Saturday, February 20, 2016

A One Handed Shocker

I stumbled upon this illustration from 1910 (before my time) and tried to figure out what it was about without reading the caption.

My first guess was a double duty pill crusher. It even looks like there might be pill residue on the business ends of the two pestle-like gizmos which is a common problem with the assorted pill crushers available today.

 The best way I discovered to crush pills was to place them in a paper soufflĂ© cup, fold it, and crush cup with pills using a hemostat. No clean up and remember it's not wise to crush time released meds. One big SNAFU that I recall was crushing Thodur  pills and producing a hypertensive crisis.

It looks like there are even tethers of some sort on the crushers to prevent them from walking away from the med cart. One sure fire way of preventing things from walking away is to tether them to an old-fashioned metal urinal. We always had a community hemostat for clamping Foleys attached to a metal urinal. If someone attempted to pilfer the hemostat the urinal called attention to the thief by metallic clanging and banging.

Enough of my rambling! According to the caption these are actually electrodes for electroconvulsive therapy form a book entitled Care of the Nervous and Insane.  "The nurse demonstrates the method of holding electrodes in one hand. Held in this way the discs can be held close together or more widely separated. The nurse should practice employing only one hand for the electrodes so the other is free to control the patient."  Those "tethers" are actually conducting wires.

Hopefully, by control of the patient, the text translates to maintaining an airway. I guess there must have been a manpower shortage back in the day if this much was expected of the nurse.

ECT was done when I was a nurse, but it was carefully controlled by anesthetizing the patient with pentothal and sometimes even paralyzing with succinylcholine which of course required an anesthetist. I remember some of the psychiatrists thought a seizure was necessary for ECT to work and avoided the succinylcholine. This always produced impressive and classic tonic-clonic movements.

For some patients ECT seemed to be very beneficial. It seemed strange to me to utilize something that there was no idea how it worked, but I guess most psych drugs were  are  like this. Despite the blowhard attitudes of some of the psychiatrist's, this is a specialty to me that seemed like it was in it's infancy.


  1. The succ wouldn't prevent a seizure, would it? It would just prevent physical signs of it. If it prevented seizures, no one would have one under anesthesia if it were used.

  2. You are correct Saule' the succ did not prevent seizures. I think it was used with ECT to prevent musculoskeletal problems like muscle strains and possible fractures. Years ago the mechanism of action of ECT was not clear and some of the psychiatrists seemed to believe the tonic-clonic movements were somehow therapeutic. I had limited ECT experience (as a student) but clearly remember patients that experienced the tonic-colonic movements always complained of lots of muscle aches and pains so anesthesia and succ was a good idea.

    Thanks for reading my blog.