Looking back at the history of the use of electricity in the ED.
One of the most famous tropes in movies involves a frantic physician running back and forth around a table that obviously has a dead body on it. Sparks are flying, capacitors are buzzing, there is a whining noise in the background. And then the body is lifted up towards the stormy sky as thunder blasts and finally lightening comes crashing down and envelopes the body. In the ensuing tense silence the body is lowered and the physician leans over it. He looks up at the camera and screams, “It’s alive, it’s alive.”
In the ED it was a day of electricity that felt a bit like Dr. Frankenstein’s arcane laboratory — cardioversions, defibrillations and patients with pacemaker/AICD issues. We take such medical uses of electricity and electrical devices for granted that one rarely gives a thought to its development and introduction into emergency care. It is equally fascinating to think that one of the significant players in this part of medicine was not a physician but, an author who is credited with starting the genre of science fiction.
To begin this story one must go back to the early part of the 18th Century when various aspects of electricity were not just studied but, a part of various public demonstrations. Static electricity was the usual source of the electrical impulse and at parties people would hold hands to experience a shock. There was a rather famous and public feud between two of the leading experts in electricity of that time involving the concept of electrical energies within living bodies. Luigi Galvani and Alessandro Volta looked at the application of electrical current to muscle tissue and came to radically different opinions. Both observed the muscle twitch in frog legs with the application of an electrical current.
Volta was already world renowned for his work in electricity and postulated that the electrical current went through the metal wire into the muscle tissue that acted as a conductor resulting in the muscle twitch. Galvani opined that the leg movement was the result an intrinsic source electricity within the muscle tissue. He termed it “animal electricity” and while the theory was incorrect it did lead eventually to discovery of nerve action potentials.
The work of applying electrical currents to human tissue took a decidedly gruesome turn with Galvani’s nephew, Giovanni Aldini. He showed that a strong electrical current applied to a newly executed prisoner could cause muscle contraction. In several of these experiments the corpse actually sat up and even opened their eyes. The claim of reanimation as the result of such an electrical impulse was widely accepted by the lay public.
Even such leading researchers in the field, such as Humphrey Davy and William Nicholson, felt that Aldini’s experiments held some veracity in terms of restoring life to the dead. As it happened, Mr. Shelly was good friends with both Davy and Nicholson who were often in the Shelly home discussing these theories.
One most attentive listener to these discussions was the daughter, Mary Shelly. She melded these advanced theories of electricity into her landmark play Frankenstein in 1823. That seminal scene of the reanimation of the monster by a lightning bolt was straight out of the discussions Ms. Shelly had with some of the leading scientists studying electric phenomenon of the time. As such, the concept that electricity could not just restore movement but actual life was so well known that the scene as portrayed in Frankenstein was not such an outlandish idea. Many literary experts feel Mary Shelly was the originator of science fiction and her book remains a classic even today.
Jolt to the heart
The idea that the human body was an electrical entity gained further credence when Carlo Matteucci showed that each heart beat produced an electrical impulse. In 1895, the Dutch physician, William Einthoven showed that those electrical impulses could be displayed as a time vs. voltage graph that he termed an EKG. A more practical use of electricity was reported in 1947 when Dr. Charles S. Beck performed the first open thoracotomy defibrillation using two spoons and a defibrillation device he was experimenting with in his lab. However, having to perform a thoracotomy in order to apply the paddles was a distinct drawback until 1959, when the Russian engineers Drs. V. Eskin and A. Klimov pioneered an external defibrillator.
It was large and clumsy compared to today’s devices but, nonetheless was much more practical than opening up the chest. The concept of bringing electrical therapies to the prehospital setting was first advanced in Northern Ireland by Dr. James Francis Pantridge with a portable defibrillators on their EMS rigs. This idea got a huge boost in 1972 when former President Lyndon Johnson was defibrillated following an acute myocardial infarction.
With the ensuing federal legislation portable devices became common in EMS rigs. In Minnesota one of the pioneers of open heart surgery, C. Walton Lillehei, was appalled when one of his patients died because of a lack of access to a defibrillator. He came up with the idea of an implantable device with leads running into the heart. At the University of Minnesota Earl Bakken developed such a device for Dr. Lellehei. His implantable device spawned the company that now dominates the pacemaker and AICD market — Medtronics.
So, we can trace a path from the early 19th Century fascination with electricity and its ability to cause muscle contraction, fictionally popularized by Mary Shelly’s Frankenstein, to our work in the ED today. From fictional reanimation, to the discovery of intrinsic electrical activity in the muscles and nerves, to being able to graph that activity in an EKG, to using external shocks to treat cardiac arrhythmias — and now mini-computers not only pace the heart, but detect arrhythmias and deliver a shock directly to the heart that would have made Mary Shelley nod in satisfaction.
I now tell my patients whom I electively cardiovert that I am going to essentially do what Dr. Frankenstein did to reanimate his creation. Patients get the idea instantly. It might be something to think about the next time you use electricity to treat a patient — however after such a successful application of an electrical shock I do refrain from saying that famous line in Frankenstein movie – “He’s alive, he’s alive!”