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Tete essere SSssise A WORKING MANUAL OF HIGH FREQUENCY) - CURRENTS ~ By NOBLE M. EBERHART, M.D., Ph.D., D.CL. Head of the Department of Physiologic Therapeutics, Medical Department of Loyola University; Professor of High Fre- quency, Illinois School of Electrotherapeutics. Formerly Head of Department of Ellectrotherapy, Chicago Col- lege of Medicine and Surgery; Formerly Attending Physician Cook County Hospital; Formerly Professor of Electrophysics Post Graduate Medical School, Chicago; ete. Member of Chicago and Illinois State Medical Societies; American Medical Association; American Medical Editors’ Associa- tion; Victoria Institute or Philosophical Society of Great Britain; etc. Author of “Practical X-ray Therapy;’’ Brief Guide to Vibratory Technique,” etc. Fourth Edition; Revised and Enlarged. CHICAGO NEW MEDICINE PUBLISHING CO., 25 EK. Washington St. eS cca! COPYRIGHT 1911, BY NOBLE M. EBERHART. COPYRIGHT 1913, BY NOBLE M. EBERHART. COPYRIGHT 1915, BY NOBLE M. EBERHART. COPYRIGHT 1916, BY NOBLE M. EBERHART. Nikola Tesla, Inventor of the Tesla Coil—Courtesy “Elec- trical Review and Western Electrician.” INTRODUCTION. The literature on High Frequency Currents is not extensive and much of it is too technical for the average physician, who is more interested in the application of these currents than he is in the precise manner in which they are generated. For this reason I have given comparatively little space to the consideration of the various forms of apparatus, other than to outline the types upon one or another of which all of the machines are based. VIL. Further information along this line is properly within the sphere of the various manufacturers. My intention has been to make this a practical hand-book for the busy physician who wishes to use high frequency currents and to learn how to do so with as little ‘‘red tape’’ as possible. I have expressed my individual opinion on many points, and sometimes this may be found at variance ~ with that of other authors, but it 1s based upon fifteen years’ practical experience involving the daily use of High Frequency Currents and upon thirteen years’ experience in teaching the subject. My indebtedness for data furnished is acknowl- edged to Drs. W. B. Snow, W. H. King, H. EH. Waite, “F. de Krafft R. A. Black, E. CG. Titus, H. F. Pit- cher, S. Stevens, R. E. Farmer, and Messrs. F.. H. Swett, J. B. Wantz, Wm. Meyer, Samuel T. Hut- ton, Edwin L. Edwards, H. L. Kahl, F. A. Wiggin, } R. and F. H. Wappler, T. B. McClintock, C. E. An- , |. derson, M. Sanchez, J. E. Clapp, H. W. Young and Win. Stahl. Also to Popular Electricity for the use of a num- ber of illustrations. THE AUTHOR. 25 BE. Washington St., Chicago. | Stic VIII. CONTENTS. Chapter. Page. I. Definition of High Frequency Current; Alternation; Cycle; Period; Oscilla- tion; Frequency; Lighting Vacuum Tube Not Proof of High Frequency Current. The Development of the Current; Ley- den Jars; Plate Condensers; Electrical Oscillation. Types of Apparatus; D’Arsonval Type Tesla Transformer; Impedance; Ou- din’s Resonator; Measuring the Cur- rent. Various Forms of Vacuum Tubes; Hf- fects of Different Vacua; Insulated Tubes; Fixed and Adjustable Socket Handles; Spatulate Tubes. 1D Chapter. Page. V. Physiological Action of the Current; High Frequency Burns; Offsetting Tendency to X-ray Burns. General Technique; Vacuum Tubes; Lu- brication; Cautions; Asepsis; Stand- ardizing Dosage; Preparation of Pa- tients; Technique for Skin Diseases; Relief of Pain; Cauterization ; Orificial ‘Technique; Cataphoresis ; Fuleura- tion; Auto-Conduction ; Auto-Conden- sation; Portable and Home-Made Pads; Surgings; Water Spray; Local Auto-Condensation; Indirect Sparks; Taking the Blood Pressure Special Technique for Har, Hye, Nose, Rectum and Prostate, Scalp, Throat, Urethra and Vagina. Practical High Frequency Therapy, Dis- eases and Symptoms Alphabetically Arranged with Methods of Treatment. 159 x tr se stientisietorstestistetetiense eG IS IE pyre ee ee Se SS es a Soong eaten ns ss oesneseasss ists bs set as tila pseeesreserneree ios Chapter. Page. IX. Ozone; Nature; Physiological Action; Methods of) Administration; Diseases in which It is Indicated. High Frequency X-ray; Its Scope and Limitations; Resume of Skiagraphic and Therapeutic Technique. Diathermy ; Electro-coagulation; Ther- mo-penetration. High Frequency in Dentistry. Glossary. Index. EBERHART’S MANUAL, OF Fig. 1—Large Tesla Coil. HIGH FREQUENCY CURRENTS CHAPTER ONE. Definition of High Frequency Current; Alternation; Cycle; Oscillation ; Period; Frequency; Explanation of Terms; Pulsatory Currents; Periodicity ; Lighting Vacuum Tube Not Proof of High Frequency Current. What is a High Frequency Current? A high fre- queney current is an alternating (oscillating) ecur- rent in which the frequency is beyond the point of producing muscular contractions. An Alternation is a complete reversal of the direc- tion of a current as any one of the waves shown in Fig. 3. A Cycle is two alternations It constitutes the round or circle of the current, embracing one posi- tive and one negative wave or alternation. Oscillation. An oscillation is a series of diminish- ing waves which flow alternately in opposite direc- 14 EBERHART’S MANUAL, OF tions, but not necessarily in the same time. Oscilla- tory currents periodically reproduce similar series of waves as shown in Fig. 3. Their frequency 1s very high and is the reciprocal of period. It 1s com- ‘puted on the number of double alternations, thus corresponding to the method employed with low fre- quency currents. | Period is the time required for one cyele. Frequency is the number of complete cycles oc- curring in one second of.time. It is the reciprocal of period. Explanation. In order to understand the forego- ing definitions it will be necessary to recall some fundamental facts. The direct current is one which always acts in one direction, that is from positive to negative, and is graphically represented by a straight line. The alternating current in contrast to this, is one in which the current is constantly changing its di- rection or polarity, and we represent it by a waved line (Fig. 3), the waves above the line being pos- HIGH FREQUENCY CURRENTS 15 Fig. 2—Portable High Frequency Coil. 16 EBERHART’S MANUAL, OF itive waves or alternations and those below the line “negative waves. oe Let us eall the line zero in volts and the crest of the ane 110 volts. The current starts at zero, reaches the maximum positive voltage and then reverses and goes back to zero and repeats on the negative side. This complete reversal of the cur- rent is called an alternation and two of them make a eyele. If we only represented two alternations as in Fig. 4 and then made the second one return to the starting point as shown by the dotted line we would have in this case a circle, and the word cir- cle will keep the meaning of cycle fixed in the mind. Alternations do not necessarily assume the shape of a semi-circle but may represent any form of wave, still two of them represent the completion of the circuit or cycle. In high frequency currents these cycles become a succession of oscillations or undu- lations as represented graphically in Fig. 3. Frequency is a term properly belonging only to the alternating current. We have uni-directional currents such as those derived from induction coils, HIGH FREQUENCY CURREN'’S Le !20 110 Fig. 3. % ONE CYCLE. Fig. 4. Fig. 3—Alternating and Oscillating Currents. Vig. 4—Analogy Between Cycle and Circle, 18 EBERHART’S MANUAL OF in which the current is broken up into a rapid series of waves, with those which would be- below the line damped out, leaving a succession of pulsations This current lights up vacuum tubes and performs much of the same work as the high frequency, but 1s not a true high frequency current. ; These are called pulsatory currents and in place of the word frequency we indicate their rapidity by the term periodicity. | | To return to our explanation of the alternating eurrent let us suppose that it takes one-one hun- dred and twentieth of a second for any one of the alternations in Fie. 3. Then two alternations or one cycle would take two times one-one hundred and twentieth, which equals one-sixtieth ofa second, and this is the period of the current illustrated. If lt takes one-sixtieth of a second for one cycle, there will be sixty times as many in one second and this is the frequency. It will be seen that if we have the period of the current, all that is necessary is to invert the frac- tion and we have the frequency or number of cycles. In the illustration we have arbitrarily represented HIGH FREQUENCY CURRENTS 19 an alternating current of 110. volts, sixty cycles, which is the ordinary commercial alternating cur- rent employed in electric lighting. It is a low fre- quency current. Other low frequency currents have 29 cycles, 125 eycles, 133 cycles, ete. Low, Medium and High Frequency Currents. If we apply a low frequency current to a muscle we find that the muscle contracts, and this is powerful and may be strong enough to be painful. As we in- —erease the frequency of the current the painfulness decreases, but more than a single muscle tends to contract. These are currents of medium frequency of which the sinusoidal current is a type. At a frequency of about 10,000 cycles these tetanic contractions disappear and above that frequency there is neither pain nor eross muscular contrac- tion. The absence of pain is supposed to be due to the inability of the sensory nerves to comprehend such rapid alternations just as we have vibrations that eannot be recognized by the auditory nerve as sound or by the eye as light. 20 EBERHART’S MANUAL, OF ss” FREQUENCY REGULATOR Fig. 5—Portable High Frequency Coils. HIGH FREQUENCY CURRENTS 21 In these higher frequencies the contractile effect is expended upon the individual cells making up the tissues instead of on individual muscles. This I eall cellular massage and it is one important rea- son why high frequency currents produce such a marked benefit on nutrition and metabolism. Ag the current increases in frequency and volt- age, other peculiarities appear and it no longer re- quires a complete metallic circuit but is capable of traversing long distances as ether waves as in the wireless telegraph. In fact high frequency currents are better understood as vibrations than as ordinary currents. From the fact that muscular contractions cease with 10,000 cycles or oscillations, this has been taken as the dividing line between medium and high frequency currents. As the frequency with some apparatus is esti- mated in millions, I have been advocating a higher dividing line, say 100,000 as more in proportion, but this would cause considerable confusion at pres- ent and so the original nomenclature is adhered to. UTE Ee a 22 EBERHART’S MANUAL, OF Lighting of Vacuum Tube Not Proof of High Fre- quency Current. As intimated above, exciting a vac- uum tube as from the static machine or from one terminal of an induction coil is not proof of the presence of a high frequency eurrent. To produce the high frequency current there must be attached to either of the above one of the several forms of high frequency apparatus described in Chapter III. HIGH FREQUENCY CURRENTS 23) CHAPTER TWO. The Development of the High Frequency Current; Leyden Jars; Plate Condensers ; Electrical Oscillation. The Development of High Frequency Therapy. The therapeutic value of the high frequency cur- rent depends upon a number of physical phenomena, some of which were known many years before the high frequency was thought of. In looking backward over electrical history, there are three points that bear particularly upon the development of high frequency therapy. First: The invention of the Leyden jar, or an electrical condenser ; secondly, the discovery of what is known as electrical oscillation; and finally, its application to the human body. | 24 EBERHART’S MANUAL, OF rie 7 | HIGH FREQUENCY CURRENTS 25 Sil The Leyden Jar or Condenser. The Leyden jar was discovered in 1775 by Musschenbroek, and takes its name from the City of Leyden. It consists of a glass jar covered on both the outside and the inside BREAN Lat ieep ae Piahsadgaeathaaistbrarisisipsiieeeetet with tin foil. (Fig. 7). These coverings only ex- tend part way to the top of the jar. A chain from OU SMU anata ag aaa as the cover of the jar connects with the inner layer, i; terminating above in a small rod with a ball tip. screed eT ieee HET HES ESR SEAT ETE Bi | This is for the purpose of charging the jar by con- Ee) tact with the charging source or discharging 1G? 11 | = | ain Fi a = this knob is brought nearly or quite in contact with . ee a a metallic conductor touching the outer layer. \ 7 j | id ———————SSS= us i 5 dee) Sale) Wan fic WP) isaac A VERA Pek Geen. f yaa Ae 2, y i / > oes 04 The peculiarity of the Leyden jar consists in the _ fact that when a charge of electricity is placed on i we iat end one of its layers, another charge of opposite polar- —. eee — iii i a sy y iy SU ae) Iss A | : ity immediately appears on the other layer of the jar. Bl For instance, if the inner layer receives a positive charge, a negative one will be found on the outer | lead foil and vice versa. : zs | Fig. 6—High Frequency Coil, Giving All Modalities. something occurs to connect the two layers and al- 3 These charges will be held for some time unless : : i | | a , : 7 | 26 EBERHART’S MANUAL OF ce . | . a HIGH FREQUENCY CURREN’'S Q7 | | low the opposite kinds of electricity to neutralize | . *>one another. In the Leyden jar then, we have two charges of electricity separated from one another by the glass, ‘\\ which, although it keeps the charges from Serine, Gee | | to one another, does not prevent their exercising | | i : | an attraction upon each other; or, to speak more precisely, the one charge induces an opposite charge on the other layer. fas A substance which separates two charges of elec- tricity in a condenser while still permitting them to) i have an influence on one another, is called a di- electric. Other di-electrics than glass are mica, vu-. . ) | canite, etc. The contraction of the charge on the layer of the jar, causes a crowding together or con- densing of the electrical ions, and thereby gives rise to the name condenser for the Leyden jar or the .| 3 are y J Fig. 7—Leyden Jars, Cylindrical Type. other form known as the plate condenser. | : | In the plate condenser we have two layers of tin foil separated by a plate of glass, thus keeping up the same relative arrangement that exists in the Leyden jar. To make the analogy more complete, ee 28 EBERHART’S MANUAL, OF I have been accustomed in my classes to make use of the illustration in Fig. 8, showing a section of a Leyden jar; and then supposing that this were made of flexible material, let us imagine that we took hold of the ends of the section and straightened it out when it would appear as in Fig. 9, which rep- Z / resents a cross section of a plate condenser. + + Rar | ct: "| a OTT TTI LTT TTT TL LTT TTA LAT TLL LT LLL LLL N,_D.