ELECTROCUTION

Q) What are the factors related to outcome of Electrocution?

Ans) Two types of factors are related to outcome of electrocution –

1) Factors related to nature of electric supply –

(i) Voltage (Tension)
(ii) Amperage (Intensity)
(iii) Form of current (AC/DC)

2) Factors related to the Victim –

(iv) Resistance of the body tissues
(v) Area of contact of body
(vi) Duration of contact
(vii) Earthing/Insulation
(viii)Other factors
Q) What are different types of voltage in reference to electric shock
and how do they cause harm or lethality ?
Ans) 1) Volt is the unit of electromotive force. It is the force required to produce 1 ampere of
intensity when passed through a conductor having the resistance of 1 ohm.
2) Types of voltage (tension) based on their range : -
(i) Low voltage (below 50 volts), as used therapeutically, are usually not fatal. However,
fatalities due to alternating current of low tension have been reported.
(ii) Medium voltages, i.e. under 500 volts - Most fatalities follow shocks from currents at
tensions of 220–250 volts, which is the usual range of household supply. At such voltages,
the usual visible damage to the body occurs in the form of small ‘electric marks’ and death
is owing to internal derangement of functions. Medium voltage predispose to prolonged
contact due to induction of spasm of the muscles and therefore the victim grips and ‘holds
on’ to the conductor. Under these conditions, a current whose momentary passage would
merely cause a shock may become lethal.
(iii) High voltages, i.e. above 500 volts - a person may be thrown clear of the source by the
violent muscular contractions caused by the current or the body may be extensively
damaged with severe and deep burns
Q) What is the cause of death at various ranges of voltage?
Ans) 1) Electrocution is rare at < 100 V and most deaths occur at > 200 V

2) In low or medium voltage current: The precise mechanism of electrocution is not known.
(i) Usually death occurs by Ventricular fibrillation.
(ii) Prolonged ventricular fibrillation may cause ischemic brain insult and death.
(iii) However, in some cases the death may be attributed to asphyxia or respiratory paralysis.
The current passing through the chest may induce tetanic contraction of extrinsic muscles
of respiration and thus causes mechanical asphyxia.
(iv) If the head is in the circuit, then there may be paralysis of respiratory center or cardiac
arrest due to inhibition of centers in brainstem.

3) In high voltage current:

(i) Here the death is due to arching (flash-over) of electric current or due to ignition of
clothes. Due to ignition of clothes, person may sustain burn injuries.
(ii) Some victims may be thrown off from the site and sustains secondary injuries due to fall.
Q) Which is the most important factor in electrocution? How much
amperage is lethal?
Ans) 1) Amperage (Intensity) is probably the most important factor as far as the electricity
itself is concerned as it indicates the actual intensity/amount of electricity which passes
through the body.

2) It is the unit of intensity of electric current and may be calculated in any given circuit by
dividing the voltage by the resistance in ohms.

3) On receiving a current of 1 mA, a person usually experiences tingling sensations and as

the intensity of the current is increased, contraction of the muscles is greater and the current
of about 8–20 mA is sufficient to prevent the victim letting go off the source of the current.

4) At much higher currents, this factor of ‘hold on’ is not seen, and the victim may be
thrown clear of the source of the current by violent muscular contractions and this may be
responsible for secondary injuries to be sustained by the victim depending upon the
circumstances.
Q) Which is the most important factor in electrocution? How much
amperage is lethal?
5) The intensity of 70–80 mA created by alternating current and 200–250 mA by direct
current are considered to be dangerous.

6) The danger increases as the amperage rises above 100 mA up to about 4 A and
thereafter it decreases.

7) Amperage above 4 A arrests ventricular fibrillation; this is the principle of treatment

with a defibrillator.

8) A current of high voltage with low amperage can be less dangerous than one with
moderate voltage but high amperage.

9) This again emphasizes that the amperage is more important than the voltage.
 Q) What is AC & DC current and which is more
dangerous?
Ans) 1) There is 2 types of current (i) Alernate Current (AC) & (ii) Direct
Current (DC)

2) Alternating current (AC) is one that reverses its direction at regular

intervals & the electricity flow occurs alternatively in the opposite
direction.

3) Direct current (DC) is one where the electric current flows constantly in
the same direction

4) AC is more dangerous than DC. AC is 4-5 times more dangerous than DC.
 Q) What is AC & DC current and which is more
dangerous?
5) Reason for greater lethality of AC is that it causes tetany within the flexor muscles of
hand and forearm, and hence the patient is unable to release the device until the power
is turned off. It also interferes with the normal cardiac pacing causing cardiac arrest.

