713

5. Wurzinger LJ, Opitz R, Blasberg P, Schmid-Schongein H. Platelet andcoagulation parameters following millisecond exposure to laminarshear stress. Thromb Haemostat 1985; 54: 381-86.

6. Moake JL, Turner NA, Stathopoulos NA, Nolasco L, Hellums JD,Shear-induced platelet aggregation can be mediated by vWf releasedfrom platelets, as well as by exogenous large or unusually large vWfmultimers, requires adenosine diphosphate, and is resistant to aspirin.Blood 1988; 71: 1366-74.

7. Ikeda Y, Murata M, Araki Y, et al. Importance of fibrinogen and plateletmembrane glycoprotein IIb/IIIa in shear-induced platelet aggregation.Thromb Res 1988; 51: 157-63.

8. O’Bnen JR, Salmon GP. Shear stress activation of platelet glycoproteinIIb/IIIa plus von Willebrand factor causes aggregation: filter blockageand the long bleeding time in von Willebrand’s disease. Blood 1987; 70:1354-61.

9. Berliner S, Niinga K, Roberts JR, Houghton BA, Ruggeri ZM.Generation and characterization of peptide-specific antibodies thatinhibit vW factor binding to glycoprotein IIb/IIIa without interactingwith other adhesive molecules. J Biol Chem 1988; 263: 7500-05.

10. Baumgartner HR. The role of blood flow in platelet adhesion, fibrindeposition, and formation of mural thrombi. Microvasc Res 1973; 5:167-79.

11. Weiss HJ, Hawiger J, Ruggeri ZM, Turitto VT, Thiagarajan P,Hoffman T. Fibrinogen-independent platelet adhesion and thrombusformation on subendothelium mediated by glycoprotein IIb/IIIacomplex at high shear rate. J Clin Invest 1989; 83: 288-97.

12. Badimon L, Badimon JJ, Turitto VT, Fuster V. Role of von Willebrandfactor in mediating platelet-vessel wall interaction at low shear rate: theimportance of perfusion conditions. Blood 1989; 73: 961-67.

13. Sakariassen KS, Nievelstein PFEM, Coller BS, Sizma JJ. The role ofplatelet membrane glycoproteins Ib and IIb-IIIa in platelet adherenceto human artery subendothelium. Br J Haematol 1986; 63: 681-91.

14. Baumgartner HR, Tschopp TB, Meyer D. Shear rate dependentinhibition of platelet adhesion and aggregation on collagenous surfacesby antibodies to human factor VIII/von Willebrand factor. Br JHaematol 1980; 44: 127-39.

15. Mannucci PM. Desmopressin: a nontransfusional form of treatment forcongenital and acquired bleeding disorders. Blood 1988; 72: 1449-55.

16. Fuster V, Stein B, Badimon L, Chesebro JH. Antithrombotic therapyafter myocardial reperfusion in acute myocardial infarction. J Am CollCardiol 1988; 12: 78A-84A.

17. O’Brien JR, Salmon GP. Heat treatment in von Willebrand’s disease.Br Med J 1985; 291: 409.

18. O’Brien JR, Green PJ, Salmon GP. Desmopressin and sheared platelets:a test. Lancet 1988; i: 655.

19. Coller BS, Folts JD, Scudder LE, Smith SR. Antithrombotic effect of amonoclonal antibody to the platelet glycoprotein IIb/IIIa receptor inan experimental animal model. Blood 1986; 68: 783-86.

20. Hanson SR, Pareti FI, Ruggeri ZM, et al. Effects of monoclonalantibodies against the platelet glycoprotein IIb/IIIa complex onthrombosis and hemostasis in the baboon. J Clin Invest 1988; 81:149-58.

21. Yasuda T, Gold HK, Fallon JT, et al. Monoclonal antibody against theplatelet glycoprotein (GP) IIb/IIIa receptor prevents coronary arteryreocclusion after reperfusion with recombinent tissue-typeplasminogen activator in dogs. J Clin Invest 1988; 81: 1284-91.

22. Bellinger DA, Nichols TC, Read MS, et al. Prevention of occlusivecoronary artery thrombus by a mural monoclonal antibody toporcine von Willebrand factor. Proc Natl Acad Sci USA 1987; 84:8100-04.

23. Lambrecht LK, Young BR, Stafford RE, et al. The influence of

preadsorbed canine von Willebrand factor, fibronectin and fibrinogenon ex vivo artificial surface-induced thrombosis. Throm Res 1986; 41:99-117.

24. Davies MJ, Thomas AC, Knapman PA, Hangartner JR. Intramyocardialplatelet aggregation in patients with unstable angina suffering suddenischemic cardiac death. Circulation 1986; 73: 418-27.

25. Coller BS, Beer JH, Scudder, Steinberg MH. Collagen-plateletinteractions: evidence for a direct interaction of collagen with plateletGPIa/IIa and an indirect interaction with platelet GPIIb-IIIamediated by adhesive proteins. Blood 1989; 72: 182-92.