-E Fig. 8—Section of Jar. Fig. 9—Section of Plate Condenser. Electrical Oscillation. When a Leyden jar or other condenser is discharged through an air space, there is apparently a single spark passing across the gap. From the time of the discovery of the jar in 1775 until 1842, this was supposed to be the case. At this © time Professor Henry announced in reality there was a series of sparks passing back and forth be- tween the terminals of the spark gap. This phe- nomenon has received the name electrical oscilla- HIGH FREQUENCY CURREN'T'S 29 tion. It has been compared to the action of two col- umns of water of different heights connected at the bottom by a pipe with a valve in it. When the valve is opened, since water seeks its own level, the higher column descends, and the lower column rises, Ag a result of the action of gravity on the greater weight of the higher column, instead of the column descend- ing until level with the other column and then stop- ping, this force carries it below until it becomes the lower column and the other column the higher one, and thus the two columns balance back and forth until finally they come to rest at a level. Another ‘illustration may be made use of. in the pendulum, which when raised to one side and re- leased, swings over the opposite side nearly as far, and so back and forth through shorter and shorter ares until it finally stops in the center. Electricity following the same principle as it passes from a higher to a lower potential, produces a similar oscillation. — Lodge gave an especially suitable illustration by likening the action to the vibration of a straight | steel spring fastened at one end. eet edssacttl state tiisesgeaty cas . / | HI) \ Hilt) Hil . 2 o iH EBERHART’S MANUAL, OF SSNS SSS SS SSS SE SES SS SS HINT (tes SSS SSS SSS SSS SSS So SI) == IIIf : } - 2 = = a Fig. 10—Large High Frequency Outfit. HIGH FREQUENCY CURRENTS ; 31 Electrical oscillation is the keynote in the thera- peutic application of high frequency currents, al- though it was nearly forty years after its discovery a before anyone thought of applying the principle in the treatment of the human body. 32 EBERHART’S MANUAL, OF CHAPTER THREE. Types of Apparatus; D’Arsonval Type; Tesla Trans. | formers; Impedance; Direct D’Arsonval Cur- rents; Auto-Conduction; Auto-Condensa- tion; Resonator of Oudin; Tuning Coils: Measuring the Current. Types of Apparatus. . There is no intention on the part of the author to encumber this volume with lengthy descriptions of apparatus. For such infor- mation, the reader is referred to the manufacturers | of electrical outfits. All high frequency instruments, however, are con- structed along two principal types—that of D’Ar- sonval and that of Tesla, and these should be un- derstood by the high frequency operator since ail HIGH FREQUENCY CURRENTS Figs. 11 and 12—Portable Coils. 33 HIGH FREQUENCY CURRENTS : 35 AAR same general lines as is the D’Arsonval and has the tion of these types. same wide range of usefulness but the general char- In connection or combination with them, a third acteristics of the current are different in that the \ instrument, the resonator of Oudin, is in such com- Tesla type of apparatus delivers a high potential, HUME SSRURUR THEM rea bee beaat apie ef low milliamperage current. a machines represent one or the other or a combina- mon use that it also calls for special description. In If every physician employing high frequency ap- : 34 _ EBERHART’S MANUAL, OF speaking of high frequency currents, to be specific, ME MN TINE SST eater we should always state the form of current used, TERE ESET A paratus was aware of this difference it is the au- thor’s opinion that many cases of misunderstanding Uitiniiliinnhiiaien ais Mirebedie isi siiisatiiennsieatrenics testite tts as D’Arsonval high frequency, or Tesla high fre- quency, ete. : The D’Arsonval type of apparatus as it 1s man- ufactured today consists of a combination of the D’Arsonval solenoid and an improved type of the Oudin resonator. The Oudin current derrved from this type of apparatus serves to energize vacuum electrodes, the spray electrode, the so-called “‘static spark’’ electrode, the portable ozone inhaler, and also is the current which is utilized for obtaining the ‘cold’? fulguration spark. The D’Arsonval solenoid is utilized for auto-condensation, auto-con- duction and diathermy. The D’Arsonval solenoid in this instance delivers a comparatively low poten- tial and high milliamperage current. The Tesla type of apparatus is designed along the and dissatisfaction would be cleared away. In other words the milliamperage reading oi the meter is not an indicator of the capacity or power of the apparatus. This means that 500 milliamperes of Tesla high frequency current is just as capable of producing deep constitutional effects as 1,500 milliamperes on a D’Arsonval high frequency ap- paratus. The relative merit of the ‘‘Tesla’’ versus the ‘‘T)’Arsonval’’ apparatus more particularly as re- gards auto-condensation and diathermy has been the subject of numerous discussions among electro-ther- apeutists. The thickness of the di-electrie (auto- condensation cushion) has also entered into this dis- cussion. It has been proved that either type is cap- 36 . EBERHART’S MANUAL, OF able of producing results and in consequence thereof the author does not feel capable of choosing him- -gelf as the sole arbitrator in deciding. which is bet- ter. He, however, for the past three years has been employing the Tesla type of apparatus in his indi- © vidual practice and has been deriving eminent sat- isfaction from its use. He employs a cushion of approximately three inches in thickness—this size being endorsed by the standardization committee of the American Electro-Therapeutic Association. | As will be stated in Chapter VI, the author orig- — inated the thin cushion as well as the portable thick pad, and the method of making these different forms is given. He bows to the ruling of the committee referred to above and now employs only the thicker cushion. — The D’Arsonval Current is one of high frequency, ~ not very high voltage, and high amperage. It is administered as a bi-polar method, thereby producing constitutional effects. D’Arsonval started with an induction coil attached to the direct cur- rent. The terminals of the secondary coil were at- tached to the inner layers of two Leyden jars, there- HIGH FREQUENCY CURRENTS SPARK GAP JARS Ca SLIDING << {_ ROD | SOLENOID (1 PATIENT COUCH or SOLENOID Fig. 13—Diagram of D’Arsonval Type. 38 EBERHART’S MANUAL OF a -_ . HIGH FREQUENCY CURREN''S by charging one of them positively and the other negatively. In the circuit between these two layers was placed an adjustable spark gap. Between the ; 3 \Low Voutage outer layers of the jars was placed a solenoid or 1. aSyY Lio [WSOtY coil consisting of fifteen to twenty turns of coarse copper wire. This combination of condensers con- necting on one side through a spark gap, and on the other through a coil of wire, is an absolute neces- I sity in order to obtain the D’Arsonval current, and it therefore constitutes this type. See Fig. 13. YaWUodIsSnuy When the positive layer of the first receives a sufficiently high charge, it jumps across the spark | gap to neutralize the negative charge in the second jar. Immediately the positive charge on the outer C2 oO Zz 3 al Zz “ ha A j —_ £2 x ome > ~ ae 2 ~2 rr} ge “TH x m Pp layer of the second jar is released and passes through the coil of wire to neutralize the negative charge on . the outer layer of the first jar, and as it passes | through this coil or solenoid, it produces a high fre- queney current, keeping in mind the fact that the a | Very High VoLtage-Hign FREQ. Fig. 14—Diagram of Tesla Type. oscillation back and forth through the condensers exists as described in Chapter II. The patient is connected on that side of the condensers that dis- charges through the coil and is really on a shunt or 40 EBERHART’S MANUAL OF switch from that part of the circuit, and the reason the patient receives any current at all, is because the solenoid possesses the property known as self- inductance, which impedes the passage of the cur- rent, allowing part of it to go through the lesser re- sistance in the patient’s circuit. The process of in- terfering with the current as a result of the self- inductance is called impedance. The Tesla Transformer and Coil. Tesla started with the alternating current, and by referring to our definition of high frequency currents (Chapter I.), it is seen that all that was required was the increasing of the frequency to a point which we properly call high. To do this, he used as a primary, . a coarse coil of wire consisting of a few turns only, while the secondary coil consisted of an extraord-- inary number of turns of very fine wire—the result being that the current induced therein was of very high tension and very high frequency. The Tesla: transformer or coil, is especially adapted to the al- ternating current. It is employed in all of the port- able high frequency apparatus on the market. The Tesla primary resembles the D’Arsonval current ex- HIGH FREQUENCY CURRENTS 41 cept the amperage is less. Fig. 14 shows one method of evolving the various currents. Administration of the D’Arsonval Current. There are three prineipal ways in which this current is applied to the body; first, the direct bi-polar method, which has also been subdivided into two or three forms; second, auto-conduction, and third, auto-con- densation. In the first method, the patient is direct- ly connected to the terminals of the apparatus. Whether the patient holds the two electrodes, or whether he is attached to one pole, while the other pole is connected with an electrode in. the hands of the operator, the method is still called direct appl- cation. It should be borne in mind that the direct D’Arsonval current is also known under several other terms, such as diathermy, electro-coagulation and thermo-penetration. See Chapter x1) eter,” | ring back for a moment to the component elements of the D’Arsonval apparatus, it is seen that sole- noids and condensers are fundamental parts. In the elementary D’Arsonval type we have one set of condensers and one solenoid. It would appear, therefore, that the inventor said to himself: ‘‘If 42 EBERHART’S MANUAL, OF one solenoid gives a current of high frequency, let us add another solenoid and see what that will do.’’ Thus the second type, auto-conduction, is construct- ed, and a large solenoid is connected in the shunt which forms the patient’s circuit, and it is made so large that the patient may be placed within this coil or cage when it is found that as the high frequency currents traverse the coil, other high frequency cur- rents are induced in the body of the patient. This is auto-conduction. Auto-condensation. Again reverting to our ele- mentary type instead of using the second solenoid, the next arrangement was the use of an extra con- denser, and the current passes from one terminal ‘into one plate of the condenser, while the other plate was formed by the body of the patient, hence the term auto-condensation. Oudin’s Resonator. Oudin discovered that with a coil of wire properly tuned or adjusted to the coarse coil or solenoid of D’Arsonval, the electrical currents of the latter produced currents of such strength’ that they might be taken from the terminal of the larger solenoid and applied to the body. They are HIGH FREQUENCY CURRENTS Fig. 15—Diagram of Oudin Resonator. 44 EBERHART’S MANUAL OF of high frequency, high voltage and low amperage, resembling the Tesla secondary. As ordinarily con- structed, the D’Arsonval apparatus and the res- onator are combined in one instrument; the resona- tor proper consisting of a large coil of fine wire placed above the coarse solenoid of the D’Arsonval - machine. See Fig. 15. Tuning Coils. The best results in resonance are obtained when the coils are properly adjusted and , attuned to one another. To facilitate this, the wire that passes from one side of the solenoid is attached to a sliding metal finger, which may be moved up or down on the solenoid and thereby increase or de- crease the number of turns of wire employed. This permits proper adjustment of the coils at the same time it is found that the greater the number of turns included, the sharper the resulting spark, and vice versa. | ia Measuring High Frequency Currents. High fre- quency currents cannot, be measured with an ord1- nary meter. For D’Arsonval currents the method customarily employed is the use of a hot wire me- ter. This is really a thermostat instead of an elec- — HIGH FREQUENCY CURRENTS 45 trical device. It is based upon the fact that the passage of the high frequency current gives rise to neat and this heat causes expansion in a platinum wire and thereby deflects the needle in proportion. Hot wire meters are faulty, but give a relative idea of dosage when employed on the same apparatus. Fig. 16—Hot Wire Meter. One is shown in Fig. 16. Other methods of meas- q uring these currents are by Gaiffe and Meylon’s in- - duction amperemeter, which ‘‘measures the repul- _ sive force between the original current and the cur- | q rent which it induces in a coil attached to the indi- eator.’’ EBERHART’S MANUAL, OF Fig. 17—Resonator for Static Machine. HIGH FREQUENCY CURRENTS CHAPTER FOUR. Various Forms of Vacuum Tubes; Effects of Dif- ferent Vacua; Insulated Tubes; Fixed and Adjustable Socket Handles. Various Forms of Tubes. The vacuum tubes used i high frequency work have been made in almost every conceivable form to enable them to be ap- plied to various parts of the body. The vacuum of these tubes varies from one-five hundredth of an atmosphere up to that possessed by the X-ray, one one-millionth. The color which appears in the tube | varies according to the degree of vacuum; thus a low vacuum will produce a reddish color or glow in the tube; one of medium or slightly above me- dium vacuum, a blue color; and a high vacuum a white appearance. | Strong says, ‘‘As the exhaustion proceeds from one-five hundredth to one-ten thousandth of an at- mosphere, the disks become thicker and the stria- tions fewer, and the color changes from a rose-pink 48 EBERHART’S MANUAL OF to violet, blue (one one-thousandth), blue-white, and finally to a dense yellow-white. A low X-ray. vacuum would be about one one-hundred thou- sandth of an atmosphere.”’ Besides the degree of vacuum, the light is also supposed to be influenced by the kind of gas re- maining in the tube, and some authorities claim ~ that there is a direct analogy between the rapidity of the oscillations at the spark gap and the color of light in the tube. As the lowest number of vibra- tions producing the color ‘‘red’’ is 450 billions per second and the highest violet 750 billions, this - analogy seems improbable. The low vacuum tubes give off more heat, while the high ones give some chemical (ultra-violet) rays and if very high, X-rays. The red or red-pink vacuum besides giving off — more heat, is sedative and useful in painful con- ~ ditions and in acute diseases and inflamation. The medium, blue, or blue-white vacuum gives off some chemical rays, and is more appropriate in |. - chronic conditions. It is often employed where the white vacuum would really be indicated as this _ HIGH FREQUENCY CURRENTS Fig. 18—Interrupterless Transformer, with Resonator Employed in Giving Auto-condensation. ol we Ba) Z x] oa ed PD O ~ O Z [x] +) e) 2) [a4 Fy ae O eI ae EBERHART’S MANUAL OF 50 Tubes: and Handles. 