6) In contrast, DC tends to cause a single muscle contraction, throwing the victim, and
resulting in a shorter duration of exposure to the electrical source, but increasing the
chance of blunt trauma.
Q) At what range of cycles per second is AC dangerous and at
what range not dangerous?
Ans) 1) The AC between 40 to 150 cps is most dangerous. An increase in rate
above this range decreases the danger.

2) The usual frequency of AC is 50 cycles/sec (CPS).

3) Ordinary household supply of current is around 50 cps

4) Frequency of commercial supply is between 25 to 60 cps.

5) The body is much less susceptible to very rapidly alternating or slowly

alternating currents, for instance, below 10 and above 1000 cycles per second.
Q) At what range of cycles per second is AC dangerous and at
what range not dangerous?

6) Prevost and Battelli (1899) found that heart was about 20 times more tolerant when
the current was raised to 1720 cycles per second than to one at 150 cycles per second.
The high frequency current used in the diathermy, which oscillates at one million cycles
per second and carries 20,000–40,000 volts at 1–2 mA, is harmless as the effect of each
impulse is to annul the effect of the preceding impulse
Q) What are the various pathways of electric current which can lead to
death?

A – Rt hand to B – Lt hand to Rt foot C – Head to Rt hand D – Head to Rt foot E – Head

Lt hand to Lt foot

PC - Point of contact. PG – Point of grounding

1) Electric current runs from PC to PG through the shortest path.
2) These are 5 most dangerous pathways taken by electric current which can cause death.
3) Path A, B, and E passes through heart and can cause Ventricular fibrillation
4) Path C & D passing through brain stem can cause respiratory failure.
Possible pathways of electric current which can lead to death
Q) Describe the factors related to victim in electrocution?
Ans) Factors related to the Victim are –
(i) Resistance of the body tissues
(ii) Area of contact of body
(iii) Duration of contact
(iv) Earthing/Insulation
(v) Other factors - (a) Personal idiosyncrasies, (b) Awareness of the victim
(c) Presence of any disease
 1) Resistance of the Body Tissues
(i) It is well-known that the current flowing through the conductor is determined by the
voltage divided by the resistance, i.e. I=V/R, where I is the current in amperes, V is the
potential difference in volts and R is the resistance in ohms.

(ii) Therefore, the resistance of the body tissues plays its role. The greater the resistance,
the more likely that burns will result.

(iii) The major barrier to the electric current is the skin, which exercises far greater
resistance than the internal body tissues.

(iv) Once the skin has been overpowered by the electric current, the vascular system filled
with electrolyte rich fluid serves as a favourable medium for the passage of current.

(v) The resistance offered by the skin is further modified by the thickness (on soles and
finger pads and palmar surfaces, the resistance is greater than the thin skin elsewhere)
and the dryness or dampness of the skin.
 1) Resistance of the Body Tissues
(vi) The dry skin of the palms offers the greatest resistance. (Can be upto 1 – 2 million
ohms)

(vii) Sweating can appreciably reduces resistance from 30000 ohms to 2500 ohms.

(viii) The resistance of the skin varies from one region to the other, it being
greatest in the palm and least on the inner side of the thighs.

(ix) The average skin resistance is of the order of 500–10,000 ohms.

(x) Bone has a resistance of about 900,000 ohms.

(xi) Vascular areas like cheeks, mucosae, etc. offer less resistance.
 2) Area of Contact of the Body

Area of contact carries importance in two respects.

(i) Firstly, the smaller area of contact between the skin and the electric supply
will exert more resistance than the larger area, e.g., the tip of the finger
compared to the palm of the hand.
(ii) Broad good contact usually reduces the resistance considerably (from
100,000 ohms to 1000 ohms as reported by Simonin, 1955).
(iii) This may occur when one grasps a hot wire with a wet/sweated hand. Here,
the entire skin surface being bathed in salt water (sweating) becomes a
conductor and not enough current passes through any localised portion of
hand to generate sufficient heat to burn the skin, which is the most efficient
barrier against the passage of the current and hence electrocution can occur
with no visible skin burning. Similarly, electrocution in a bath may occur without
any external mark.
 2) Area of Contact of the Body

(iv) Secondly, the part/site of the body and the route of current through the body
have a considerable bearing.

(v) The passage through the region of the heart is most dangerous.

(vi) Heart is usually involved when the path is from hand to hand or from left arm
to the right leg.

