Medical Jurisprudence, Forensic medicine and Toxicology. Vol. 1

by R. A. Witthaus; Tracy C. Becker

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.