20— 1S EF ode, Condenser Electr ae Fig. 19—Portable Outfits. Fig. 21—Insulated Tubes. 52 EBERHART’S MANUAL, OF contains not only blue and violet, but also some ul- tra-violet rays. All chronic ailments, where the vi- tality is impaired, skin diseases, indolent ulcers, etc., call for the employment of the white or blue-white tube. | | Much of the foregoing is more theoretical than it is practical and I have finally come to the coneclu- | sion that a medium vacuum electrode (purple tinge) answers all practical purposes, and this is what I am now using. Vacuum tubes are ordinarily made in a single chamber, the tube fitting into the socket of a handle that is used for all the different forms. Some tubes have a leading-in wire and others instead of having a single chamber in the tube, have the vacuum di- vided into two chambers the size of the circumfer- ence of the tube, connected by a small tube, possibly the size of a small pencil, and surrounded by a cham- ber that is not a vacuum. These latter are known as Insulated tubes. The tubes used most frequently are shown in Fig. 20. No. 1 is the body tube which is used also rbd treating face and scalp. No. 2 is the rectal tube; HIGH FREQUENCY CURRENTS 30A IONIZER WAITES #24 A TONGUE Fig. 22—Various Types of Tubes. #19 DOUBLE EYE 54 EBERHART’S MANUAL, OF SF ( "35 INSULATED EaR #36 INSULATED THROAT #40 INSULATED TEETH fee INSUL. CauTERY #6) SURFACE “Y Fig. 23—Vacuum Tubes. 3 vaginal ; 4, nasal; 5, urethral or aural; 6, throat. In place of No. 1, No. 11, Fig. 21 will be found - - equally useful and in some instances superior on a- account of the ridges around the depression, en bling it to be used where it would be difficult to ~ place the body tube. HIGH FREQUENCY CURREN’S 55) Insulated Tubes. The advantage of the insulated tube which I have been in the habit of calling the Titus tube, because I believe it was first designed by Dr. Titus, is that with this tube the current may be introduced without loss into an orifice of the body. Take a plain vacuum tube and attach to the eurrent and when it is lighted up, surround it with the thumb and forefinger and it will be observed that there is no light beyond the point of contact. It stands to reason, therefore, that if such a tube were introduced, for instance into the rectum, the point of contact with the body would draw off much of the current and the surface within the body would receive but little treatment. For this reason with the insulated tube the opening of the orifice comes in contact with the non-vacuum part of the tube and the end of the tube where the vacuum ex- ists thus conveys all of the current in at the desired point. I have been taken to task for my statement above, on the ground that contact with the encircling finger possesses no capacity. It simulates, however, the conditions of certain orificial treatments and after 56 -EBERHART’S MANUAL OF trying the experiment referred to, I am sure the physician will resort to the use of insulated tubes for rectal and other orificial work. The principal forms of insulated tubes in use are shown in Fig. 21. No. 7 is for the ear; 8, rectal, or prostatic; 9, post-nasal; 10, for vagina or uterus ; 11, prostatic or for general surface use; 12, urethral or aural; 18, nasal. , | The Adjustable Socket Handle. The ordinary holder for high frequency tubes consists of a straight handle with a metal socket into which the tube is received as shown in Fig. 20. This is suitable for holding electrodes that are applied to the surfaces of the body, but for most conditions I prefer a han- dle with a movable or adjustable socket. Fig. 20 This socket may be placed at any angle to the han- dle that may be desired and with a thumb screw made secure at this point necessary. The advan- tage of this will be discussed in detail in Chapter VII, when considering the special technique for va- rious portions of the body. The latest type of my adjustable handle 1s shown in Fig. 24. It is of spring steel and accommodates tubes of varying diameters. Author’s Spatulate Tubes. I have recently de- HIGH FREQUENCY CURRENTS ily mi 1 ~ ~ — a ee! ore peters el mut ning A aie Chet Nisan) < — ei Fig. 24—Author’s Latest Adjustable Handle. signed the tubes shown in Fig. 27. They end. in : _ flattened spatulate extremity. In the body tube the HIGH FREQUENCY CURRENTS cy I b ) R O U 2 a o e S S p o e S o a 6 a e s q F O o. & O S e t e O a r s A s o Pp , g e o s m n H O 0 F O ) > a a o te C u Ac s Q , : r o o d o F 4 c o P y 2 o F l m 2 S i) Bo yt c p s c S a © O o S m i e ss , S e e e o i 2 a p . B e o i e T o r o d y i G S o c eI a ) P y a o D D e l B e a a i e ti ce o s B o o e n e O e R S 4 S b TD . D e i a a S e e e e S o D 4 ca B a e H e r s o l e e S © < q ro B o 4 O e ol wl N S e n e e § em i) a aS S d S o g y 8 oe % OO ! (Q O Ce S a s e e 5 e d e a N i t e fe b) o p e c o p t C O . i ) w n < » Bw Ae OC S r e S e ce e 16 8 8 o r e s CO s: e a e S m S H r o as P S AC S —_ H D 4 oO D R S Pi es l e pa re ie ea st ! | F a o O w ~ S t i e e a a e e Pe n) B S R e e B e e S o d a e e e zm B e Se ct e o ce a t e S o e o u s S e F y S a o e S e e = o S S S e S B i = O o 8 8 O S o F is e > SG o s S D o S e e e e e e . So 2 5 A s S S | 60 EBERHART’S MANUAL, OF Fig. 27—Author’s New Spatulate Tubes. HIGH FREQUENCY CURRENTS CHAPTER FIVE Physiological Action of High Frequency Currents; Burns; Offsetting Tendency to X-Ray Burns. The physiological action of high frequency varies with the form employed. In the construction of the apparatus the coarse coil or solenoid of the D’Arsonval machine is used as the primary coil of the Oudin resonator, and the current from the secondary of the Tesla coil is es- sentially the same as that from the secondary of the resonator. If a vacuum tube is excited by attaching to one pole of the Tesla secondary it gives the same effect as if coming from the top of the Oudin resonator. With the hyper-static transformer the primary yields a D’Arsonval current and the secondary one _ similar to that of the resonator or Tesla secondary. 62 EBERHARTS MANUAL OF When vacuum tubes are applied locally there is soon produced redness and hyperemia, with all of | the resultant benefits on nutrition. In short, the fundamental value of high frequency currents is their beneficial effect on all nutritive processes. Incidental to this we have increased oxy-_ venation of blood and tissues, increased leucocytosis (and phagocytosis) ; and increased elimination. : There is no painful sensation produced by the vac- uum tube when held firmly in the hand, thus estab- lishing complete electrical contact. Ordinarily there | is a sensation of heat and in some instances percep-, — tible vibration. Removing the tube produces a spark which increases in sharpness as the tube is — drawn away, up to the full length spark it is cap- | able of emitting. The longest spark which may be ' drawn from the tube has been my method of roughly calculating the strength of the current and the reg- ulation of the dosage. See Chapter VI. : General Action of Vacuum Electrode. In a gen- eral way the action of the current when appled by. means of the glass vacuum electrode is as follows: A mild current with tube in contact is sedative. As HIGH FREQUENCY CURRENTS 63 the current is increased, or the electrode removed from the surface, allowing a spark to pass, it be- comes first mildly stimulating, nea strongly stim- ulating and finally caustic or destructive. The whole gradation of effect from sedation to cauterization being essentially a question of current intensity and - Jength or sharpness of spark. With this is the effect of hyperemia and the ger- micidal action of the spark and the ozone which it liberates. Summary of Vacuum Tube Effects, from Oudin resonator or Tesla secondary: 1. Increase blood-supply to a given area. (Hy- peremia. | 2. Increase oxidation and local nutrition. Increase oxygenation of blood. Increase intake of oxygen. Inerease secretions. 3 “. do. Increase output of carbon dioxide. : 7 Increase elimination of waste products. 8. Liberate ozone, with the resultant benefit of more or less of this ozone being inhaled by the pa- 64 EBERHART’S MANUAI, OF tient, and also probably carried directly into the tissues. | | 9, Increase bodily heat, without a corresponding rise in temperature. | | 10. Locally germicidal. 11. Mild and medium sparks stimulate or soothe according to length and character of application. 12. Strong sparks are caustic. Be Sparks to spine increase arterial tension. 14, Promote absorption of plastic exudates or ad- hesions. : | These effects of vacuum tube applications while . essentially local, are not absolutely so. The current traverses the body in all directions from the point of entry, but is, of course, most intense and pro- nounced at the latter point. Prolonged applica- tions of vacuum tubes will give systemic effects, but these are obtained more easily by auto-condensa- » tion. Constitutional Effects. These are derived through auto-condensation and auto-conduction. These cur- rents increase bodily heat, almost always showing HIGH FREQUENCY CURRENTS 65 a rise of from one-half to one and a half degrees in temperature during a ten-minute application. Some attribute the effect of these currents to the heat they develop in the tissues. In my opinion their principal effects are due to ‘‘cellular mas- sage.’’ They have, therefore, a great effect upon metabolism. The effect of auto-condensation in producing ecel- lular massage is appreciated when we realize that the charge in the patient’s body must return back into the circuit and then alternate with one of op- posite polarity, thus, first a positive and then a neg- ative charge is carried into the body and back again. This produces a to-and-fro wave that acts upon every cell in the organism. No sensation is usually perceptible if perfect electrical contact with the pa- tient exists in the latter’s circuit. Synopsis of Constitutional Effects: 1. Increase general metabolism. Increase glandular activity. 2 3. Increase temperature and bodily heat. 4 . Increase oxidation and hemoglobin. 66 EBERHART’S MANUAL, OF 5. Insrease secretions. 6. Increase elimination. 7. Lower blood-pressure when hypertension ex- ists. 8. Soothing to the nervous system. High Frequency Burns. This is a subject which has not been touched upon in the literature on high frequency. There is a prevalent idea among many operators that these currents do not and cannot produce a burn. True, they do not cause a derma- titis, comparable to that produced by the X-ray, but they are still capable of causing annoying sur- face burns. It will be noted by the physician who is accus- ~tomed to handling the excited tube with his hands that after a time the skin, especially about the fin- ger tips, feels as if he had been handling a hot dish, that had seared the outer skin. Also in giving va- ginal treatments, prolonged application may result in shreds of the mucous membrane adhering to the tube when it is withdrawn. To avoid this, I make. it a rule never to leave a vacuum tube in contact HIGH FREQUENCY CURRENTS Fig. 28—Formalin Sterilizer, 68 . - EBERHART’S MANUAL OF with a mucous membrane for more than seven min- utes at a time. Occasionally the urgency of a case is such that I am willing to give longer treatments and take the chance of a possible burn. High frequency currents seem to have no cumula- tive effect in so far as burning is concerned, and > treatment may be repeated frequently without any — apparent danger; thus three seven-minute treat- | ments may be given in one day with intervals of three to six hours between, without any serious consequence when one twenty-minute treatment may be disastrous. : High frequency burns appear immediately ; there is no interval as with the X-ray. Another use of the high frequency in which burns may result is in the application of the spark to a mucous membrane, as for instance, to the lip, where care and judgment ~ must be used. I have seen a fairly sharp application to a ‘‘eold sore’’ result in the formation of a large vesicle which ruptured and poured forth an ineredible amount of serum and was three weeks in healing. HIGH FREQUENCY CURRENTS 69 As a sharp spark has a cauterizing effect and is used for that purpose, it is readily inferred that the reaction just referred to is of this nature, as even a comparatively mild spark will influence a mucous membrane. Another condition in which these currents must be used with care is about the neck or scalp, where there is a fine, fuzzy growth of hair, as with some forms of apparatus having considerable amperage, enough current comes through to produce a spark capable of setting fire to any inflammable substance. This property of the high frequency spark may be bacily demonstrated by lighting a gas jet with it. I have been told of one or two instances where severe burns occurred from the spreading of the tiny flame. to the hair on the head. I wish to specially caution against the danger of | using the high frequency spark on the scalp in con- nection with lotions containing a high per cent of alcohol or other readily inflammable material. Where ‘such lotions are employed, the high frequency spark must be used first and the lotion applied thereafter, or a serious accident may happen. 70 EBERHART’S MANUAL, OF The same point must be kept in mind when using the cataphoriec electrode. Offsetting Tendency to X-Ray Burns. While I - am touching on the subject of burns I wish to call attention to a use which I have made of the high frequency current, regarding which I have seen no reference elsewhere. This is the use of this current to offset some of the effects of the X-ray, and by its use in conjunction with the latter, to enable a larger dose of the X-ray to be administered without a corresponding degree of danger. A stimulating. application is used to the point of producing some reddening of the skin. | | | The ultimate action of the application of the X-ray is to cause a decreased amount of blood in the part treated through the action of the ray in in- creasing the cellular lining of the arterioles and thereby producing a diminution in their caliber. It is well known that in deep X-ray burns we have a condition of starvation and death of tissues; result- ing from insufficient nourishment. Now, as far as the action of the high frequency current on the ves- sels is concerned it is diametrically opposite. It in- rent. ) This must not confound the reader with the action HIGH FREQUENCY CURRENTS ~ ya ereases the blood-supply to the part treated, and to this extent it tends to offset the anemia produced by the X-ray. Otherwise the two methods usually act in harmony with one another in a large number of diseases, particularly those affecting the skin, and by combining the two, a greater amount of X-ray may be safely used, while its action is hastened by the complementary effect of the high frequency cur- of strong sparks, which, as in fulguration, destroy arterioles, or produce an endarteritis similar to that caused by the X-ray. EBERHART’S MANUAL OF CHAPTER SIX. General Technique; Vacuum Tubes; Lubrication ; Cautions; Asepsis; Method of Standardizing Dosage; | Author’s Unit for Measuring Auto-Condensation; Preparation of Patient; Technique for Skin Dis- eases or Surface Lesion; for Relief of Pain; Cauter- ization; Orificial Technique; Cataphoresis; Bi-Polar Tesla Technique; Selection of Most Suitable Forn of Current; Fulguration; Constitutional Treatment; Auto-Conduction; Auto-Condensation; Portable Pads; Home-Made Couches and Pads; D’Arsonval ‘‘Surgings’’; Water Spray; Local Auto-Condensa- tion; Indirect Sparks; Taking the Blood Pressure: Miscellaneous Suggestions; Diathermy. One author gives upwards of twenty different methods of using high frequency currents. This is apt to prove confusing to the ordinary user of these currents, and I have reduced the headings under HIGH FREQUENCY CURRENTS — Saat Ss which to discuss technique to those methods most commonly in vogue. Classification of Technique: 1. Vacuum tube technique. (Tube excited by Oudin or Tesla currents) 2. Fulguration. 