(vii) When the head of the worker may come in contact with the conductor, brain
stem may be directly involved leading to paralysis of cardiac or respiratory centre.
 3) Duration of Contact
(i) It will obviously determine the amount of damage.
(ii) The longer the contact, the greater will be the damage.
(iii) Low tension currents may prove lethal if the contact is maintained
for sufficiently long periods.
 4) Earthing/Insulation
(i) The pathway of the current will depend mainly upon the relative resistance
of the various potential exit points.
(ii) It tends to follow the shortest route, irrespective of the varying
conductivity of the various internal tissues.
(iii) The current enters at one point (most often at the hand as the hand is
mostly used to hold, touch or to manipulate some electric appliances) and
then leaves the body at some exit point, usually to the earth.
(iv) The better the contact between the person and the earth at the time of
sustaining the electric shock, the more dangerous will be its effects.
(v) A person, therefore, standing with dry shoes on a dry surface may scarcely
notice a shock, which could prove fatal to someone standing bare footed on
a wet surface.
(vi) Hence, stout rubber gloves and rubber boots provide considerable
protection.
 5) Other factors
(i) Personal idiosyncrasies of the human beings may also play a role. The
personality and physical condition of the individual and the existence of bodily
or mental distress at the time of sustaining shock influence the effects of the
shock.

(ii) Further, awareness of the victim towards the possibility of shock being sustained
may make the victim withstand one which might otherwise be dangerous.
Reported cases show that an individual taken by surprise may succumb to shocks
that ordinarily produce no ill effects. An engine driver used to exhibit his skills by
exposing himself to shocks from an electric lamp carrying a tension of 50 volts by
catching hold of the lamp with both hands and letting it go as a bet for a glass of
beer. He succeeded in doing so with impunity until one day he happened to have
accidental contact with the lamp and died of an unexpected shock (Taylor, 1948).

(iii) Presence of any disease in the victim, especially the cardiac disease, may
predispose to death from currents of low tensions.
Q) What are the various causes of death in Electric shock
or electrocution?
Ans) 1) Ventricular fibrillation –
(i) Most deaths from the electric shock are from cardiac arrhythmias, usually
ventricular fibrillation terminating in arrest. This occurs when the current passes
through the thorax, from hand to hand or from hand to leg routes.
(ii) The critical level of current seems to be of the order of 100 mA
(iii) The most dangerous is from the left arm to the opposite leg; from arm to arm is
about 60% as lethal.
(iv) Loss of consciousness needs not be immediate, and some may even be able to
walk some distance before they die.
Q) What are the various causes of death in Electric shock
or electrocution?
2) SPASM OF THE RESPIRATORY MUSCLES (TETANIC ASPHYXIA) –

(i) Electric current passing through the thorax may lead to tetanic contraction of the
muscles of respiration and ultimately producing respiratory arrest.

(ii) Here the mode of death obviously will be congestive hypoxia.

(iii) These victims are likely to be cyanosed whereas in case of death due to
ventricular fibrillation, they usually appear pale.

(iv) The range of current that can induce tetanic contractions of the extrinsic
muscles of respiration may be 20–30 mA.
Q) What are the various causes of death in Electric shock
or electrocution?

3) PARALYSIS OF THE RESPIRATORY CENTRE -

(i) Paralysis of the respiratory centre occurs when the current passes through the
head, which is a rare event.
(ii) The passage of several hundred milliamperes through the brain during the
electroconvulsive therapy rarely results in suppression of respiratory centre,
though a current of much less intensity would be sufficient if it passed through
the centre.
(iii) The heart may continue to beat and hence the importance of resuscitation, as
already stressed.
Q) What are the various causes of death in Electric shock
or electrocution?
4) SECONDARY CAUSES –

(i) Death, in some cases, may occur actually due to sustaining

of mechanical injuries, secondary to the circumstances of electrocution, as
may happen when a worker working on a high voltage supply system gets
electrocuted and falls from a height and receives head injury or some other
injuries.
(ii) Late deaths can occur in those who do not die immediately and sustain
severe burns due to infection or haemorrhage because of damage to the
blood vessels
 Q) What are the conditions when entry wound is
absent in electrocution?

Ans) Absence of entry wound does not rule out electrocution.

(1) If absent- (a) Prerequisites:
(i) Large surface area from where current enters
(ii) Low skin resistance.
(b) Both these conditions are aptly met when electrocution occurs in the
bathtub, or when a live electric wire is grasped with a wet hand.
(iii) Low voltage current also leaves no mark
(c) Diagnosis – in such cases is entirely dependent upon the circumstances of
death
 Q) WHAT ARE THE TYPES OF ENTRY WOUNDS IN
ELECTROCUTION ?

Ans) 3 types of entry wounds in electrocution

(i) Joule burn (endogenous burns) - Joule burn is typically produced in low voltage
(household ) currents, where heat is produced by conversion of electrical energy to
heat energy within the tissues (hence called endogenous burns also)

(ii) Flash or spark burn (exogenous burns) - Flash or spark burn is typically produced
in high voltage (industrial ) currents, when sparking occurs between the conductor
and the victim. Also known as exogenous burns, because the source of heat is
outside.

