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.