8 Constitutional (auto-condensation and auto- conduction. ) 4. Diathermy. (Direct D’Arsonval; electro-co- agulation ; thermo-penetration. ) | 1. VACUUM TUBE TECHNIQUE, This involves the use of the tubes by direct con- tact, by effleuve (fine spray) and by actual sparks, from the mildest form to the sharp caustic forms. It may be classified otherwise according to its use as in (a) skin diseases, ulcers, inflammatory proc- esses, etc; (b) relief of pain, as in neuralgias, etc. ; @ orificial application. Vacuum tubes are employed where an essentially local effect is desired. | Lubrication of Tubes. Any of the lubricating jel- lies, unguents or cerates may be employed on tubes used within the urethra, vagina or rectum. - 74 EBERHART’S MANUAL OF Vaseline answers very well, for, although it Is a non-conductor of ordinary electricity, the thin coat- ing required on these tubes is absolutely no bar to high frequency currents. Cautions. 1. As stated in Chapter V, high fre- quency currents are capable of producing annoying but not ordinarily serious surface burns. These ef- fects are especially quick to appear when mucous surfaces are treated, as in rectal, vaginal, urethral or nasal applications, and also in treating diseased areas about the lips. On this account the applica- tion should be relatively short and mild if a spark is employed in treating within the various orifices. Make it a general rule never to allow a vacuum tube to remain in contact with a mucous membrane for more than seven minutes at one treatment... 2. When the current is one of relatively high amperage, the spark will set fire to any easily in- flammable material. This may be illustrated by , lighting the gas with the Spark, as previously re- ferred to. On this account care must be exercised instreating in certain areas. HIGH FREQUENCY CURRENTS 45 3. When introducing glass sounds into the male urethra great care must be exercised not to use any undue force and thereby break off the glass tube within the canal. These tubes are made of strong glass, but may be broken by unusual pressure, or by a sudden jerk. If difficult of introduction it is better to pass steel sounds-first to a size larger than the glass sound, as suggested in Chapter VII under - Urethral Technique. Care of Vacuum Tubes. Asepsis. Although the spark or effleuve from the vacuum tube is germi- cidal in character, still it is the duty of the physi- cian to use the utmost care and cleanliness in em- ploying it in order to gvuard against any possibility of spreading infection from one patient to another. In other words he would better follow some def- ninite system of sterilizing and disinfecting the tubes, and the nearer this is to surgical asepsis the bet- = Ler: Wiping off the tubes on a cloth or towel or sim- ply rinsing in water is not enough. Apply the test to yourself. How would you like to be treated with a tube that had been used in 76 EBERHART’S MANUAI, OF contact with a specific. disease and which had re- ceived no further cleaning than mere dipping in water and then being wiped off with a towel that _had already done similar service an indefinite num- ber of times? Let your technique be so careful and conscien- tious that you need never blame yourself for spread- ing contagion or infection of any kind. This is a subject that I have not seen mentioned in any treatises on high frequency currents. Do not use the same tube for specific and non- specific orificial cases. This alone will do much toward lessening the danger of infection. As these tubes bear heating, they may be ster- ilized by boiling, just as surgical instruments are sterilized. This, however, is not necessary as immersion in _ strong antiseptic solutions will be sufficient. A tube that is to be used in contact with a mucous | membrane, such, for instance, as a vaginal or ure- thral electrode, should be immersed in pure car- bolic acid or in pure crethol, benetol: or lysol, be- HIGH FREQUENCY CURREN’'S Hip fore again using, if it has been in contact with the discharge from a specific disease. In cases such as acne, psoriasis, eczema, neural- gia, non-specific diseases of the urethra, rectum or vagina, ete., it will suffice if the tube is immerséd for a few moments or kept permanently when not in. use, in a strong solution of any one of the three antiseptics mentioned in the preceding paragraph. For this purpose a glass jar, large enough to take in the various electrodes, should be filled with a twenty per cent solution of carbolic acid (a five per cent solution is not enough); or as its equiva- lent, one of erethol, benetol or lysol containing a tablespoonful of either to the pint of water. An ideal way would be to have two jars, one con- taining the full strength antiseptic, for the tubes employed in infectious cases, and the other for those used in non-contagious diseases. . Personally I prefer crethol or lysol to carbolie acid, because equally satisfactory and not caustic if any of the full strength liquid-accidentally comes in contact with the operator’s hands. 78 3 EBERHART’S MANUAL, OF If the tubes are immersed in the pure antiseptic they should be thoroughly rinsed in alcohol and — water, or in water alone before using. From the weaker solutions, water alone is necessary, but in both eases hot water is preferable. The conveniences of most of our modern office buildings make the technique of sterilizing the tubes | a simple one in the large cities, but in smaller towns the physician will find it somewhat more of a task. ' In the absence of large jars to keep the two so- - lutions in, with the tubes constantly immersed, wide- mouthed bottles may be employed for use before and after each treatment. By sterilizing in this manner both before and after, the tube not only receives a double steriliza- tion, but also if it has been taken care of immedi- ately after use, if such a thing should happen that it should be used again without remembering about | sterilizing it, the danger would be slight, and fur- thermore the tube is easier sterilized immediately after using, than it is when the secretions or dis- charges have dried upon it. © HIGH FREQUENCY CURRENTS © G9 I have spoken of using the same care that you would with a surgical instrument, although the danger with these tubes is not as great as with surgical instruments for several reasons. In the first place, they are not employed ordinarily in a fresh wound; secondly, the danger is in carrying infection from one patient to another and not the | additional danger which accompanies a surgical op- eration, of infecting the wound from the individual aS well, and finally, in the majority of the cases treated there is practically no serious danger of in- fection. If one had a sufficient number of tubes it would be desirable to keep an individual tube for each patient, which was used for no other. Immersion in the weaker solutions referred to above and rins- ing, or even ordinary cleanliness would be suffi- cient; but at the close of the course of treatments, before the tube was used for another case it then should receive vigorous and thorough sterilization, in proportion to the danger of infection involved in the case. | 80 : EBERHART’S MANUAL, OF The sterilizer shown in Fig. 28 is an excellent one. A basin of formalin solution keeps the tubes always sterile. | Some of my readers may think I am devoting too much space to this subject, but it is an important one and my early surgical training has made me aie ‘“‘erank’’ on this point, and really, could you ever | excuse yourself if through your carelessness you spread, say a specific infection, even in one single instance ? Measuring Dosage. One problem that confronts - the physician who is beginning to use the high fre- quency, is a method of measuring dosage. There is no meter which will measure the output of the vae- uum electrode, or in other words the unipolar cur- rent. For auto-condensation and for diathermy the hot-wire meter is used and proves relatively satisfactory. For the vacuum tube, in order to con-. vey an idea that would apply, no matter what size or make of apparatus might be employed, I have. made use of the length of spark which it is possible to draw. from the vacuum tube as a simple method HIGH FREQUENCY CURRENTS 81 of giving some idea of the strength of current em- ployed. This is a very crude method, and open to some serious objections, but will answer the pur- pose in a general way and convey a more intelli- gent idea than any method other than a meter. With a definite amount of current passing through the apparatus, there is a positive point near the tube that represents its utmost sparking distance, that is, the longest spark that can be drawn from that tube, and this will remain constant as long as the current is constant—lessening the current shortens the spark; increasing it, lengthens it. Therefore, Mel say A employ for skin diseases a tube capable of yielding a one-quarter inch or one-half inch spark, I give to the physician a definite idea of the amount of current I would employ in the tube. This does not take into consideration the sharp- ‘ness of the spark which must be adjusted in accord- ance with individual susceptibility and the type of machine used. | Ses With the Tesla type of apparatus and particularly with small machines, the spark is apt to be sharper in proportion, and is designated frequently as a 82 EBERHART’S MANUAL OF ‘‘hot’’ spark. With these outfits it 1s often impos- sible to employ a spark more than a quarter of an inch in length. With other types, a longer spark will be tolerated, and with the Oudin type of ap- paratus we have what may be called a ‘‘cold”’ spark, and frequently one three-quarters or an- inch long may be more easily borne than a quarter-inch ‘‘hot’’ spark. The cold spark is dehydratory and the hot spark caustic. In interpreting my sugges- tions for dosage in Chapter VIII, these facts should be taken into consideration. Ordinarily if the dose | is given one-fourth to one-half inch the first would \ be for the ‘‘hot’’ and the second for the ‘‘cold”? spark. The Eberhart. Author’s Unit of Measurement for, Auto-Condensation. For a long time both physi- clans and manufacturers have felt the need of a standard unit for measuring auto-condensation one that would fairly represent the auto-condensation output of any type of machine. I believe I have solved this problem, and have a standard of meas-_ urement that will prove acceptable to the manufac- HIGH FREQUENCY CURRENTS 83 turers of any form of apparatus. It will be found convenient for the manufacturer to state with the directions for auto-condensation that the output of the machine is so many Eberharts per minute to each 100 milliamperes registered on the hot-wire meter. In this way with the dosage given as a cer- tain number of Eberharts, it is easy to note by the meter how many Eberharts are passing per minute and by noting how many times this number will go in the total dose stated the number of minutes re- quired for the treatment is ascertained. There are three essential elements entering into auto-condensation. First the pressure or potential (voltage), second the rate of meter reading (amper- age); and third, the time. When ‘the voltage is high the amperage is correspondingly low and vice versa. In a general way the effectiveness of any machine for auto-condensation may be expressed in terms representing the product of the voltage and the meter reading (equivalent of amperage.) ‘Thus 50,000 volts at 500 is the same as 25,000 volts at 1,000; each representing an auto-condensation effect- iveness of 25,000,000. | ’ | | 4 iH | : a 1 | | | po See EBERHART’S MANUAL, OF ; _ - HIGH FREQUENCY CURREN''S 85 | 3 | i My unit of measurement for auto-condensation. q The manufacturer may state the voltage of his | ; 3 I 7 is based on the passage of 1,000 volts at a rate of 7 machine, if desired, but the simpler way is to give | | | | 100 milliamperes in one minute of time. This unit . the number of Eberharts to each 100 milliamperes I) | | | 3 I call the Eberhart and abbreviate it H. ; meter reading. He should also state the average | | : | | | We have two types of apparatus for auto-conden- q “meter reading at which the apparatus is to be ope- | | ' | i sation, the one high voltage and comparatively low 7 rated. If he states the voltage, to compute a re- | | | ) i | | amperage; the other low voltage and high amper- } quired dose, multiply the meter reading by the num- i! ill age. In a general way I-assume that the first rep- ber of thousand volts, and divide this product by a | | resents a current of about 50,000 volts delivered at 4 4 100. This is the ie ee of Eberhart units being : | | | il a rate of 350 to 500 milliamperes as shown on a given per minute and by dividing the dose as given i i | hot-wire meter. The second averages 25,000 volts, _ _ in Eberharts by this, we have the number of min- | | i | | potential, and is ordinarily delivered at a rate aver- 7 q utes required. Going back to our previous example: a / ; | i | ~ aging 750 to 1,200; 1,000 being a frequent rate. Ap- q to give 2,500 E. auto-condensation on a machine es | | i} | | || | plying our unit it will be seen that 50,000 volts equal 50,000 volts with enough current passing to raise | a | | 50 E. for each 100 milliamperes meter reading, and meter to 500, multiply number of thousand volts, | | i if the meter read 500, there would be delivéred 5 00 by meter reading 500, and product is 25,000. Di- | | ) | ; times 50 or 250 BE. for each minute of time, and this vide by 100 which is done by cutting off two ciphers i) ia | | would give 2,500 E. in a ten-minute treatment. With. and we have 250, which is the number of Eberharts | the other machine 25,000 volts equal 25 E. per 100, per minute—250 goes into 2,500 ten times, therefore iI | il and with meter at 1,000 would give 10 times 25 E. = it takes ten minutes to give the required dose of Vit | or 250 HE. per minute, or 2,500 E. would require a i. - | q 2,500 E. | | | | | | ten-minute treatment. AS 3 It will be seen that it would be much simpler if | di | ail | HT 86 EBERHART’S MANUAL OF the manufacturer stated with this machine that the auto-condensation output was 50 Eberharts per minute for each 100 milliamperes registered by the meter. Then if the dose to be given is 2,500 EK. and the meter registers 500, or five times the 100 rate, it is easy to figure then that 500 is five times 50 or 250 E., and this goes in 2,500 ten times, therefore it takes ten minutes to give that amount. With the other type of machine we will say