(iii) Electric splits

 What are the characteristics of Joule burn
(Endogenous Burn) ?
Ans) 5 Characteristics of joule burns to be noted are -
1) Appearance
2) Site
3) Temperature
4) Smell
5) Histology
 (1) What is the appearance of Joule burns (Endogenous
burn)?
Appearance of joule burn may have following characteristics :
(i) Crater
(ii) Broken blister
(iii) Incised wound
(iv) Bullet wound
(v) May be visible on drying of skin
(vi) Charring
(vii) Metallization
 (i) Crater appearance of Joule burn
• Crater - most common appearance of joule burn is crater.
(a) Mechanism of production of crater - The blister is created by the steam produced in
the heating of the tissues by the electric current, the so-called endogenous burns. When
the current ceases, the blister cools and collapses to leave a crater with a raised rim

(b) Shape - Round or oval shallow crater. Occasionally the mark may take the shape of
the conductor
(c) Size - 1-3 cm in diameter
(d) Has a ridge of skin about 1 mm high around part or whole of circumference
(e) Floor is pale [Floor is lined by pale flattened skin]
(f) Periphery may be blanched due to arteriolar spasm caused by current.
(g) Sometimes there may be a hyperemic border outside the blanched area.
(h) Commonly occurs in exposed parts like palmer aspect of hands.
Joule Burn
 Appearance of Joule burn
(ii) Broken blister -Sometimes the skin may break at the site of electrical contact. It then
resembles a broken blister.

(iii) Incised wound - In some cases, especially when a wire was involved, the skin would
be linearly divided, mimicking an incised wound. Also known as electric Splits.

(iv) Bullet wound- Rarely, the mark may penetrate the muscle and bone simulating a
bullet wound.

(v) Entry marks may not be visible when skin is wet. Entry marks are discernible on
drying of skin.

(vi) Charring – when there is more prolonged contact.

• Electric injury caused by pin of
mobile charger in mouth of
toddler
vii. Q) Write is metallization in joule burn?
Q) Does metallization proves burn to be caused by electrocution?

Ans) 1) Electrical metallization in electrocution was first shown to occur by

Schrader in 1932.

2) Definition – Metallization is the occurrence of the metallic traces of the

metallic conductor in the electric mark deposited in the skin and
subcutaneous tissue due to electrocution.

3) Mechanism – When current is passing from a metal conductor, there

occurs electrolysis due to which the metal ions are deposited in the skin and
subcutaneous tissue at the point of entry. These metal ions combine with
tissue anions and forms metal salts.
4) Metallization is a definite evidence that the burn was produced by
electricity and not by flame. Even during touching of skin with hot metallic
conductors (in the absence of electricity), metallization does not take place.

(5) A number of methods were later devised to detect it –

(I) Color - The metallization, when gross may be visible to naked eye as the
color or stain of the electric mark gives a clue about the composition of the
electrode as the color is due to deposition of metal. The metalized skin
desquamates within a few weeks.
(a) Silvery - Aluminum
(b) Reddish brown - Copper
(c) Brownish black – Iron.
(II) In rare cases, metallic coating may be seen on nails too.
 Q) What are the tests for metallization?

(III) Various test for detection of metallization are –

(1) Acroreaction test - This test demonstrates metallization.
(i) It is a much simpler microchemical test for metals
(ii) Applicable for entry marks; not exit marks
(iii) Procedure – Treat metalized skin with acid (HCl or HNOs). A portion of
the acid is then taken with a tiny wedge of filter paper treated with a
suitable reagent. Production of color is indicative of metal [e.g.
potassium ferrocyanide detects iron by the production of Prussian blue].
 Q) What are the tests for metallization?
(2) Other tests are -
(i) Histochemical
(ii) Microprobe analyzer
(iii) Polarographic analysis
(iv) Scanning electron microscope [SEM]
(v) Spectroscopic
(vi) Stereomicroscopic
(vii)Transmission electron microscope and
(viii) Variable pressure scanning electron microscope (VP-SEM) with energy dispersive
X-ray (EDX) microanalysis may determine the nature of the metal, which may be
compared with the suspect electrode.

(3) These methods may be used even if decomposition has set in.
 Q) What is depth of penetration in metallization?
Ans). Depth of penetration-
(1) Spectroscopic analysis has shown that -
(i) Penetration of the skin up to 3 mm - aluminum, magnesium, manganese,
molybdenum and zinc.
(ii) Penetration of the skin up to 5 mm - chromium, copper and iron.

