ELECTRICITY 203 In some instances there may be paralysis due to degenerative changes in the nervous system. Rarely, optic atrophy and other intraocular lesions may develop several months afterwards.13 Lucas14 reports the case of a boy, aged 15 years, who, while standing on a dis- charged transformer so as to dust a ledge, slipped and clutched at a cable carrying a current of 1(1,000 volts. Respiration at once ceased and the limbs were burnt, swollen and stiff. The boy recovered consciousness after artificial respiration, but the limbs became gangrenous. On the third day the right arm was amputated through the shoulder-joint. Arterial thrombosis was found upto the origin of the superior profunda. Both legs were amputated on the sixth day. Toxsemia set in, and the boy died on the ninth day after the accident Causes of Death.—Death from electric shock may occur from sudden stoppage of the action of the heart, or from paralysis of the respiratory centre due to nervous inhibition. According to the experiments of Lang- worthy 15 death from fibrillation of the cardiac ventricles is believed to be more common after contact with low voltage circuits, while circuits at high voltages cause death from respiratory failure due to central inhibition in the nervous system. Treatment.—The current should be switched off at once, or the patient should be removed from the vicinity of the live wires, but the person trying to remove him should guard himself against its effects by wearing India- rubber gloves, by wrapping his hands in several folds of dry cloth, by standing on hay, or by using a long stick to remove the wires. The treat- ment to be adopted after removal is stimulation, warmth, friction, artificial respiration and venesection, if necessary. Pometta16 recommends that artificial respiration should be continued for at least five hours except in those cases where the injuries are so severe that the patient cannot possibly be alive. Carbon dioxide is a valuable respiratory stimulant, and can be given from a soda-water syphon, when no cylinder is available. The syphon is half emptied and a rubber tube is attached to its nozzle ; it is then inverted and the fluid is blown out of the glass tube. Gas is admitted to the patient's air-passages through one nostril. Post-mortem Appearances—External.—The face is generally pale, the eyes are congested and the pupils are dilated. Local lesions are found at the points of entrance and exit of the electric current. Professor Jellinek 17 has pointed out that the micropathological changes, as observed in the skin at the site of an electrical lesion, are a compression of the horny layer into an homogeneous plaque, and an ironing out of the underlying papillary process. Occasionally fissures and hollows appear between the corneum pud germinativum, but this is not invariable, and th£ surest sign that an| electric current has passed is the coalescence into a star-shaped or rod-like I structure of the basal cells in each group of the rete Malpighii. Internal.—The lungs are often found oedematous, and the other internal organs are congested. Minute haemorrhages are seen in the meninges, and Tardieu's spots are found on the pleurae, pericardium and endocardium. Ecchymoses may be noticed along the path of the current. In the case 1S of a young man, about 21 years of age, who was killed by a direct current of 220 volts, the following post-mortem appearances were found : — There was no sign of electric burn on the skin. There was intense vascular congestion of the dura mater, more noticeable on the left than on 13. Bainbridge, Brit. Med. Jour., Dec. 6, 1930, p. 955. 14. Brit. Med. Jour,, Jan. 21, 1905, p. 134. 15. Jour. Exper. Med., June 1, 1930, p. 943; Brit. MecL Jour., Aug. 30, 1930, 1^^ p. 38. 16. Schw&z Med. Wach., 1930, Vol. IV, p. 82 ; Lancet, Feb. 8, 1930, p. 310. 17. Lancet, Nov. 5, 1927, p. 1,002 ; Medizinisclie, Klinik, Sep. 23, 1927. 18. Lancet, April 14, 1928, p. 756.