that the output is 25 E. per minute per 100 milliamperes ; but this machine will ordinarily be operated at about ° 1,000 milliamperes, or ten times 100, therefore it is_ also delivering ten times 25 E. or 250 E. per min- ute and it will also take ten minutes to give 2,500 K. In Chapter VIII the dosage of auto-condensa- — tion will be stated in Eberharts. It is well to remember that there is essentially no danger in auto-condensation and therefore no > over-dose, so that the dosage stated may be greatly increased if results are not obtained. The only cases in which caution is necessary, are those where a patient is carrying a high temperature or where the pulse pressure is 20 or lower. HIGH FREQUENCY CURRENTS 87 _ Preparation of Patient. When the surface of the body is to be treated, the question of removing the clothing arises. If no spark is desired, the electrode must be in contact with the skin, and any clothing covering the part must be removed. All metal, such as chains, corset-steels, wire hair- pins, ete., with which the tube comes in contact or within sparking distance of, will be charged with the eurtent and give rise to sharp and disagreeabli: sensations. If they cannot be avoided they should be removed. a Applications to the body, calling for a mild spark, may be given through thin underclothing, or the patient stripped and covered with a sheet, through which the spark is employed. _ Aside from the reason spoken of above (chains, : etc.), when a sharp spark is required there is no especial need of removing the clothing, in fact, a definite thickness insures a definite length of spark. When the tube sticks on the skin, dust on taleum powder or lay over the surface a very thin cloth, such as a handkerchief. In vaginal treatments no disrobing 1s necessary. mull | : Ni i 1] i i) ne Hl -q | oy i| | | 7: ne | i] | : 88 EBERHART’S MANUAL OF a = | HIGH FREQUENCY CURRENTS oe Hil | I! i : 4 SN Wi - . . ° Hl | | i \| General Technique in Skin Diseases and Surface , _-will pass lightly over the surface without any sud- i i a os si ac | TN 1 - Lesions. In applying the high frequency spark over den jerks or elevations to cause annoying sparks. | | 4 If ° ° ° ; . ° | | i) the surface of the body, as in acne, eczema, etc., I If the skin is moist and the tube sticks, it may I | HI | : ‘ e e Hi Hi i employ a current of sufficient strength to produce be dusted with talcum or other dusting powder to Hi | HAN) ante ef obviate this difficulty. Another method is to place Ni | ih Hl a spark one-quarter to three-quarters of an inch in | | Hi il ii : : % | a thin cloth over the surface, which will enable ie Wii length. The discharge from the smaller Tesla coils | a : eer: We Hall i the tube to be used smoothly and at the same time Wie Wil is relatively sharper than from the resonator or : A a HH] | | |= does not remove it far enough from the surface to Wie MW larger Tesla outfits, and a shorter spark is used 2 | Wie | i i : 7 make an unpleasant spark. he a ient cannot tolerate quite as much curren : a ease qe ee | | | i] as the patien “d ; Where itching is marked, the tube is raised from ii | Ht i eo . With a vacuum electrode cap- ne | i | | az these spans eee z the skin and as sharp a spark applied as the patient Hl nl | | iveri der he length given, Peeks é vee ee | | | able. of delwering: 4 spark (oF the tenet. 2 ! will tolerate for a short period of time. This quickly Hil | HI il Ke but 22 a ae | ate: ae | } do not try to make use of the full length spark, but | relieves the itching, and also quickly produces the Wh | | i | in Ii rith the skin, thus | ae 1 Boo aie tube ny teri owee: will bee a A 4 characteristic reaction of the current (hyperemia, i | | | | Hl _ giving a sufficient intensity of current but avoiding . : 4 ce : i | i) = | eg were held at | . @ a | a a | | ; the pain that would result if the tube were held a — 4 In treating epitheliomas, lupus and any chronic Hie i 7 1a : ms Th a ; : ; r i tN | i full sparking distance from the surtace cue a ulcers, a spark is employed in the same manner, that MM Hl : s . h eo { : : SS is paszed: Tapidly bags oud porn re ae eee a is, a Sharp as the patient can stand, but not for ~~ Will \ | treated, and this will be accomplished in the easiest | a a long period, say from two to three up to occa- Ml i | | manner by holding the tube handle lightly with the | 4 sionally five minutes. Unless cauterization is sought, | i i fingers with the thumb extended along the handle. 4 4g the tube should be kept moving rapidly over the | i) : | : A side to side motion with the wrist will soon be- _ 4 | surface and not allowed to expend its full effect il q | | come a matter of habit to the operator and the tube © i q steadily over any minute area. At the present time | | | | 2 | q i HIGH FREQUENCY CURRENTS 91 | i | | ih | 3 | | | i 90 EBERHART’S MANUAL, OF hc - fulguration (caustic) would be employed more fre- quently for epithelioma and lupus. ; Technique for Relief of Pain. In congestive head- aches, neuralgias and other painful conditions, the beneficial action of the high frequency current seems ‘to be largely the result of counter-irritation. There- fore, it makes very little difference whether a sharp spark is used with the rapidly moving tube at full sparking distance, or whether with the same inten- sity of current, the tube is kept in contact with the skin. It depends upon the sensitiveness of the pa- tient and also upon the location of the area treat- ed. A long sharp spark occasionally exerts a slight caustic effect, and the surface will be covered with tiny blebs, which are followed by minute scabs, making the skin sore and uncomfortable. Unless the case to be treated is a severe one, it is not per- missible to push the treatment to this degree. Le Cauterization. If a hot spark is held steadily over the spot for from thirty seconds, up to two © or three minutes, varying with the patient, it will have a cauterizing effect. The reaction is severe ~ and the destruction of the tissue may be carried in Chapter V.) to a marked degree. Such applications have been used in the treatment of warts, moles, etc. I have treated epitheliomas in this manner and have had them separate from the surrounding tis- sue and peel out as smoothly as if cut out with a. die. It is too severe a measure, however, for the average case. Fulguration involves the same prin- ciples, and is preferable. The spark is derived from a metal point and anesthesia may be employed if desired. The technique of this will be considered in another section. _ Orificial Technique. The technique of the appli- cation to the orifices of the body involves the use of tubes suited to the various areas, and also in- volves the question of sterilization and lubrication. In these cases the tube is in contact with the mucous membrane and there is no sensation to the treat- ment except usually that of warmth. There is in these cases ereater danger of producing burns, and the tube should seldom be left in contact for a longer period than seven minutes at any single treatment. (See the section on vacuum tube burns The technique is so peculiarly that 92 _ EBERHART’S MANUAL OF } of the special organ involved that it will be given - under its appropriate heading in Chapter VII. It is desirable to remember that tubes should always be inserted before the current is turned on, and the latter turned off again before the tube is removed, thus avoiding all pain and shock to the patient. Cataphoresis. For cataphoresis a special electrode is employed. See Fig. 29. The substance to be car- Fig. 29—Cataphoresis Electrode. ried into the eee is in solution, and cotton gauze or felt wet in the solution is placed in the depres- sion on the face of the tube when the latter is placed in contact with the desired area and the current passes for from five to ten minutes or more as re- quired. I caution against the use of solutions con- taining alcohol or other inflammable substance be- HIGH FREQUENCY CURREN'S 93 cause of the danger of setting same afire with the current. In one form an insulating ring prevents loss of current and is a great improvement on the older style of tube. | | See Chapter XII for special electrodes used by dentists. Although strong claims have been made concern- ing the value of high frequency currents for the purpose of carrying substances into the tissues, I believe they are so far inferior to the galvanic current for use for these purposes that they are entitled to comparatively little consideration. The principle upon which cataphoresis depends is the separating of the particles (ions) composing the fluid by reason of the attraction possessed for them by poles of the battery; thus all positive elements remain at or are drawn through the tis- sues toward the negative pole, and vice-versa. Now, in using high frequency currents, which are alter- nating, the attraction would be first in one direction and then in the other, and as a result practically nothing would be accomplished. a local effect is more essential, vacuum tubes, metal electrodes, ete., are employed, but if a systemic or constitutional effect is desired, auto-condensation 1s to be selected, or the diathermic treatment may be © used. 2. Dehydratory or cold fulguration, employed with Oudin apparatus. The destruction of tissue is | through a drying process and there is no sloughing. There is essentially no pain, but its range is neces- sarily limited. \ i) Hi | ; | | i), | ( i i i i | | Ti ; J | 94 EBERHART’S MANUAL, OF HIGH FREQUENCY CURRENTS 95 | ai | | : | | The claim is made that the high frequency cur- I | Ww ; , } : ee . i | | / rent drives substances into the tissues by ° molecular 4 2. FULGURATION. | i vai oe ata. a | i | | bombardment.’ I maintain, however, that the cata 1 Fulguration. A long, sharp spark for escharotic | ik | | phorie action of the high frequency current 1s too | or destructive purposes was employed for a long Hi | | feeble to commend it for general use, for which pur- | time by high frequency operators, but the use of a | | aah | = | ; i |) | pose nothing takes the place of the galvanic current. ’ metal electrode devised by Keating-Hart for this | at a é : ; fe = - . : i | i Bi-polar Tesla Technique. Ordinarily the vacuum 1 , purpose, which he termed fulguration, gave an un- i | Va : } aes | Vi | tube is attached to one pole of the Tesla outfit. In ‘. usual impetus to the method. | it | some coils the sharpness of the spark is regulated | Fulguration as employed at the present time may ‘| Vat ? : ie ail | | | by drawing off a certain amount of the current from be considered under two forms: 1. Caustic or hot | H | | the active pole by bringing the sparking rod near fulguration, employed with D’Arsonval or Tesla | a | | aes | 1) | | it, thus lessening the available current. E apparatus, and giving a hot, caustic, or cauterizing | | i | a : } | | If it is desired to intensify the action of the Tesla | spark. The D’Arsonval fulguration is particularly Mi I | | | coil, the indifferent pole should be attached to the q j suitable in orificial work, such as papilloma of the | patient or grounded by connecting to a gas or water : bladder, etc. The Tesla is especially advantageous - | si pei . i | | pipe. | in surface work, such as moles, warts and other | | | | | Selection of Most Suitable Form to Use. Where superficial growths. HIGH FREQUENCY CURRENTS ENE EBERHART’S MANUAI, OF 96 Vibrator in Form. fob) a ea) las] a5 Son S _ fas} fal §) | = 5 mM o aa = (=) oO tI a or 5 ~~ a) a fos © — 4 o) Zi | ro (se) 20 fey th Numerous ncy wi one in All gh Freque ing Hi , Twenty 1es in it dal Outfit Comb Other Mo Fig. 30—An 98 EBERHART’S MANUAL, OF Soke \ Dr. W. F. Clark of Philadelphia employs a method of cold fulguration with the static machine, to which he has applied the term dessication. General Caustic Fulguration. The technique which I employ for warts, moles and small growths is as follows: The fulguration electrode is attached and the cur- rent turned on gradually, while the length of spark from the metal point (Fig. 33), is tested by bringing the point nearly in contact with a piece of metal, such as a coin. Without an anaesthetic it is impos- sible to employ one more than one-thirty-second to one-eighth or occasionally three-sixteenths of jan inch in length. This spark is hot, and actually sears or burns the tissue, as noted by the eye and usually by the odor. It is not desirable to keep this spark in steady contact, as it is too painful, but if the point is touched to: the surface and quickly brought away . beyond sparking distance, the patient is better able to stand it, and by a series of rapid sparks produced by a tapping motion of the point, thorough fulgura- HIGH FREQUENCY CURREN'TS 99 4 tion may be achieved without unbearable pain to the patient. Ordinarily I pass around the margin of the growth first, and then fulgurate the center. It should, be done thoroughly, and the growth will pre- Fig. 32—Fulguration Electrode. sent a brown, burned appearance. There is seldom any hemorrhage, but usually some serous oozing. A crust or scab forms which separates in a week or ten days (average eight), leaving no scar. It is well to bear in mind that if you do not get it all off the first time you can fulgurate again, but if Nace. eee eS ee * 100 EBERHART’S MANUAL OF you remove too much you cannot place it back again. , | s For more extensive work, local or general. an- aesthesia 1s necessary. - It is fair to state that very satisfactory caustic (hot) fulguration may be accomplished with small machines. In papillomata of the bladder, fulguration fas been particularly valuable. Fulguration of Papillomata of Bladder. The | author strongly advises the use of the D’Arsonval current (bi-polar method) in preference to the Tesla or Oudin currents. One terminal of the ap- paratus is connected to the fulguration wire, which is passed through the cystoscope, and the other ter- minal is connected to an indifferent flat metallic: electrode placed on the abdomen. The fuleuration wire or electrode consists of a steel wire insulated — with pure gutta-percha. As this wire is to be passed _ through the channel of an ordinary catheterizing eystoscope, it should not be larger in eauge than No. 6 French. HIGH FREQUENCY CURRENTS 101 The patient is prepared with green soap and water and bichlorid, and the bladder distended with water. After the cystoscope is introduced, the tumor 1s brought into view and the fulguration wire passed through the catheter channel of the eystoscope until the end of the wire is in view. The wire is then plunged into the tumor and the current turned on. (Before introducing the wire into the cystoscope, cut the wire so that the insulation is flush with the end of the wire.) Just as soon as the high frequency current is turned on, bubbles (presumably hydro- gen) are seen emanating from the tumor. If the tumor is small, or the electrode has been placed near 3 _ the top of the tumor, an immediate blanching of the tumor is seen. .This treatment can readily be ear- ried out under fie guidance of the eye, providing the insulation of the fulguration wire is intact; un- less the insulation is intact, a short-circuit in the eystoscope and subsequent burning out of the cysto- scopic lamp may result. After allowing the current to pass into the tumor — for about