26. Fuster V, Chesebro JH. Mechanisms of unstable angina. N Engl J Med1986; 315: 1023-25.

27. Parker RI, Graenick HR. Inhibition of platelet-von Willebrand factorbinding to platelets by adhesion site peptides. Blood 1989; 74: 1226-30.

28. Plow EF, Pierschbacher MD, Ruoslahti E, Marguerie GA, GinsbergMH. The effect of arg-gly-asp-containing peptides on fibrinogen andvon Willebrand factor binding to platelets. Proc Natl Acad Sci USA1985; 82: 8057-61.

29. Cadroy Y, Houghton RA, Hanson SR. RGDV peptide selectivelyinhibits platelets-dependent thrombus formation in vivo: studies usinga baboon model. J Clin Invest 1989; 84: 939-44.

VIEWPOINT

Judicial electrocution and the

prison doctor

ADDRESS: 30 Poplar Walk, London SE24 0BU, UK (G. R. N. Jones,PhD).

Execution in the electric chair passed into law in New YorkState on Jan 1, 1889. Despite falling into disuse in the late1960s and 1970s, this method of capital punishment is againbecoming widely used in the United States. Furtherexecutions became possible following a ruling by theSupreme Court on June 26, 1989, which announced thatnothing barring cruel and unusual punishment preventsmentally retarded individuals and those under the age of 18from paying the ultimate penalty. Some 2000 people arenow on "death row" waiting the results of protractedappeals. Most will have years to wait, a form of mental strainakin to torture. Acceptance of capital punishment remainsenshrined in the traditions of the United States, and themorality of execution and the physiological responses toelectrocution are seldom questioned. Nor is the role of theprison surgeon.

History of the electric chairIn New York State botched public hangings in the mid-19thcentury provided the impetus for a more humane method ofexecution. In the 1870s the electric power industry was in itsinfancy. Voltages were much higher than they are today, andin cities power was transmitted by overhead cables.1 Thisled to several accidental deaths from electrocution. The

opponents of hanging soon made the connection. Theadvice of Thomas Edison was sought. A key factor inoverwhelming opposition to electrocution was the authorityof his confident claim that death would be instantaneous.This was combined with a shameless "dirty tricks"

campaign/ in which Westinghouse’s alternating current,then competing with the direct current preferred by Edison,was to be denigrated. One of Edison’s assistants installedWestinghouse AC generators for electric chairs at Auburn,Sing Sing, and Clinton prisons.i-3 Agents in Rio de Janeirowere instructed to purchase generators which had been usedat Oneonta in New York State4 so as not to alert

Westinghouse to the plan. Meanwhile articles emphasisingthe deadliness of alternating current in causing accidents andits eminent suitability for the purpose of execution appearedin the trade press. It was hoped that AC generators would bestigmatised by this debased use.2Two provisions of the New York State Electrical

Execution Law are noteworthy. First, the killing and burialwere to be kept private, and second, the corpse was to bedissected by doctors.1

The electric chair in practiceThe first electrocution took place on Aug 6, 1890.1.5 Thevictim was William Kemmler, who had murdered hismistress. In violation of the law the State Governor admitted

correspondents from Associated Press and United Press;1 26

714

witnesses were present, including 12 doctors.** An

eyewitness account’ described how 1400 V for 17 secondswas insufficient, and how Kemmler began to recover over aminute later. There was a delay of 2 minutes before a furthershock lasting 24 minutes was administered to the groaningvictim. At the end of that time Kemmler was pronounceddead. The nightmarish scene, with smoke rising from theburnt corpse,s caused one reporter to faint, while theprosecuting attorney ran out of the room in horror.’

Although the experimental nature of early executions wasopenly recognised at the time,6-8 it quickly became apparentthat for most victims death in the chair was anything butinstantaneous.6,9 One writer of unmistakeable experienceand authority has expressed doubt.10

Edison’s claim, based on deaths from accidental electrocutionand on some crude animal experiments and motivated by anobsessional urge to destroy his rival Westinghouse, was nonsense.But by now too many reputations were at stake, and scatteredcriticisms of electrocution’,"-" were easily ignored. The

administration of several shocks over a period of minutes rapidlybecame standard practice.10,14.15 Nonetheless, the bungling ofexecutions has persisted over the years," a recent instance being thatof a "mildly retarded" black man in Alabama within three weeks oflast year’s Supreme Court ruling.

In December, 1984, one victim struggled for 8 minutes. InIndiana, in October, 1985, electrocution took 17 minutes. Therefurbishment of electric chairs is now big business for Fred A.Leutcher Associates, of Boston. In a nauseating interview, MrLeutcher justifies a 2640 V, 5 A current. 2000 V to "seize the heart"plus another 640 to allow for big builds and voltage drops, whileeven 20% more current would produce a cadaver "like meat on anovercooked chicken".

