RESUSCITATION FROM ELECTRIC SHOCK AND DROWNING 321 



severe tetanic convulsions. However, caisson workers often experience 

 very severe symptoms, such as bleeding from the nose, dyspnea, vascular 

 inco-ordination, etc. These symptoms are due not so much to the great 

 increase in pressure as to the release from the pressure. When the 

 pressure is released too rapidly, the excess of gases in the tissues and in the 

 blood are set free more rapidly than they can be thrown off by excretion 

 processes. Gases, as such, gather in the blood vessels and form embolisms 

 which occlude the finer vessels. This, of course, produces serious dis- 

 turbances in the nutrition of the parts involved. If these parts happen to 

 be vital, death may result. 



Resuscitation from Electric Shock and Drowning. Of the numerous 

 conditions which lead to accidental asphyxiation, electric shock on the one 

 hand, and drowning on the other are of great scientific and practical importance 

 in the present day. These special conditions of asphyxiation necessarily in- 

 volve problems of general tissue asphyxiation and resuscitation. Under the 

 influence of electric shock of sufficient intensity, an immediate result is 

 paralysis of the nervous respiratory control, with whatever else may be 

 directly or indirectly involved. This condition quickly brings on asphyxia- 

 tion with all of its train of perverted functional activity. So also in drowning, 

 suspension under water blocks respiratory activity and induces asphyxia- 

 tion. Within the last few years careful investigation of this condition has 

 been made by Stewart, Guthrie and Pike, by Crile and Dolley, and by 

 numerous others. The work has tended to set the time limits of tissue 

 asphyxiation after which recovery is impossible or at most incomplete. The 

 nerve tissues are most susceptible to injury here, see page 303. Within 

 the nervous tissues, the different functional centers manifest different degrees 

 of susceptibility. Those immediately involved in the injuries are the re- 

 spiratory, vaso-motor, and cardiac regulative centers. If all the activities 

 of these nervous mechanisms can be re-established, control of general vis- 

 ceral reactions will be insured. The delicate functional activity of the 

 higher or cortical regions of the brain are even more susceptible to asphyxia- 

 tion, and recover more slowly if at all. 



In the condition of drowning there are no highly important special 

 injuries. In electric shock on the other hand, there may be a series of 

 local injuries from electric burns, etc. These may injure only the point of 

 contact between the surface of the body and the electric conductor, but it 

 is perfectly possible that the injury may be intense on some deep-seated 

 vital structure. In such cases, recovery of the respiration or of the circula- 

 tion will not necessarily insure ultimate success in the efforts to revive the 

 individual. 



Considering the fact that the nervous tissue cannot be safely recovered 

 beyond the limit of 15 minutes (this is a fair maximum average from our 

 most reliable authorities) it follows that immediate and careful steps must 



