THE

CHICAGO MEDICAL

RECORDER

MARCH, 1904.

Original Articles.

ELECTRICAL OPHTHALMIA.

BY JAMES BURRY, M. D., Chicago.

Electricity is daily occupying a more prominent position in the world's industries, and the uses to which it is put are becoming more varied day by day. As its use increases more people are exposed to its dangers. These dangers are not confined entirely to those engaged in electrical work. The on-looker or passer-by is not infrequently exposed to dangers of which he has no conception.. The transmission of high tension currents over wires stretched through public places may be the source of great danger, and those of lower tension cause unpleasant experiences.

An illustration of the latter is that an unpleasant shock may be experienced from touching a tree, after a shower, through the branches of which a telephone wire passes, and the swaying of the limbs and the wire cause a contact and consequent leakage of cur

rent.

The dangers of electrical currents may be classified under four general heads:

First, those attributable to shocks; by shocks meaning injury due to the passage of the current through the body.

Second, those attributable to burns or injuries caused by burning some portion of the body by contact with an electric arc.

Third, those attributable to falls caused primarily by shocks or burns.

Fourth, flashes or injuries to the eyes by exposure to the intense light of an arc.

A shock may be received from an electrical circuit, provided the body or some portion of the body be allowed to form a link

in the circuit. No shock can be obtained unless the circuit is completed through the body. The severity of a shock usually depends upon the amount of current passing through the body; this current depends upon the voltage of the circuit and the completeness of the contact. It is possible to receive a fatal shock from a 125-volt circuit, if very complete contact with the two sides is made.

An electric wire carrying 20,000-volt 3-phase A. C. circuit is extremely dangerous. When such a line is installed careful instructions are always given all the electrical workmen. No work should ever be done upon this circuit or upon any apparatus connected to it, unless is is absolutely certain that the power has been cut off. With such a high voltage the ordinary precautions, such as standing on an insulator or wearing insulated gloves, are of no value. No lineman should ever climb the poles carrying this circuit, and no attendant should attempt to adjust apparatus used for the control of this circuit without special instructions having been issued for such work by the electrician in control. It is dangerous to life to touch a pole carrying a wire of such high tension. Standing on the ground at the foot of such a pole is hazardous.

I recall a case where a workman was walking on a high trestle, near which was stretched a wire carrying one of these deadly currents, and the leakage from which charged a portion of the trestle. When he reached the charged portion he received an unexpected shock, which threw him from the trestle to the ground, and his death resulted from the fall. The insulating of wires can not be depended upon to protect a man from shock.

The usual cause of an unexpected electric arc is a short circuit, and this may be caused in many ways. A lineman may get his plyers from side to side of a circuit; he may also allow a wire to drop across, or he may bring two sides of a circuit in contact with each other, not knowing that they are of opposite polarization or thinking they are dead. The resulting arc may injure him seriously, and may injure others.

A metallic tape measure fell across the third rail and track rail of the Aurora, Elgin & Chicago Electric Railway, and the resulting arc "flashed" an onlooker, so that he was disabled for two weeks.

Another instance is that of a boy, who was at work about two feet from an incandescent lamp on a 220 volt circuit, when, probably from an imperfect fuse, a short circuit was established in the lamp, causing an explosion of the lamp, and the resulting arc "flashed" the boy's eyes, so that he was disabled for three days.

A number of times the Alley "L" elevated railway has been stopped in its operation, and passengers have received shocks, owing to short circuiting. The last one occurred about the 20th of last January, when the entire system was tied up for an hour or more.

The only way to avoid these accidents is to avoid the short circuit. The man working on circuits should never take any steps unless he has full knowledge of what the result should be, knowing the danger he should take no chances. Most such accidents arise from carelessness or lack of caution. Frequent causes of arcs is the opening of a switch carrying a large amount of current. There are many special conditions which make any electrical work dangerous. It is not possible to explain in detail all causes. It may be stated, however, that experienced workers are always "afraid."

Passing over the question of burns and injuries from shock, either direct or indirect, we will consider those injuries to the eyes arising from exposure to the intense light of an arc.

The symptoms of ophthalmitis usually commence six or ten hours after exposure to an arc. The first symptom noticed by the patient is intense pain in the eyes. There is present conjunctival hyperemia and severe photophobia, and there may be sloughing of the epithelial covering of the cornea and hyperemia of the retinal vessels. As a result of these conditions, the patient is unable to use the eyes, and states that he is blind, but examination shows that extreme loss of sight is produced by conjunctival irritation and lachrymation.

