struggle before smelling smoke
and fire. Furniture was not burned, nor the house. The prisoner was
found guilty of murder.
CASE 20. _Blisters. Was the Scalding Ante Mortem?_ (Taylor, “Med.
Jurisprudence,” 8th Am. Ed., p. 411).—The body of an infant found in
a saucepan, boiled. The prisoner admitted that the child had breathed.
The boiling water had destroyed the means of positively deciding
whether the child had breathed. Blisters found upon it contained
yellow serum. Was the child living when put in the water? The prisoner
was acquitted.
CASE 21. _Scald of a Lunatic in a Bath_ (Taylor, “Med. Jurisprudence,”
8th Am. Ed., p. 411).—Insane patient placed in a hot bath.
Temperature 123° F. Death in collapse next day (1879).
CASE 22. _Criminal Burning, Strangling_ (Report of Profs. Liebig and
Bischoff, of Giessen, March, 1850).—The man Stauff was tried at
Darmstadt for the murder of the Countess of Goerlitz, whom he had
attacked and murdered in her chamber, and then fired the furniture in
order to conceal the crime. It was uncertain whether she had died from
injury to the head or from strangulation. The tongue protruded and was
swollen, as in cases of strangling, and maintained this condition. He
was convicted chiefly on circumstantial evidence. After conviction
he confessed that he had strangled her and then set fire to the
furniture, which he had piled up about her.
CASE 23. _Murder. Body Burned._ _Identified_ (“Report of the Trial
of Prof. Webster,” etc., Boston, 1850).—Prof. Webster killed Dr.
Parkman and then burned the body, in portions, in a furnace in his
laboratory. Search among the cinders of the furnace disclosed pieces
of human bones and a set of false teeth which the dentist who made
them recognized as made by him for Dr. Parkman, etc.
CASE 24. _Murder. Body Entirely Burned._ _Identified_ (the “Druse
Case,” Trans. New York State Med. Soc., 1887, p. 417).—Mrs. Druse,
with the compulsory aid of her children, killed her husband with an
axe. The body was burned in a wood stove, with pine shingles. The
ashes were thrown into a swamp near by. They were found and carefully
sifted. Pieces of bone of various sizes, identified as human, were
found, as also a few porcelain buttons, etc. A few hairs found, with
stains, completed the identity. Experiments in this case showed that
the body could have been consumed within _ten_ hours. The prisoner was
convicted of murder.
THE MEDICO-LEGAL RELATIONS
OF
ELECTRICITY.
BY
WILLIAM N. BULLARD, M.D.
MEDICO-LEGAL RELATIONS OF ELECTRICITY.
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 œdema
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:
═══════════════════╤════════════╤═════════════════════════════════════
│ │ TIME, SECONDS.
│ Number of ├─────────┬────────┬────────┬─────────
│ Contacts. │ 1st. │ 2d. │ 3d. │ 4th.
───────────────────┼────────────┼─────────┼────────┼────────┼─────────
Kemmler │ 2 │ 17 │ 70 │ │
Slocum │ 2 │ 27 │ 26 │ │
Smiler │ 4 │ 10 │ 10 │ 10 │ 19
Hood │ 3 │ 20 │ 20 │ 20 │
Jugigo │ 3 │ 15 │ 15 │ 15 │
Loppy │ 4 │ 15 │ 11 │ 15½ │ 10½
McElvaine │ 2 │ 50 │ 36 │ │
Tice │ 4 │ Total time, 50.
───────────────────┴────────────┴─────────────────────────────────────
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
dyspnœa. 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 œdema 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.
THE MEDICO-LEGAL CONSIDERATION
OF
DEATH BY MECHANICAL SUFFOCATION
INCLUDING
HANGING AND STRANGULATION.
BY
DANIEL SMITH LAMB, A.M., M.D.,
_Pathologist Army Medical Museum, Washington, D.C._; _Professor of
Anatomy Medical Department Howard University, Washington_; _Secretary
Association of American Anatomists_; _Late Acting Assistant Surgeon
United States Army_; _President of Association of Acting Assistant
Surgeons U. S. A._; _Member of Learned Societies_.
MECHANICAL SUFFOCATION.
=Suffocation= is the name applied to both the act of and condition
resulting from the deprivation of atmospheric air. If the deprivation
is due to mechanical interference, the term MECHANICAL SUFFOCATION is
used.
Mechanical interference may be by pressure upon or obstruction within
some portion of the respiratory tract. Suffocation by pressure upon
the neck is called =hanging= when the constricting force is the
weight of the body itself; and =strangulation= in all other cases.
German writers designate strangulation by cords, ropes, and the like
as _Erdrosselung_, and by the hand as _Erwürgung_; French writers do
not make this distinction. In English the word throttling is probably
oftener applied to strangulation by the hand than by cords.
The term =suffocation= is also applied in a _special_ sense to the
act and result of pressure on the mouth, nose, or chest and abdomen,
stopping the breathing; or of obstruction within the respiratory tract;
or of pressure upon the tract from the œsophagus, etc.; or of breathing
of irrespirable gases.