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.