(2) No suitable explanation has been found for the difference in penetrating
power
 Q) What are the various sites of joule burn?
Ans) (1) May be on palmar aspects of fingers and hands usually, as these
areas come in contact with electricity mostly
(2) Rarely on genitals or anus - in sexual perversions
(3) May be under intact clothing or under hair - If under hair, may remain
unnoticed. Scalp must be thoroughly palpated, and if any suspect lesion felt,
hair carefully shaved from that area.
(4) Inside mouth –
(i) Accidental - when children place a live plug between their lips. Joule
burn may be on tongue or buccal mucosa
(ii) homicidal - in children. Done intentionally to hide from investigators.
 Q) What is the temperature and smell of joule burn?

Ans) (1) Temperature - Temperature directly underneath the joule burn

may be as high as 95 degree Celsius.

(2) Smell of recent current marks resemble that of burn cork

 Q) What are the histological changes in joule burn?
Ans) Histology changes are – Microscopically, the epidermis shows a Swiss
cheese appearance.
(1) Microblisters – The epidermis is elevated with microblister developing in
squamous epithelium and also in the external horny layer. These blisters
develop due to cooking effect of the tissues.

(2) Electric channels – Cells are separated in the form of sharp slits. This pattern
is called electric channels or vacuolation

(3) Palisading and streaming of the nuclei - Nuclei of epidermal cells are
stretched, elongated and placed at right angles to the dermis, to produce a
palisade type appearance [streaming of the nuclei ]
Q) What are the histological
changes in joule burn?
 Q) What are the histological changes in joule burn?
(4) Collagen – stains blue in ordinary H&E stain due to thermal
denaturation of collage.

(5) Nuclei of vascular media – are twisted so as to resemble spirals. This

may occur at points quite distant from the site of contact with the
electrode. They are localized in the arterial walls, because of blood being a
good conductor of electricity. Indeed most current passes through the
body via blood vessels.

(6) Vascular intima – tearing of elastic fibres and overlying intima. May
cause secondary thrombosis and gangrene
 Q) What is spark or flash burn in electrocution?
Q) What is the mechanism of development of spark/flash burn (Exogenous
burns) ?
Q) What are the salient features of spark/flash (exogenous) burns?
Ans) (1) Flash or spark burn is typically produced in high voltage (industrial ) currents,
when sparking occurs between the conductor and the victim. Also known as exogenous
bums, because the source of heat is outside.

(2) When the contact between conductor and victim is not good or is less firm, an
air gap exists between skin and conductor. The current jumps the gap between
the source and the skin in the form of a spark.

(3) High voltage currents can jump several millimeters across air and cause
lesions [In dry air, 1000 V will jump several millimeters and 100 KV about 35
cm ]
(4) Such high voltage currents produce extremely high temperatures (upto
4000°C).
(5) Causes keratin of the skin to melt over multiple small areas.

(6) On cooling, molten keratin over these areas fuses into multiple hard
brownish nodules [as resolidified wax] raised above the surrounding surface
and usually surrounded by pale halo or areola , as in the skin of a crocodile
[another phenomenon seen due to keratin melting and resolidifying is
clubbed appearance of hair tips in firearm wounds].
(7) Crocodile skin: In high-voltage current, sparking may occur over many
millimeters or centimeters. The sparking may cause multiple focal burns or spark
lesion resembling crocodile skin

(8) The flash can ignite the patient’s clothes causing flame burns along with
singeing of hair.
 Q) What is the effect of arc light due to spark or flash on
eyes?
Ans) (1) Arc eye - Electric arc produces heat and UV light.
(2) Clinically this produces a superficial and painful keratitis [arc eye].
(3) If the patient survives, the onset of symptoms occurs 6-8 hrs after exposure.

(4) The characteristic features are –

(i) Intense bilateral lacrimation
(ii) Blepharospasm
(iii) Photophobia.

(5) The injury resolves spontaneously within 36 hours. Fluorescein staining of the eye
[both in the living and at pm ] reveals many punctate erosions of the cornea.
 Q) What is Electric splits? Is it another type of electric entry
wound ?
Ans) Electric splits is another variant of electric entry wound.
(1) When the electrical conductor is a wire, a linear burn may occur.

(2) In some cases the point of entry shows lacerations in the form of electric splits

(3) The splits are dry, hard, firm, charred, insensitive, with ragged edges. and their
form is round, oval, linear, or of irregular shape.