Electrocution and the bodyIn an electrocution every nerve is stimulated way beyond its

capacity to transmit motor or sensory impulses, and muscles arethrown into fixed and rigid spasm.5 During electrocution norespiratory or circulatory functions are possible, and stores ofhigh-energy phosphate can be expected to drain away. As long asthe capacity for vital function remains intact, the ability to recoverprobably depends on the persistence of tissue levels of chemicalenergy sufficient for the heart and respiratory system to

recommence spontaneous function at some point after electricalcontact has been broken. A victim in poor health may die quickly,while a healthy young man (as many condemned victims are) takesmuch longer to die.15There are few published accounts of necropsies on victims of the

electric chair, no doubt reflecting the secrecy clause in the

legislation. Nonetheless, one pathologist,ls familiar with necropsiesafter executions by hanging and the guillotine, concluded that theelectric chair produced more bodily alterations than any other formof capital punishment. At 1400-2000 V the current delivers 10-16kW to the body;18 extensive heating of tissues15 and burning16 haveoften been recorded. In the very first execution local heating causedthe spinal muscles to appear "cooked, like overdone beef the braincortex was hardened along one-sixth of its depth; the meningealvessels around the area of contact with the head electrode were

brittle, presenting a broken appearance, and were filled withcarbonised blood.5 In four other cases the anterior parts of thecornea were desquamated from the central portion by the action ofheat.’9 Peculiar brain lesions have also been described;2Olongitudinal tracts of the mid-brain presented a ragged appearance,as though torn by some diffusively explosive or disruptive force.Ruptured myelin sheaths were also occasionally seen. The changesappeared consistent with a sudden liberation of bubbles of gasproduced by the electrolytic properties of the current.

Electrocution and the prison doctorPrison doctors have always sided with authority against theprisoner whenever it was necessary to ensure that the death

penalty was carried out. In one disgraceful instance,21 inwhich the execution took 75 min, ether and chloroform wereadministered to the conscious, resisting victim after thearmature of the generator had burnt out12 and morphia hadfailed to kill him.21 The man was finally dispatched withwiring from a light circuit.12 The central role of the prisondoctor in the execution process was revealed by theadmission that the legal provision for an immediate

necropsy was "to make assurance doubly sure",1° a viewendorsed by Warden Denno of Sing Sing. 18 The realpurpose of the necropsy had been trenchantly exposed byDr J. A. O’Neill, who witnessed an electrocution at SingSing in 1898:13"The law requires the post-mortem mutilation. It is ... a part of

the penalty ... as it reveals no cause of death and teaches nothing ofinterest to science, it is evident that its purpose is to complete thekilling. If that is true, then that section of the law relating to theautopsy should be repealed at once. If the convict is dead, he willstay dead, without the autopsy. If he is alive, then the autopsy is acrime that outrages all decency, a crime a thousand times morehorrible than the homicide for which the convict forfeits his life....To be hanged, drawn and quartered was the sentence of the middleages. To be rendered helpless by an electric shock and thendisembowelled by doctors, before the body is cold, is the decree ofour twentieth-century courts ... the profession at large shouldprotest vigorously against performing the legitimate functions of ahangman."

"

Despite ample opportunity, countries retaining (orformerly practising) capital punishment have chosen not toadopt this form of execution, a fact which American

legislatures might usefully ponder on. The United Stateshas voted against an accord on the death penalty as a

violation of human rights, drawn up last December by theUN General Assembly. The approaching centenary of thefirst execution by electricity provides an opportunity formore humane attitudes to prevail-and for medical

organisations to come together and state collectively thatparticipation by the profession in electrocution or any otherform of capital punishment is no longer acceptable.

REFERENCES

1. Beichman A. The first electrocution. Commentary 1963; 35: 410-19.2. Sci Am 1889; 61: 240.3. Clark RW. Edison: the man who made the future. London: Macdonald &

Janes, 1977: 160-61.4. Electrical World 1890; 15: 296.5. Med Rec (NY) 1890; 38: 154-56.6. Med Rec (NY) 1891; 40: 458.7. Med Rec (NY) 1891; 40: 717.8. Abolition of electrical execution. Med Rec (NY) 1892; 41: 183.9. Electrocution. Med Rec (NY) 1905; 68: 542-43.

10. Electrocution. Encyclopaedia Britannica, 14th ed: vol VIII. 1929: 316.11. The electricians on electrocution. Lancet 1891; ii: 1462-63.12. Med Rec (NY) 1893; 44: 178.13. A ghastly view of electncal execution. NY Med J 1898; 68: 487.14. Marvin FR. Execution by electricity. Med Rec (NY) 1904; 66: 145-46.15. Klein SR. Capital punishment in the electric chair. NY Med J 1914; 99:

1089-90.

16. When the State kills-the death penalty versus human rights. London:Amnesty International, 1989: 57-58.

17. Lehman S. A matter of engineeering: capital punishment as a technicalproblem. Atlantic 1990 (Feb): 26-29.

18. Denno WL. Electrocution. Encyclopaedia Britannica, 16th ed: vol VIII.1960: 289.

18. MacDonald CF. The infliction of the death penalty by means ofelectricity. NY Med J 1892; 55: 535-42.

20. Spitzka EA, Radasch HE. The brain lesions produced by electricity asobserved after legal execution. Am J Med Sci 1912; 144: 341-44.

21. Brown JW. The latest electrocution. Med Rec (NY) 1893; 44: 222-23.