twelve to fifteen seconds, the current is 102 EBERHART’S MANUAL, OF shut off, the fulguration wire withdrawn and re- - applied to another part of the tumor. In large tumors, this procedure can be repeated until many different areas of the tumor have been treated in one sitting. As long as five or six minutes may be ~ consumed in one sitting. Naturally, the duration of each treatment will depend on the size of the tumor. For example, in one ease, one sitting con- sisting of three 12-second applications was enough to completely destroy a small papilloma. ' As long as the intra-vesical electrode remains in contact with the tumor no pain iS experienced by the patient. When working near the base of the tumor, or if the electrode comes in contact. with the bladder-wall, the patient frequently complains of pain. So that during the first fulgurations there is no pain, whereas, toward the end of the treat- ment, while working near the bladder in treating the remaining tags, the patient at times complains of pain. It is also necessary to consider the pain incident to cystoscopy. This is variable in different persons, so that some of the patients cannot tolerate long sessions as well as others. The number of HIGH FREQUENCY CURRENTS 103 treatments or sittings, as previously stated, is deter- mined by the size of the tumor, some cases requiring as many as six sittings. | Attention is called to the burning off of the insu- lation near the end of the fulguration wire. After the current has been turned on and the treatment carried on for a little while, sometimes only ten seconds, the insulation becomes soft and falls off or burns off from the end of the wire, so that it becomes necessary to withdraw the wire and cut the end off squarely. Unless this is done, there is dan- eer of the bare wire causing a short-circuit in the eystoscope. . | Usually when the high frequency current is ap- plied the tissues become white and shrivel up. Some- times the tumor surface appears dark, as though it were baked. Not infrequently after an applica- © ‘tion a larger or smaller piece of the tumor adheres to the end of the fulguration wire. At other times these small pieces may be passed at the next urina- tion, and often they are obtained from the wash- water. These are carefully saved and examined microscopically. Seeiieiieiar Re ne 2 Hs” il) (i) 4 || | | | | | | 104 EBERHART’S MANUAL OF ~ | 4 3 . HIGH FREQUENCY CURRENTS ; 105 - | i | | ; It is suggested that papillomata should be con- . = q q e ? I] | q | sidered malignant in all cases; that in all cases of | | | | i : long standing cystitis which has persisted even in i) | | | the presence of careful treatment, or with the his- q | | | tory of frequent relapses, papilloma should be Sus- . | | | pected, and the diagnosis confirmed or contradicted 3 | i | | 2 by cystoscopy. It is the consensus of opinion that q | dl i : the fulguration method is followed by remarkable 4 | i | | | results, but as yet sufficient time has not elapsed | ‘ i) il | for us to make a definite statement as to an abso- - Wh | | | | lute guarantee that this treatment will prevent ree a , | ee Hi | | | eurrences. (Abstracted from an original article, | , Wd All ‘“Muleuration Treatment of Bladder Tumors,’’. by | Herman L. Kretschmer, M. D., of Chicago. Illinois. Medical Journal, April, 1913.) il Auto-conduction. In auto-conduction the patient | | Wl ie WA Vie | . | 106 EBERHART’S MANUAL, OF ; ad | | HIGH FREQUENCY CURRENTS 107 I. . i} i pet t 4 a | | He : 4 3 | ie ne 3. CONSTITUTIONAL (AUTO-CONDENSATION t | a HE AND AUTO-CONDUCTION). | : : | nie | | | | | 1 _ 1s placed within a large solenoid or coil, constituting | : : I _ Small cages are also made into which the arm or _—— | acage. The patient is not in contact with this cage , | ic — :. at any point and the high frequency currents in the | | P | | | patient’s body are produced by conduction. | q . ) : : i | | | The cages are of several types, some In perpen- E i \ : | dicular form, and others in a horizontal position. | E | \ | ; In the latter the patient is either placed on a board - : | : | | ; which slides into the cage, or the top of the latter : il | | i | is hinged like the cover of a basket. Some of the e i | | | | perpendicular forms are collapsible, others are fitted 8 Nl | | | with a door, the patient une or sitting on a a i| i | | | stool. 3 ts | Fry i i | | =e leg may be introduced, thus producing localized | | | The dosage is the same as with auto-condensation. ~~ a Owing to an inherent objection on the part of the human race to being incarcerated in a cage, even — il . c a : 2 : MW ii | for a short time, this method of treatment, although | > | | | 1 | | | auto-conduction effects. _ = Sa ee fy all Wi 108 EBERHART’S MANUAL OF excellent in results, is used comparatively little at — the present time; furthermore, it has no advantage Over auto-condensation. Auto-condensation. In auto-condensation, one of the terminals of the apparatus is attached to the. — metal. forming one plate of a condenser and the 35-2 So (LLL LLL LALLA TIT (CCC) ‘MDE Riges606 7 Fig. 37. other to the patient, who becomes in this manner the other condenser plate. The patient is insulated from the metal plate by silk floss, rubber, mica, glass, or other form of di-— electric. In Figure 36 is shown a cross-section of a plate condenser. In Figure 37 the body of a woman is substituted for the upper plate, thus showing the ‘principle involved in auto-condensation. — - Auto-condensation is administered by means of HIGH FREQUENCY CURRENTS 109 a couch or pad designed for the purpose and may inelude the whole body or be constructed to in- fluence only a part of it. The original couch was in a form similar to that of a Morris chair (Fig. 38), the plates of zine being under the cushions on back and seat, the cushions themselves being stuffed with silk floss or with Spanish moss. The plates connect with one binding 7 post of the apparatus, and the other is connected to a rod from which wires run to metal handles on each side, which are held by the patient, who re- ceives the charge whether one or both handles are orasped. In that part of the circuit that is connected to the handles a hot wire meter is placed to measure the dosage. No other form of electrical treatment gives so high an amperage, except diathermy, the dose running from 150 to 1,500 milliamperes, with occa- sional reports of the use of even a stronger dose. It is well to remember that there are two types of machines used in producing auto-condensation. One has high voltage, but comparatively low amper- age, requires a cushion at least three inches thick = ——— S 4 a ie We | | | i HI | ii | } } _— , Wie 2 : : | 110 EBERHART’S MANUAL OF 2 -_ 7 MACH SNES UENENS CURRENTS os | 4 | t -_—.. | Hi : : 7 ; - Mil 4 | | | and has great penetration, so that a vacuum tube will o> 7 | 4 / } e e ° eas 5 il ; , | light up within an area of several feet surrounding i | the patient. With this type the average meter read- | ia . . . ° | | ‘Auto-Condensation—Aluto-Conduction—Auto- ; | 4 Wl ing to obtain satisfactory results is 350 to 500. Tt ‘lucien Vader Rayo Alte for paling | | | (| | : . . ; = Sinusoidal and Thermo Faradic Currents, Hl | i Hi is seldom necessary or desirable to secure a higher . | itl a7 — ‘Head Section for Wl a | | reading. Lower readings, 150 to 200, would be used _— D’Arsonval treatment’ ——-55 We Hh i | : ° : eke : ; ag Condenser. | | | | where it was desired to influence nutrition without ae Ht | | ) i | } F me Pushbutton Hi | ii I particularly lowering blood-pressure. Metal hand / control of Hl a HM . ie | I | _ The other type machine has comparatively low | | Wa | LO Mii & ip | | voltage, but high amperage. It may be used with a Wd A | ,; ‘ie | | thin pad if desired. The meter will read 750 to Hi | Hh | 1,000 on an average, and up to 1,200 or 1,500, accord- || | AN A i ; ; 3 a | § | | ing to the potential of the apparatus. Auto-conden- ~ ‘= | qn on oe : . | WM sation is measured in Eberharts, as stated in a pre- a HW | it ae eee a i: | | ceding section in this chapter. Lone, ie Hit | : Seetee ° : evanae ions We Hi | As long as the patient is in electrical contact with - Scondenser Fg teal Wd i} || H > : : Leg Support for : BARC CaN, i i i the handles, that is, perfect contact, no sensation . D-Arsonval treatment AN Tih : — ; a ~- Hi} 17 TAT : : ‘ : : Hg A | is felt except occasionally a slight tingling or sen- ; Hi il! | ; — Fig. 37a—A High Frequency Treatment Chair. Wi i / sation of warmth. Sparks may be drawn from the . os 1 | i | patient, and these may be quite painful. In type | | | He : ° ° . f: 3 \ ii | No. 1 a vacuum tube held in operator’s hand will | | : 3 i | | draw a spark from patient which is known as one 7 i form of indirect spark. In general, a feeling of a | EBERHART’S MANUAL OF hig. 38—Auto-Condensation Couch with Oudin Resonator Induction Coil. Original Type. HIGH FREQUENCY CURRENTS Fig. 38a—Portable Outfit and Cabinet. 114 EBERHART’S MANUAL OF warmth pervades the body after a few moments, — and the temperature is shown by the clinical ther- mometer to be from one-half to one degree higher than before the treatment. The couch or cushion is connected to one terminal of the apparatus, the patient to the other. The static machine with hyper-static transformer does not give a sufficient amperage for the satisfactory operation — of a couch; neither does the average portable outhit, although the latter has more amperage than the static machine. Both of these may be used for charging small pads for restricted areas, and some types of the larger portable coils I have found capa- ble of operating a good-sized pad, if the di-electric — is thin. In 19031 designed the first portable body pad, which folded together when not in use. It con- -gisted essentially of the top of the couch and was intended to save the space required for the latter. About the same time Piffard produced a condenser pad for the seat of an ordinary chair (Fig. 41). It is a well-known fact. that the thinner the di- | electric is, as long as it is a perfect di-electric, the © HIGH FREQUENCY CURRENTS 115 greater the corresponding charge that may be held on each layer of condenser. This caused me to sub- | stitute flexible mica for the material used in the ordinary pad and thus produce a portable auto-con- densation pad only half an inch thick, and capable of being slipped under the leather cushion of the ordinary office treatment table, converting the lat- ter into an auto-condensation table. At the same time a much greater charge of electricity may be condensed in the patient than with the thicker pads. Pads less than three inches thick have been con- demned by the standardization committee of the American Electro-therapeutic Association, therefore, at the present time I employ only the thick cushion, Many ingenious operators construct their own chair or couch, and from an article of mine on this subject in Popular Hlectricity, November, 1909, I make a few excerpts: Dey ‘A. glass slab, four or five feet in length, twenty inches wide and about one inch thick, such as is used in a glass-topped operating table, is fitted in a wooden frame and to the under surface is attached a strip of zine or of sheet lead 1/32 of an inch —————S—SSSS } | 1 i] ‘ nit | |) i HI i WT) ‘ i HH NII} i Hi} H ! Wl MIT i Tt i WH i HHH ] | | HI} . 40—Portable Coil. Fig Ww a Z as] &S a4 3) CS Ya by oO wr. ea Bi ) % eS cc . o ie S EBERHART’S MANUAL OF Fig. 39—Portable Coil. S a == = = = s s | a i 118 EBERHART’S MANUAL OF thick. This strip should be about ten or twelve inches wide, so that when placed on the lower sur- face of the glass it will leave a margin of about four or five inches between the edge of the zine and the edge of the glass. It should extend lengthwise to within six inches of either end of the glass slab. Fig. 41—Condenser Cushion for Chair. The zine or lead plate is connected by an ordinary | covered conducting wire (say, not smaller than No. 10 or 12), to one pole of the high frequency appa- ratus and the patient connected by an ordinary metal electrode to the other pole. The patient may be placed directly on the glass, but it 1s preferable to place him on a thin cushion upon the glass, for the sake of comfort. ‘¢ Another method is to take a wooden table long on wy = * HIGH FREQUENCY CURREN'TS 119 enough for the patient to lie on and place under- neath the table top a layer of plate glass the full size of the top of the table with a strip of lead or zine attached to the under surface of this class, always bearing in mind that the essentials of an auto-condensation pad are to have a di-electrice with a layer of condenser below it, and the patient at- tached to the apparatus to form the upper layer. Thus, an ordinary Morris chair. or steamer-chair may be used and a layer of lead or zine fastened under- neath the back and seat of the chair, the two strips being fastened together with metallic connections (chain or wire) and underneath the ordinary cush- ion of the chair, four or five layers of rubber are placed to serve as the di-electric, although the cushions themselves, if they remove the body beyond the sparking distance of the charge on the zine plate, would really make the air space intervening Serve as a di-electric. This is not as satisfactory as when the layers of rubber are placed between. The patient then is connected by the ordinary metallic hand electrode and conducting cord or metallic handles may be fastened on the arms of the ehair, es 120 EBERHART’S MANUAL OF the two connected by a bifurcated conducting cord to the one pole, the zine plates to the other. & a] o n a a ea 5 \ ‘ 00 [ard r e 1 Tet EBERHART’S MANUAL OF : : : | : HIGH FREQUENCY CURRENTS 131 : dl In using the instrument it is customary to force -_ the mercury a little above the point where the pulse | 7 | ceases to be felt and then wait two or three seconds i -until the column settles to the point of the reap- pearance of the pulse. By doing this one, two, or : three times an absolutely accurate reading may be | depended on. The scale reads from 0 to 300 The normal is 120. The numbers refer to millimeters of mercury. .A / | i i | variation of 10 millimeters up or down would not i necessarily imply abnormal pressure, but 140 or more would be presumptive of the presence of or | — tendency to arteriosclerosis. Another instrument for accurately determining aS ars blood pressure is the tycos diaphragm type of in- St SS strument, shown in Fig. 44. This is not a mercury instrument, but the read- ings are obtained by indirect, internal pressure on | | = SSS = = sensitive diaphragm chambers, so sensitive indeed = es | Fig. 44a—Taking Blood Pressure with Mercury — | the hand on the dial, as the hand works co-inci- : S| Sphygm ter ) ie: _ phygmomanometer, | | = dently with the heart. | that every action of the heart is shown plainly by | iit /™ . With this instrument the observer can accurately | } i | i 132 EBERHART’S MANUAL OF | Fig. 44b—Portable Outfit with Novel X-Ray Tube for Surface Treatment. ae é HIGH FREQUENCY CURRENTS 133 determine complete blood pressure, by that we mean maximal or systolic; minimal or diastolic, and pulse» pressure (the difference between the two). This 1s not easy with a mercury instrument, because the ereat inertia of mercury renders it difficult to obtain a