Dr. L. D. Broose, of Evansville, Ind., reports in "Archives of Ophthalmology," Vol. 23, 1894, two cases which present the usual symptoms and history.

Dr. E. C. Rivers, Denver, Colo., reports a case with sloughing of the epithelial covering of the cornea, from which there was a complete recovery. A subsequent examination showed the normal optic discs and retinal vessels. He believes that this was the first case reported. April, 1894.

In the Atlanta Medical and Surgical Journal, 1898, Dunbar Ray reports two cases. In his cases he speaks of retinal irritation. He saw in one of his cases, white spots on the periphery of the retina, which were not so marked as those of diabetes or Bright's.

Hewet in the British Medical Journal gives the condition the name "ophthalmia electrica," and reports two cases.

Another English surgeon refers to Hewet's cases, and also reports two. In these cases the usual symptoms were described, and

without any permanent results. In all less than fifteen cases are reported, as far as I have been able to learn.

Fuchs in his Textbook on Ophthalmology, says the ophthalmoscope shows pigment changes in the macula lutea, also that there is a permanent central scotoma. He says that vision is reduced, and that it may lead to atrophy of the retina.

I have seen, during the last two years, some forty cases, most of which occurred under the following conditions: In the making of iron in a blast furnace the iron is drawn off from a hole in the side of the furnace near its bottom. This hole is stopped up before the furnace is charged with ore and fuel, with a composite substance. When the "heat" is ready to be drawn off an opening is made through this substance by means of a long iron rod manipulated by several men. Not infrequently some of the iron permeates this substance, and it is impossible to make a hole with the ordinary means.

An electric apparatus has been devised for the purpose of burning the iron which has permeated the material used for a stopper. This device consists of a carbon rod four or five feet long and four inches in diameter, to which is attached a handle. By this means an arc is obtained between the carbon and the stopper material, and an intense light is given off.

The operator of the device wears a mask of wood or metal in which eye holes are made, and these are filled with either several layers of blue and red glasses, or else a very heavy thick black glass, which is especially manufactured for the purpose. In spite of all these precautions, the operator is sometimes "flashed." If, however, other persons are in the building while the operation is going on, they are not infrequently "flashed." This accounts for the apparently large number of cases I have seen.

Mr. D., a foreman of electricians, twenty seven years of age. First "flashed" February, 1903. It made its appearance eight hours after exposure. He was troubled with cloudy vision for thirty six hours. First flash was from a sustained arc. He has been more easily affected by flashes since. He has received three bad flashes since first one. An examination January 24, 1904, shows a velvety appearance of the palpebral conjunctivae, with slight enlargement of the papilae of both conjunctivae. Vision of the right eve 6/5-2. Of the left eye 6/5-1. Fundi normal.

Mr. C., thirty six years of age, sustained four flashes. The first one four years ago, examination on same day, conjunctivae normal. Fundi normal. Central vision normal.

Mr. L., sustained bad flashes. Has normal vision. The left fundus is normal, the right fundus shows a slight congestion or strippling of the choroid, in the region of the yellow spot. This may be entirely independent of "flashing."

Mr. S., received his worst flash May 3, 1903; after working six or eight hours he was unable to see, but this condition was temporary. Conjunctiva sensitive as if he had sand in eyes. Conjunctiva injected, both bulbar and palpebral. Attempt to read precipitated prohibitory lachrymation. January 24, 1904, both eyes normal. There is an anterior synechia of the right iris, result of an accident fourteen years ago. Vision of both eyes is normal.

Mr. John S., sustained several flashes. The fundi are normal. Vision normal.

Mr. E. B. C., received first flash ten years ago. He thinks his eyes are more susceptible since, but believes he might become accustomed to arc light. Both fundi normal. Vision normal.

Mr. Robert A., sustained first flash May 3, 1903. Slight retinitis at that time. No findings.

cases.

Seclusion in a dark room is recommended as treatment in these This I have found, however, to be of no value whatever. The application of cocaine gives pronounced and immediate relief. This followed by boric acid irrigation and smoked glasses is all that is necessary and recovery is uneventful.

The conclusions of Dr. Fuchs as described in his book are, therefore, of interest. It is unfortunate that he does not cite any cases. The number of cases that I have seen with complete recovery, and none with any permanent results, even where patients have suffered from injury at three or four different times, leads me to believe that his conclusions are incorrect. In conversation with other physicians, particularly in Pennsylvania and Ohio, who have had experience with these flashes, they report no permanent conditions arising from these injuries.

THE ROOKERY.