(4) The depth of the lesion is much greater than appears on the surface. Shedding
of the superficial layers of the skin is common, and some of this may be found
attached to the conductor

(5) Wrinkling of the skin may be found and occasionally localised oedema of a limb.
(6) Aseptic necrosis develops, which often extends beyond the burns in area and
depth and may lead to sloughing.
 Q) What are features of exit wound in electrocution?
Ans) Electric exit mark
(1) Site – This mark appears where the body was earthed or 'grounded’.
(2) Appearance –
(i) Variable in appearance but usually have some of the features of entrance marks
(ii) Grayish white circular spots, firm to touch and free from inflammatory reaction
(iii) More disruption of tissue & often seen as splits in the skin at points where the
skin has been raised into ridges by passage of the current or even seen as
laceration sometimes. More damage of tissues than at entry marks.
(iii) In high-voltage current, the exit often appears as a ‘blow-out’ type wound

(3) Burns and perforations of the clothing or shoes may be seen over the site of exit.
Q) What are the systemic effects of electric shock or
electrocution?
Ans) Possible systemic effects of electrocution are –

1) Immediate death from shock.

2) CNS: Hemiplegia or paraplegia, aphasia, headache, vertigo and convulsions.

3) Eye: Cataract, optic atrophy and choroido-retinitis may occur. In case of close
range electrical flash, singeing of eyelash along with first degree burn of the skin of
face may occur (arch eye).

4) Pulseless, hypotensive, loss of response to external stimuli, cold and cyanotic and
without respiration—suspended animation like state may occur.

5) With recovery, there may be muscular pain, fatigue, headache and irritability
 Q) What are the autopsy findings in death due to electrocution?
Ans) (I) External findings –
(1) Face - pale ( Exception – In death due to tetanic asphyxia – cyanosed)
(2) Eyes- (i) Congested (ii) Pupils- dilated (iii) Petechiae are seen on eyelids and
conjunctiva
(3) Rigor mortis - appears early
(4) PM Lividity – dark blue-red postmortem staining is well developed

(5) In about 50 to 60% cases there are external marks of electric burning, and
contusion or laceration at the point of entrance and exit of the body.

(6) Joule burn at the site of entry is diagnostic. The shape and size of the mark
may correspond to the shape and size of the source of the current. The site of
entry may lack any visible marks or in some cases may show extensive
charring with heat coagulation of the muscles
 Q) What are the autopsy findings in death due to electrocution?

(6) Secondary burning - may be present due to ignition of clothing

(7) Additional findings in high tension electrocutions –

(a) Charring of the body
(b) Amputation of extremities.
(c) Secondary injuries due to fall or knock down
Q) What are the autopsy findings in death due to electrocution?
Ans) (II) Internal findings of electrocution are –
(1) Congestion - of all internal organs (Those of asphyxia).

(2 ) Petechial hemorrhages - along the line of passage of current. Depending on

route, may be present in brain, spinal cord, endocardium, pericardium and
pleurae.
[‘Electrical petechiae’: The petechiae seen in electrocution are not caused by
asphyxia but by a combination of venous congestion due to cardiac arrest and a
sudden rise in blood pressure induced by muscle contractions. Consequently, it
represents a nonspecific but typical finding in electrocution. Unlike electrical
burns, petechiae also indicate the vital origin of the events.]

(3) Brain - Irregular tears and fissures.

Q) What are the autopsy findings in death due to electrocution?
(4) Muscles and tendons:
(i) Zenker's degeneration - of skeletal muscles in the path of current [severe
glassy or waxy hyaline degeneration of skeletal muscles. Grossly the muscles
appear pale and friable; microscopically, the muscle fibers are swollen, have
a loss of cross striations, and show a hyaline appearance. Rupture and small
hemorrhage are also seen]

(ii) Release of myoglobin - Myoglobin is released into general circulation. This

may cause renal shutdown, as occurs in extensive crush injury.
Q) What are the autopsy findings in death due to electrocution?

(5) Bones and joints:

(i) Bone pearls [syn osseous pearls, wax drippings, wax pearls]- Seen in high
voltage currents. Mechanism –
(a) Heat generated by current melts calcium phosphate, - seen radiologically as
typical round density foci.
(b) Vaporization within bone- seen on the surface of bone with naked eye as
grayish white, hollow nodules of the size of a pea.

(ii) Necrosis of bone

Q) What are the autopsy findings in death due to electrocution?
(iii) Fractures –
(a) due to violent muscular contractions or falls. All electrocution deaths should be
radiographed for this reason,
(b) fractures may be hair thin [microfractures]. May be missed on X-ray. Have
an irregular zigzag course [ osseus schisis]

(c) Bones most commonly fractured in upper limb [in order of frequency]-
(1) coracoid process, (2) head of humerus, (3) neck of humerus, (4)ulna

(d) Bone most commonly fractured in lower limb – neck of femur

(e) Fracture of spinal processes

[It is postulated that these regions are susceptible to fractures due to the large
bulk of surrounding muscle and thus stronger tetanic contractions]
 Q) What are the autopsy findings in death due to electrocution?