diastolic pressure, for mercury requires one and one-half seconds ‘to recover itself, while in one sec- ond we have had one and one-fourth heart impulses, so you can see that mercury does not act quickly enough to accept the second impulse. Diastolic pres- sure with a mercury machine may be obtained by the auscultatory method described later on. The minimal or diastolic pressure is fully as es- sential as the maximal or systolic, for without an exact diastolic to subtract from the systolic we can- not get the most important thing in blood pressure, that is the pulse pressure, for by pulse pressure alone can it be determined whether a pathological condition is compensated for or not. The normal pulse pressure (difference between diastolic and systolic) should be from 20 to 55 milli- meters. | The determining of pulse pressure by those using 134 EBERHART’S MANUAL OF the high frequency current is absolutely essential, for, as said before, by this we can tell whether a condition is compensated for, and whether the use of the high frequency current is indicated or con- traindicated. As an illustration, we will say that we have a case with a systolic pressure of 170, and a diastolic pres- sure of 140. This shows, by subtracting one froth the other, that the pulse pressure is 30, therefore, normal. No matter then if the systolic be 170, for the pulse pressure being normal shows that the condition is compensated (or the pulse pressure | could not be normal), and, therefore, a circulatory equilibrium is established, and in these cases any further reduction of systolic blood pressure must be accompanied by a corresponding decrease in dias- tolic pressure or compensation will be interfered with. Of course, if ‘the systolic was reduced to 160 and the diastolic remained 140, compensation would still exist, but would be at its low limit, and the patient would probably not be as comfortable as with 165 or 170, with 140 as the diastolic. If, however, under HIGH FREQUENCY CURRENTS 135 auto-condensation both systolic and diastolic pres- sures decreased, if not always the same reduction, at least without the pulse pressure going below 29, the treatment may be persisted in until the systolic pressure 1s normal. Whenever the pulse pressure reaches 20 and stays there, after carefully giving one to three additional treatments auto-condensation should be abandoned. It has been carried as far as it can be of benefit to the patient, no matter what the systolic pressure then may be, and I would suggest spinal sparks to aise it slightly, that pulse pressure may be at least 25. : A : Where the systolic reading is high it sometimes happens that the pulse pressure will, when auto-con- densation is employed, drop to 20, or even 18, but after a few days the diastolic will reduce enough to give an increased pulse pressure, and thereafter both systolic and diastolic keep reducing in propor- tion, in which case the treatment is kept up. Sce further discussion and -examples under Arterio- sclerosis, Chapter VIII. There are two methods of determining blood pres-. 3) 136 EBERHART S MANUAL OF sure with the tycos type, which I have taken from Dr. Cowing’s book, ‘‘Blood Pressure Technique Sim- plified.’’ First, the method of oscillation. Place the bag over the arm with the two tubes well under the arm and over the brachial artery. Wrap the remainder of the sleeve around the arm — much the same as you would apply a bandage, tuck- - ing at least six inches of the sleeve under the last fold. Then place the sphygmomanometer in one tube and the bulb in another and you are ready for reading. Care should be taken not to put the sleeve on tight enough to cause any apprehensive feeling in the patient. Place the fingers lightly over the radial artery, and send the pressure in the cuff up to the point where the pulse disappears or is obliter- ated. This is the systolic or maximal reading. It is desirable that the patient’s wrist be sup- ported from below by the palm of the doctor’s hand, ° while the first and second fingers lie with their tips . over the artery. Thus the weight of the hand is prevented from shutting off the pulse too soon. Second, the method of auscultation. This is, by . HIGH FREQUENCY CURRENTS 137 far, the most practical method of accurately deter- mining blood pressure, as the dangers of personal equation are greatly lessened. See Fig. 44c. Bare the arm, adjust the sleeve well up (as above described), place the stethoscope over the brachial artery. Now gradually inflate the bag, and the Sout. \\\ YY s\\\ IIT Le i All Loa Fig. 44c—Auscultation Method. first and second sounds: of the heart will become audible. Increase the pressure in the bag to the point where all sounds cease. At this point will be the exact systolic or maximal pressure. - Having obtained this, gradually release the air by means of the valve, and the first and second sounds of the heart will become apparent, increasing in 138 EBERHART’S MANUAL OF volume as they approach the diastolic point, at which point the second sound will entirely disappear. - The above method cannot be employed where aortic insufficiency exists or where there is a dila. tation of the vessels. These conditions being ae HIGH FREQUENCY CURRENTS 153 of from one-quarter to three-quarters of an inch or keeping the tube in light contact with the sealp. If too sharp a spark is used, the sealp will be sore after the treatment and tiny sores will be found. High frequency currents are indicated in all diseases of the scalp, in falling hair, and some years ago I Fig. 49a—The Latest Scalp Electrode, made the discovery that if employed for a sufficient length of time they are capable of restoring the color to gray hair. This will be specially considered in Chapter VIII. The tube shown in Fig. 21, No. 11, is used conveniently in treating the scalp, being equally as good as the body tube, and a new tube 154 EBERHART’S MANUAL. OF HIGH FREQUENCY CURRENTS 155 - | i | | resembling a hand ane glass fingers is the latest. flexed and the legs drawn up depends somewhat I} It is illustrated herewith. : guts Bd upon the individual case; ordinarily the legs are Throat Technique. The throat electrode 1s shown _ straight, but slightly separated. | : | in’ Wig. 80, Any of the other elecueda ee : ae The sterilized sound is lubricated and introduced Wl i used externally In acute inflammatory conditions in the same manner that a steel sound would be | of the throat the low vacuum tube is preferable. I] i | used, taking care, however, not to use much force, q | | The tube may be placed directly in contact with the » ‘ on aceoutit of the possibility of brewens ie tube. | | | mucous membrane of the throat or a spark allowed a E Uhis tas Happened secasibnally, Het e apr | | | | | | a — or sidewise motion, or through a sudden jerk. i 1 | a Spo aee ae : If the canal is too small to admit of the easy 1 | | —. : passage. of the tube, steel sounds are used first to | | | Hig, 2@- Throat Hoh ode: oo 4. dilate the urethra to a sufficient size, = : ae | | fe ee a, oA . 7 4 : In case a stricture is present and the whole canal | | i ae. to pass, according to the ee neue f cannot be dilated sufficiently to allow the glass tube | | | | | from the Soe tube or from the es foe E to pass the stricture, then it is introduced as far as i ' i have been employed to destroy tollictes mm puaty the stricture and the treatment given. On sgsubse- ij sitis or in place of nitrate of silver eauterization, | - i | oe fone een used: i the qient days it will be found that the stricture gradi- i i Hi and the fulguration point has | | A | ally disappears until finally the glass tube will pass removal of the tonsils. mee = _ i : 7 by it. iI || : loyin lass. tl | Urethral Technique. es ee aa ns — . = _ When the urethral tube has been properly insert- | | sounds (Fig. 20, No. 5, or Fig. 21, No. 12) w | = ed, the socket of the holder is slipped over it, and | | the handle bent back over the patient’s abdomen. | i| on the operating table. Whether the knees are : = The patient takes hold of it and thus steadies the | | ‘| | the male urethra, the patient is placed upon his back | 156 EBERHARI’S MANUAL OF tube. In stricture he is instructed to make steady downward pressure to keep the point of the tube firmly in contact with the stricture. The handle is eonnected to the machine and the current turned ° on. In this way the patient experiences no shock. The current. is turned off before the sound is re- | moved. Duration of treatment, seven minutes. | Do not forget that the posterior urethra may be treated almost as thoroughly and with much less pain, by introducing a tube into the rectum. Uterine and Vaginal Technique. High frequency ; \ currents are suitable in all catarrhal conditions cf. uterus and vagina, including leucorrhea, cervicitis, endometritis, etc. They are extremely valuable. in specific vaginal diseases in conjunction ee a usual method. Treatment through the vagina 1s Sse indicated in diseases of the fallopian tubes and of the ovaries and in pelvic abscess and in adhe- sions. Low or medium vacuum tubes should be used in the latter diseases. The technique which I use in applying the cur- rent in the vagina, is as follows: The patient is placed on her back with her feet in the stirrups | HIGH FREQUENCY CURREN‘’S 157 and the lubricated tube in the author’s movable socket holder ig inserted, and then the handle 1s bent down to touch the table and the patient’s skirts folded over it, thus anchoring the tube and _ pre- venting it from slipping out. A towel is then wrap- ped around the metal connection between the tube and handle to prevent the latter from tipping sidc- ways and thus giving the patient an uncomfortable spark. The cord connecting with the generating | apparatus passes out under one leg of the patient and care should be exercised to see that it does not come in contact with it, nor should it rest upon any metal which touches the patient, for if there be a defect in the insulation a sharp current will be communicated along the metal. After the tube is properly adjusted the current it turned on and allowed to pass for seven minutes, when it is turned off before removing the tube. In very acute cases, I have not hesitated to give two or three treatments in a day until improvement took place. Ordinarily from one treatment a day down to two or three treatments a week will prove satisfactory in sub- acute or chronic cases. The insulated vaginal tube aE emmnees : ; ° ; : . 158 EBERHART’S MANUAL’ OF sponla be used. It is Shown in Fig. 21, No. 10. The prostatic tube also makes an excellent one for vaginal use, and Fig. 27 shows my new spatulate tubes, which admit of contact with a larger surface. Occasionally in treating diseases of the cervix, a small electrode may be inserted within the canal, taking care to insulate against contact with the metal speculum, if the latter 1s used. (An old-fash- ioned glass one 1s better.) In cancer, the fulgura- tion tube may be used through the vagina to destroy the cancerous tissue. This may or may not require an anaesthetic. One authority packs the vagina with moistened - gauze with a metal electrode in the center and thus earries the current to all contiguous parts. The D’Arsonval current may be used in the vagina by this method. Direct D’Arsonvalization is now known as diathermy. See Chapter XI. HIGH FREQUENCY CURRENTS 159 CHAPTER EIGHT. Practical High Frequency Therapy, Diseases Alpha- betically Arranged with the Technique to Be Employed. Explanatory. In the following pages no special attempt has been made to distinguish between dis- eaS$es in which the high frequency current is the sole treatment required and those in which it is of temporary value or useful merely as an adjunct to other methods; therefore, including a disease in the list, does not imply that the author necessarily considers high frequency the only, or even the best, treatment for it. Where he has a pronounced opin- ion, however, he has not hesitated to express it. To avoid frequent repetition, saaene auto-conden- sation is referred to, it is given according to the technique in Chapter VI; the same with fulguration, ete. Where special regional technique is advised, — Sas aa 160 EBERHART’S MANUAL OF as for the prostate, vagina, etc., the directions in Chapter VII are to be followed unless otherwis2 indicated. Where small Tesla coils are used with the vacuum electrode, it should be remembered that the current is sharper than that from the Oudin or larger Tesla, and shorter sparks must be used than the average stated, or the patient will complain. Where two spark-lengths are given, for example,’ one-quarter to one-half inch, the shorter would be — for the machine giving a ‘hot’? spark and the longer for one eiving-a comparatively ‘“eold’’ spark. Bear in mind that this stating the strength of a: vacuum electrode in terms of a certain length of spark does not necessarily mean that the tube is held away from the surface so that a spark of that length actually passes, but means that enough cur- rent is passed through the electrode to make such a — spark possible. Usually the tube is kept in contact ath the skin and where itis not its so statedun the text. In any of the cases calling for the spark the indi- _ HIGH FREQUENCY CURRENTS 161 rect spark may be used instead of the direct. See Chapter VI. Where general treatment with the vacuum elec- trode is given to take the place of auto-condensa- tion or auto-conduction, the treatment must be much longer than that for a purely local effect. The aver- age duration of locdl vacuum tube treatments is from five to ten minutes; for auto-condensation or auto-conduction, ten to thirty minutes, and for the general tube treatment referred to, from twenty to thirty minutes. A number of symptoms or conditions have been indexed for convenience as if separate diseases, such as paralysis, constipation, pruritis, ete. Insulated tubes are preferable in treating the various orifices of the body. In general, limit ori-_ ficial treatments to seven minutes to avoid possible burns. In stating dose of auto-condensation I have em- ployed my new unit of measurement, the Eberhart, a full discussion of which will be found under that heading in Chapter VI. It is based on 100 milliam- 162 EBERHARYT’S MANUAL OF peres meter reading per minute to each 1,000 volts of potential There are two types of apparatus employed, which T will designate as Number One and Number Two. | I wish to remain absolutely neutral on the question of whether one type or the other is superior for auto-condensation. Type No.1. High voltage, low amperage. I as- sume that the voltage is about 50,000. This is not official, however. The machine operates ordinarily at an average meter reading of 390 to 500. In using it I never try to crowd it above 500, and usually employ it at about 400. Where a larger dose is necessary I prefer to lengthen the time, rather than increase the amperage. On the voltage stated the number of Eberharts per 100 milliamperes is 50. Type No. 2. Low voltage, high amperage. I as-— sume, unofficially, the voltage to be about 25,000, average meter reading 700 to 1,000. I believe the majority of operators use it at about 1,000, and here again I prefer lengthening the time in giving a HIGH FREQUENCY CURREN'S “S63 larger dose, rather than to crowd the