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CURRENT LITERATURE.

How to Deal With Apparent Death From Electric Shock

(By Augustin H. Goelet, M. D.) Much interest has recently been excited by the report from France of the resuscitation of a man apparently killed by electricity, and by the announcement of the French scientist D'Arsonval that a person so shocked should be treated as one drowned. The suggestion is a good one but may be somewhat misleading unless understood; that is, unless the person understanding the resuscitation appreciates what is to be accomplished and just how it is to be done.

As this authority says, an electric shock may produce death in one of two ways, viz:

1. By producing destructive tissue changes, when death is absolute; or 2, by producing sudden arrest of the respiratory and heart muscles through excitement of the nerve centers, when death is only apparent; in other words, animation is merely suspended. The subject may be aroused from this syncope if efforts at resuscitation are not too long delayed.

The alternating current, which is usually regarded as the most deadly, strange to say, nearly always produces death in this second manner.

To say that a person has received a shock from a wire conveying a current of four or five thousand volts, does not necessarily signify that the body has been subjected to the full force of the current, even if the meter does register nearly one ampere during the time of the accident. In view of the fact that the human body offers a resistance of several thousand ohms, which resistance is greatly increased by imperfect contact, and by charring and burning the tissues at the points of application, it is not often that the internal structures or vital organs are submitted to a very considerable volume of current, though it apparently passes through the body. It must be borne in mind that when the clothing is moist with perspiration or wet with rain, it offers a circuit of less resistance than the human body, and in this event the body receives only a shunt current very much less in quantity than the main current. The bulk

of current, in this instance, passes over the surface and does not enter the body. This may explain the survival of some who have apparently withstood very powerful currents. It must be presumed, therefore,, that electricity seldom kills outright, though the condition of suspended animation, which it induces, would result in death if not counteracted.

All things considered, it is rational to attempt the resuscitation of those apparently killed by electricity, and if not too long delayed, the effort promises fair chances of success, provided proper means are instituted.

If the body has actually been submitted to a current of sufficient volume to produce destructive tissue changes, all efforts at resuscitation will, of course, be futile.

If, on the other hand, only respiration and the heart's action have been temporarily arrested, there is a condition of syncope simulating apparent death by drowning, or from anaesthetics, and the physician knows that patients in this condition are frequently revived. Laymen will appreciate the nature of this condition if it is explained as one of exaggerated faint, and would not feel appalled upon encountering it if previously instructed how to cope with it. In an ordinary fainting spell the necessity to stimulate is universally appreciated. In syncope resulting from an electric shock stimulation is likewise indicated, but more vigorous measures are required. This is the only difference.

As said above, the direction to treat one shocked by electricity as one drowned may be misleading, as the conception of the laymen of the necessities in this case would be to roll the body on a barrel. Let him under, stand that the condition is one of exaggerated faint, that the necessity is for prompt stimulation, and that the quickest and most powerful stimulant which can be employed is artificial respiration. The man must be made to breathe, if this is possible, and efforts to induce respiration must not be suspended until breathing is fully and normally restored or until it is absolutely certain that life is extinct. This cannot be assured in less than

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grasp the elbows and draw them well over the head, so as to bring them almost together above it, and hold them there for two or three seconds. Then he carries them down to the sides and front of the chest, firmly compressing it by throwing his weight upon them. After two or three seconds the arms are again carried above the head and the same maneuver is repeated, at the rate of fifteen or sixteen times per minute. At the same time the tongue must be drawn cut to free the throat. This manipulation

appreciate the fact that this manipulation must be executed with methodical deliberation just as described, and never hurridly nor half-heartedly. To grasp the arms and move them rapidly up and down like a pump handle is both absurd and absolutely useless.

In addition to this, if an assistant be at hand, the tongue, held by a cloth or handkerchief to prevent slipping, should be seized and drawn forcibly out during the act of inspiration or when the arms are extended above the head, and when the chest is com

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pressed it may be allowed to recede. This rhythmical traction upon the tongue is in itself an excellent stimulant of respiration. It acts not only by freeing the throat of the tongue, which may fall back and obstruct breathing, but also by reflex irritation, through the fraenum or bridle under the tongue being drawn forcibly against the lower teeth.

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Should these efforts fail to elicit any response or arouse any signs of life, recourse may be had to another method of stimulation by exciting the dormant nerve centers. This should, however, be reserved for the physician, who should always be summoned when it is possible to get one, or should be made use of only by one who realizes the injury that may be done if it is carelessly practiced. Still, when the necessity is great and other means have been exhausted, some risk is allowable.

I refer to forcibly stretching of the sphincter muscle controlling the rectum or lower bowel. It is well known to physicians that this muscle is the last portion of the body to lose its sensibility and that by irritating it by forcibly stretching, a gasp will often be elicited from one actually moribund.

The method of procedure is this:

Turning the patient on the side, the index finger or thumb is inserted into the rectum and the muscle, which, if sensible, will be felt to resist, should be forcibly and suddenly drawn backward, toward the spine. Care must be taken not to introduce the finger roughly or to use sufficient force to larcerate or wound the parts.

Having obtained one gasp, artificial respiration should be continued and a repetition of the proceeding should be reserved until respiration again fails. In some instances, however, it may necessary to repeat this with every effort at inducing inspiration, that is, every time the arms are extended over the head. The subject then being on back, the knees are drawn upward to facilitate access to the rectum.

If the accident occurs in a city or town, oxygen, which may be obtained at every drug store, may be used. This is a powerful stimulant to the heart, if it can be made to enter the lungs.

This gas comes in cylinders furnished with a stop cock and tubes and bottle, which latter is to be half filled with water, through which the gas passes when turned on. (See figures.) If a cone or mouthpiece is not furnished with the apparatus, one can be hastily improvised from a piece of stiff paper and attached by a string to the ordinary mouthpiece. To use the oxygen, place the cone over the patient's face and turn on the stop cock until the gas is seen to bubble freely through the water in the bottle. Efforts at artificial respiration should

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AN IMPROVISED MOUTHPIECE.

be kept up while the gas is being administered to favor its entrance into the lungs.

The use of electricity to reawaken the heart and lungs to action offers another auxiliary to the resuscitation process, but implies the skilled employment of special electrical apparatus purely within the possession of the physician, who naturally does not require instruction.

When I was requested by the editors of the Electrical World to contribute this article I gladly accepted because:

1. I am convinced that many who have died in consequence of electrical

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