(iv) Late bone injuries - are seen due to tissue ischemia from diminished or
obstructed blood supply

(6) Electrical injury of skull –

(i) Occurs due to arcing when transformer and switch operators and persons
working on utility poles inadvertently touch the cable with vertex of the head,
(ii) Skull may be split open,
(iii) Orbital contents extruded eye sockets,
(iv) Effects attributed to boiling of the brain and formation of steam within skull,
(v) Decapitation may also occur,

(7) Subluxation of joints - especially shoulder joint

Q) What are the autopsy findings in death due to electrocution?

(8) Current pearls – Small balls of molten metal, derived from the metal of the
contacting electrode is carried deep into the tissues.

(9) Heart: (i) Auricles - Dilated

(ii) Petechial as well as larger hemorrhages - on endocardium, pericardium and
myocardium, particularly at the base of aortic cusps,
(iii) H/P - Fragmentation, rupture and twisting of myofibres, interstitial edema and
foci of colliquative necrosis
(iv) Electron microscopy - detachment of the external myocardial membrane
Q) What are the autopsy findings in death due to electrocution?

(10) Vascular: (i) Microscopic lesions in media

(ii) Intima is relatively protected due to cooling effect of circulating blood
(iii) massive coagulation necrosis of the entire vessel wall
(iv) Hemorrhage and thrombosis. May occur immediately or up to 1-6 weeks after
the accident. May lead to thromboembolism
(v)Tissue edema [edema electricum] due to immediate and late vascular injury

(11) Kidney and urine:

(i) Lower nephron nephrosis [due to myoglobin entering nephrons]
(ii) Urine – shows myoglobin
Q) What are the autopsy findings in death due to electrocution?

(12) Fetus - If pregnant female receives electric shock, abortion may occur.
Sometimes fetus may survive too.

(13 ) Additional findings in high tension electrocutions-

(i) Viscera- may be ruptured
(ii) Bone - (a) Periosteum elevated (b) Fractures

(14 ) Electroporation - Injury of tissue through direct cellular Damage

 PM FINDINGS IN DEATH DUE TO TETANIC ASPHYXIA
DUE TO ELECTROCUTION
• In the event of death due to tetanic asphyxia:

(i) Cyanosis of the face

(ii) Petechial haemorrhage in the skin of face and beneath the pleura and
epicardium may be seen.

(iii) There may be congestion of viscera and oedema of lungs, etc.

 Q) IS ELECTRIC MARK PROOF FOR ELECTROCUTION?
• The electric mark, though specific of contact with the electricity, is not in itself a proof
of electrocution.

• Because marks resembling those found on the victims of electrocution can be

produced after death (excluding a zone of hyperaemia) as reported by Polson and
Gee.

• It is also possible to produce changes in the skin resembling an electric mark by

applying a glowing or intense hot wire to the skin.

• Distinction between electric mark and thermal burn may be made by acro reaction and
by scanning electron microscopy (SEM).

• However, they do raise strong presumption of death by electrocution and together with
the study of circumstances, diagnosis can conveniently be achieved.
 Q) What are medicolegal aspects of Electrocution?
Ans) (1 ) Electric crematorium –

(2 ) Electroconvulsive therapy [ECT] - fractures may be sustained during it, bringing allegations of

negligence against the doctor. Most famous example of this is the Bolam case.

(3) Manner of death –

(i) Accidental
(ii) Suicidal
(iii) Homicidal
(iv) Judicial

(4) Pregnancy and electrocution

(5) Use of TASER

 Q) Write a note of accidental electrocution?
Ans) (1) Virtually all electrocutions are accidents, with suicides rare and homicides even
rarer

(2) Majority of the fatalities usually result from the accidental contact with the low voltage
currents (normally 220–240 volts).

(3) Examples of accidental electrocution are -

(i) Accident from a faulty line, while working on an electric cooking heater, room heater or
inside the bathroom from a heating electric coil that, if defective, may charge the water in the
bath tub or bucket with electricity.
(ii) Accidents while repairing high-tensions overhead wire connections.

(iii) Accidental ventricular fibrillation has been recorded in cases of intracardiac

catheterisation and from the site of pacemaker.

(iv) Accidents may also be seen with the use of electric blankets, and the hazards created by
these blankets may include electric shock, burns as well as fire.
 Q) Write a note of accidental electrocution?
(v) Accidents due to contact with high-voltage supplies are usually seen in industries.

