Electroshock* †

First, Dr Cerletti presents the reasons why convulsion treatment using Cardiazol has become one of the most widespread modern shock treatments for schizophrenia and other psychotic disorders. The reasons are mostly practical, making it in many cases preferable to hypoglycaemic coma treatment: it involves less responsibility for the physician; much less medical assistance; a small number of sessions; and treatment is much cheaper. Having mentioned some more or less serious accidents (not actually frequent) which have occurred following massive rapid injections of Cardiazol, he recalls a rather serious problem: the patient’s dreadful feeling of annihilation between the injection and the onset of the epileptic seizure, which makes many patients reluctant to start the treatment. Moreover, after the post-seizure sleep, the Cardiazol remaining in circulation means that the patient remains in a state of psychomotor sub-agitation. For these reasons, Dr Cerletti began to do research aimed at finding simpler non-toxic ways of provoking epileptic convulsions. For several years, he did experimental research into different aspects of epilepsy in Genoa, using electricity to cause epileptic seizures in animals, particularly dogs. He used the common household electric current for a fraction of a second (alternating current at 125 V) by applying two electrodes: in the mouth and in the rectum (Viale method). In 1934, one of his pupils published the method and physiopathological results obtained from a large number of dogs (Chiauzzi, 1934). In 1935, he took up his experimental work again in Rome and, assisted by Dr L. Bini, an electrical engineering expert, he constructed a simple device which precisely regulated the voltage and timing of the electricity applied. He also adopted the method tried by other researchers (Pr evost, etc.), which passes the current through patient’s head. In this way, Dr Bini was able to experiment widely on a great number of dogs. When Cardiazol convulsive treatment appeared (Meduna, 1937; Sakel, 1935), it was immediately thought of using electricity for the same purpose. An important step forward towards this kind of application was made by doing a large number of experiments on pigs, using the simple device some abattoirs use to ‘stun’ animals before slaughter, with an epileptic-type shock induced by the common household electricity supply. In this way, they repeated the same experiments as those already done on dogs, but on larger animals, in order to test the minimum and maximum limits of current intensity and timing, in addition to the difficult problem of electrode application. It was, thus, possible to move on to trials involving humans and to determine the best conditions for obtaining an epileptic seizure. Special techniques are still being studied in order to obtain constant achievement of the best conditions and, above all, to eliminate any possible danger, given the variability between different individuals. Many experiments involving humans were carried out over a period of 2 months, using currents of 300–600MA, 80–115 V for 5–7 tenths of a second, depending on patients’ different levels of resistance. The seizure induced in a human being is like a typical epileptic seizure. As soon as the current is applied, the patient immediately loses consciousness; without even a single cry, the patient is gripped in a strong and generalized muscular contraction: the torso, legs, arms and hands are in spastic semi-contraction. The face turns red at first, but immediately becomes extremely pale, and then cyanotic: breathing stops. The heartbeat is regular. After 30 s, the face regains its natural colour and this is followed by a strong congestion. Rapid spastic tremors of the limbs and face quickly become clonic seizures, which last for 1 or 2min and can be more or less violent, extending to all body muscles. Before the seizure, a rubber wad must be placed between the patient’s teeth