(vi) Outside the industry, it may be encountered when an individual disregards warning
signs or ignores the presence of high-voltage cables while moving some ladder or
otherwise engaged in some activity in the vicinity of such cables or systems.

(vii) The danger of flying kites in the vicinity of overhead electric supply lines as the
ordinary string touch a live electric wire esp the ground is wet with rain and the string
moistened by contact with it.

(ix) Indirect contact with high voltage due to urinating over an electrified rail as the current
travelled upwards through the urinary stream.

(4) Accidental electrocution during autoerotic practices - Can occur

 Q) Write a note of suicidal electrocution?
Ans) (1) Electrocution is an infrequent mode of suicide.
(2) More commonly used by males
(3) Can be used to mask as homicide
(4) Commonly used methods are –
(i) The victim usually winds wire round the wrists or other parts of the body, makes their
connection with the wall socket and switches it on.
(ii) Climbing a pylon and grasping the wire carrying high voltage current
(iii) Victim fasten one end of a long wire to one of the limbs (usually the wrist) -> throws
the other end of the wire (weighted by a heavy object) over the transmission line

(5) Normally, the apparatus is found in situation when the body is examined at the scene.
(6) Miscellaneous – placing the end of an electric line in the mouth; Using an electric saw
to simulate an industrial accident
 Q) Write a note of homicidal electrocution?
Ans) (1) Homicide by electrocution, though extremely rare, is not unknown.

(2) Methods used for homicide by electrocution are –

(i) Live wire is placed across a road where the prospective victim is expected to walk
or drive
(ii) Setting up an electrical circuit within an object that victim is expected to touch
(iii) Putting a live wire, or a defective electrical appliance in the bath tub as the victim is
taking a bath.

(3) Erection of electrified wires to protect property or to attach a live wire to door knobs,
gates, railings, etc. to prevent theft and burglary may cause death of the intruder.

(4) At times, the victim may be murdered by other means and a case of electrocution by
producing electric burns on the fingers may be presented.
 Q) Write a note of Judicial electrocution?

Ans) (1) Electrocution is used as method of giving death penalty in some states in the
U.S.A.

(2) It is carried out in the electric chair made of wood (also called ‘Old sparky’).

(3) The condemned man is strapped to a wooden chair and one cap-like electrode is
put on the shaven scalp which is moistened with a conducting paste and the other on
the shaved right lower leg, and a current of 2,000 volts and 7 amperes is passed for
one minute through the body.

(4) After tetanic spasm and loss of consciousness, the same current is passed through
the body a second time for one minute.
 Q) Write a note of Judicial electrocution?

(5) PM findings –
(i) Third degree burns are produced at the site of contact between the electrodes and
skin.
(ii) Temperature - Beneath the electrodes, the skin and brain temperature may rise as
high as 60°C and vacuolation occurs around the vessels
(iii) Histologically rupture of neuroaxons and blood vessels of the brain occurs,
(iv) Right leg immediately goes into cadaveric spasm,
(v) Often ejaculation of semen occurs
Q) Write a short note on Electrocution in pregnancy and
its medicolegal aspects?
Ans) (1) Pregnancy and electric shock- If a pregnant mother receives an
electric shock, the fetus may be aborted.

(2) It may lead to claims of civil compensation, if the shock was received during
work through faulty machine,

(3) Mechanism of abortion –

(i) Fetal skin offers 200 times less resistance than does skin of a newborn
(ii) Both hyperemic pregnant uterus and amniotic fluid are excellent good
conductors
(iii) Uterine contractions - are induced by electric current, which lead to
premature expulsion of fetus
Q) Write a short note on Electrocution in pregnancy and
its medicolegal aspects?

(4) How to say positively that fetus died due to electric current-

(i) Pregnancy was normal before electric shock

(ii) There was no history of abortion in earlier pregnancies

(iii) Electric shock proven

(iv) No other factor can be explained as being responsible for abortion

(v) Stage of development of fetus corresponds to the stage of pregnancy and degree of
maceration is proportional to the time elapsed between electric shock and death of
fetus,
 Q) Write a short note on Electrocution in pregnancy and
its medicolegal aspects?
(5) Other significant points -
(i) Current enough to kill fetus- 25mA for 0.3 secs [AC]
(ii) PM findings on fetus killed by electricity –
(a) Dilatation of the heart chambers, (b) hemorrhages in brain, kidneys and liver

(6) Criminal abortion - has been tried via electricity

(7) Electroshock therapy of pregnant mother - can cause - (a) abortion, (b) temporary
disturbance of fetal heart rhythm. The doctor may face negligence suit in both. In the
latter, it has been alleged that the fetus suffered late ill effects due to disturbance.