meter reading to a higher peint. Based on 25,000 volts, the appa- ratus delivers 25 Eberharts to each 100 of meter reading, and although the voltage is one-half that of No. 1, it is. operated at twice the average meter reading, which leaves the time of treatment the same. _ The following table shows how the time coincides, the average being about ten to fifteen minutes on either to give 2,500 E. Minutes for No. Eberharts per 100 Meter Reading No. Eberharts 2,500 E No. 1 No. 2 No. 1 No.2 Bothtypes Both types 50) 25 200 400 100 25 50: 25 250 500 125 20 50o2) 2225 800 600 150° .16.67 50 25 350 700 175 14.28 50 25 400 800 200 12.50 50 25 450 900 925 IA o0 29 900 1,000 250 10 The manufacturer should state in his instructions for auto-condensation how many Eberharts per 100 of meter reading his machine produces, when the time in minutes is easily calculated. The average dose of auto-condensation is 2,500 164 EBERHART’S MANUAL, OF Eberharts, but where satisfactory results are not . shown after six to ten treatments it is my custom to increase the dose to 3,750, 5,000 or even 7,500 Eber- / harts, doing so by lengthening the time. I first. lengthen the time to about one-half more, and if _ results after another ten treatments are not as ex- » pected, I increase to double the original time, and so on. In the following pages where the dosage is eiven as 2,500 to 7,500 E., this method is intended to be followed. There is, generally speaking, no overdose of auto-condensation, therefore, consider- > able latitude in dosage is allowed, only be sure . and dose enough. The only contra-indications I con- | sider are high temperature in the patient or a pulse . pressure of 20 or less. In the first instance I would . start with about 1,000 to 1,250 E. and wait until the third day before repeating, generally increasing dose and frequency as patient showed toleration, : as indicated by a correspondingly smaller rise in _ temperature immediately following treatment. In the latter case if patient was applying for first — treatment. I would not employ auto-condensation at. all, but spinal sparks instead If patient had been HIGH FREQUENCY CURRENTS 165 under treatment for high blood pressure and pulse pressure went to 20 or below, I would either stop the ‘eronaamneent for a few days or give the small dose (1,000 to 1,250 E.), and if it still stayed as low, I would abandon auto-condensation, even though the systolic blood pressure was still abnormally high. When the blood pressure of the patient is normal or below normal, auto-condensation generally would be contra-indicated, but in those cases where it is desired to use it for its effect in improving meta- bolism, the dose should average about 1,250 Kber- harts and should be given at a low meter reading (200 to 250 for No. 1; 400 to 500 for No. 2). If this is shown to materially decrease the systolic blood pressure, each treatment should be followed by sharp sparks to the patient’s spine, for five minutes. Abscess. To prevent the formation of an abscess, the use of a low vacuum electrode is theoretically indicated. The intensity of current employed should be that capable of producing a spark of one-quarter to three-quarters of an inch, but in employing the tube it should be kept in contact with the skin. Use enough current to get the effect of the heat gener- 166 : EBERHART’S MANUAL, OF ated. Duration of treatment ten to fifteen minutes, ~ repeated daily or twice a day if necessary. In those — cases where an abscess already exists the high vacuum tube is preferable, using the same intensity. - Duration of treatment, seven to ten minutes. High ~ candle power ligths are useful in connection with. high frequency. Acne Rosacea (Red Nose). To destroy the en- larged veins in this disease, the spark must be em- | ployed to get a cauterizing action. For this the. ’ best method is to use the fuleuration edectrode, regu- A lating the strength of spark in accordance with the toleration of the patient and treating from two or ing to the amount of destruction required. A spark from one-quarter to one-half of an inch in length from any vacuum tube may be employed in place of a fulguration point With the latter, the treat-— ments should not be repeated until the effect of the first has subsided, which will average from six to ten days. The X-ray in connection with the high — frequency current is indicated, but I believe carbon. dioxide snow, first suggested for this purpose by three up to six or eight minutes at a sitting, accord-. HIGH FREQUENCY CURRENTS 167 me, is superior to either, and we must not forget the curative effect of electrolysis. Acne Vulgaris (Pimples). One of the best fields for the employment of high frequency is in this form of acne. It is used preferably in conjunction with the X-ray, and with this combination a cure should be effected in practically every case. The vacuum tube is used for the high frequency application,— the so-called body tube, Fig. 51, being that ordi- rounlhe employed, and a sufficient amount of current passed through the apparatus to produce a spark of one-quarter to three-quarters of an inch. The tube. however, is not raised from the skin, but kept in light contact with it, dusting on taleum powder if the tube sticks to the skin, or else treating through a single thickness of cloth, as through a handker- chief. In place of the body tube, I have found that any of the glass vacuum tubes ending in a vacuum not less than an inch in diameter may be employed as easily as the body tube. For instance, the pros- tatic tube, Fig. 21, No. 11, makes an excellent elec- trode for treatment of the face, because the edges surrounding the depression on the surface of the PPR CHUN NRO PIE NE OEE ATA OREN SCOT 168 Fig. EBERHART’S MANUAL OF 51—Body Electrode Applied to the Face, HIGH FREQUENCY CURRENTS 169 tube enable the operator to get a better contact about the nose or other sharp angles than is possible with the body tube. The tube is kept moving rap- idly back and forth over the surface and is not allowed to remain stationary over any point., Lately I have made considerable use of the indirect spark with the patient on the auto-condensation pad. If the treatment is given in connection with the X-ray, the duration of the high frequency treatment should be from ‘three to five minutes, but if given alone, a treatment of seven to twelve minutes is indicated. Treatments may be given three to six times a week with the high frequency, but not more than three seven-minute treatments per week with the X-ray. The high frequency X-ray tube proves very satis- factory for the treatment of acne, as little penetra- tion is required. Where pustules are forming, I have found it advantageous to raise the tube for fifteen to thirty seconds and apply for that length of time a reasonably sharp spark. This often aborts the pustules, and even if it does not, will limit their size. I do not approve of deep lancing of pustules on account of the consequent scarring When a 170 EBERHART’S MANUAL, OF yellow head appears on the pustule it should be opened with a sterilized needle, and then instead of using pressure to evacuate the contents, the shaft of the needle should be passed across the pustule, which will remove all of the pus that is ready, with- out bruising the tissues and extending the focus ! of infection. Where sears are already present there is no more efficient application for them than a sharp spark from the glass electrode, or a very mild spark from the fuleuration point may be employed. Actinomycosis (Ray Fungus). In this disease the high frequency spark is employed as an adjunct to the X-ray. The spark should be from one-quarter to three-quarters of an inch in lence according to the toleration of the patient, providing the vacuum tube is used. If the fulguration point is employed, a shorter spark is required. Three treatments per week. Adenitis, Cervical (See Tuberculosis of Glands) Adhesions. Where pelvic or other adhesions fol- low operations or inflammatory conditions, the high HIGH FREQUENCY CURRENTS LA: frequency current will be useful. The vacuum tube is employed, using an intensity capable of producing a one-half inch spark and keeping the tube in light contact with the abdominal wall, passing back and forth over the area involved for from seven to ten minutes. In pelvic adhesions, the use of the vacuum electrode in the vagina in connection with the sur- face application will hasten results. Mechanical vibration is advised in connection. | Albuminuria (Nephritis; Bright’s Disease) Bene- fit in these diseases has been obtained from the application of high frequency currents. The best method is the use of auto-condensation, 2,500 to 7,500 E. per day, in connection with the use of a vacuum tube over the region of the kidneys There have been many reports of the disappearance of the albumen following this method of treatment. I have myself seen both albumen and casts disappear, but do not wish to be understood as making the state- ~ment that this treatment will cure Bright’s Disease. That it is of sufficient value to warrant its employ- ment, if possible, in every case, is my firm belief, particularly in cases where high blood pressure ex- . 172 EBERHART’S MANUAL OF ists. This is always the case in chronic interstitial nephritis, as high pressure in the renal artery is apparently the primary cause of the disease. (See Arteriosclerosis.) Auto-condensation in these cases will lower the blood pressure and by relieving the ~ pressure in the kidney, the strain is taken off the 2 filtering tubules and the result is at least beneficial even if not necessarily curative. High frequency in this disease must be considered solely as an adjunct to our usual routine treatment and should not be looked upon as taking the place of these measures. Alcoholism. Use of the vacuum tube over the spine, solar plexus and to the extremities in connec- tion with other means to overcome the effects of alcoholism, has been advised by several operators. If the blood pressure is high, the spinal application would be contra-indicated and auto-condensation or auto-conduction should be substituted. The latter forms are also specially sedative where nervous excitement is present. (See Drug Addictions.) Alopecia (Loss of Hair). Where baldness occurs as a result of faulty nutrition, the high frequency HIGH FREQUENCY CURREN'TS 173 current naturally suggests itself as an ideal remedy. The applications are made with the vacuum tube, using either the tube shown in Fig. 51 or that in Fig. 21, No. 11. Sufficient current is to be sent through the apparatus to make it possible to draw a spark of, from one-quarter to three-quarters of an inch. A case being treated with the spark from a portable outfit is shown in Fig. 52. The tube is ordinarily ia light contact with the scalp, but occasionally may be raised slightly, giving a short but rather intense spark. It is to be kept moving about over the scalp, for from five to ten minutes at a treatment. If too sharp a spark is employed, the scalp will become sore and tiny little places will appear where it has exerted an escharotic effect. To geet the best results a, daily treatment is advised, and two short treat- ments per day would not be too much. In connee- tion with the high frequency a few moments’ use of the vibrator is strongly advised. In Alopecia Areata, the X-ray is employed in connection with the high frequency current, using a medium or high vacuum. The scalp is particularly sensitive to the X-ray. 174 EBERHART’S MANUAL OF Fig. 52—Treating Alopecia (Lloyd). HIGH FREQUENCY CURREN'S 175 Amenorrhea. That the high frequency current when applied through the vagina sometimes has an emmmenagogue effect has been noted by several authors. I have occasionally observed the same ef- fect, although I cannot reconcile this action with the beneficial results we obtain from the same current in menorrhagia and metrorrhagia ; conditions which are precisely opposite. As the current determines an increased amount of blood to the area treated, its employment in absence of the menses would appear reasonable. The technique is the use of the insu- lated vaginal tube for seven minutes, three to six times a week, and in connection therewith, thie. ap- plication of a spark to the lower part of the spine for from three to six minutes. Another method is to use the bi-polar Tesla treatment with one pole over the sacrum and the other over the tubes; two or three times a week. In those cases that result from anemia, the gen- eral effect on metabolism of auto-condensation will call for its employment, 2,500 to 7,500 E. three to six times per week. Mechanical vibration is very effective in amenorrhea, and should be employed in i eae 176 EBERHART’S MANUAL OF connection. In virgins, where the menstrual fune- tion is irregular, a small tube, such as shown in Fig. 20, No. 4, may be employed, or the treatment given through the rectum with the insulated tube shown in Fig. 21, No.8. Ozone inhalations will still further | assist in those cases caused by anemia. Anemia and Chlorosis. As high frequency cur- rents increase the oxygenation of the blood, thereby . increasing both the reduction of oxyhemoglobin and also the number of red orm and the percent- age of hemoglobin, their employment in anemia, es- pecially of the chlorotic type, is quite as effective as iron tonies, and at the same time does not inter- fere with the joint use of the latter. The method of administering the current 1s by auto-condensation. If the blood pressure is normal or above, give 2,500 to 7,500 E. three to six times per week. If the blood pressure is below normal give 1,000 to 1,250 HE. with» meter reading about 250 for low amperage machines, and 500 for high amperage outfits. Ozone inhalations are clearly indicated and are of the utmost value in these cases. In one of my HIGH FREQUENCY CURRENTS 177 cases the percentage of hemoglobin increased from thirty per cent to eighty per cent in eight weeks. Intra-muscular injections of iron solutions are ad- vised. Aneurism. Auto-condensation, 2,500 to 5,000 E., three to six times per week gives relief, but is, of course, not curative. Under no circumstances should the vacuum electrode be employed locally over the ~ aneurism. Appendicitis, Catarrhal. In catarrhal appendi- citis, the vacuum tube has been employed locally, using a tube capable of emitting a one-fourth or one-half inch spark, keeping it moving in contact with the skin over the region of the appendix. Both the monopolar application from the resonator or Tesla, and the bi-polar Tesla current have been em- ployed. In the latter ease, the other pole is placed over the lumbar region, or grounded by attachment to gas or water pipe. It is my opinion that appendi- citis, in any form, is a disease which high frequency operators should not trifle with, but turn over to their surgical friends. f = — ————— e eee ! Arteriosclerosis and High Blood Pressure. Arte- plete round of the circulation, the blood following riosclerosis is a disease that is of the utmost im- — the rule of water and of electricity and flowing from portance, because it is the primary condition which : ej a higher to a lower pressure. Normal pressure of | | | | | W } 178 : EBERHART’S MANUAL OF - | HIGH FREQUENCY CURRENTS | 179 ff | 7 i | | | | results in so many diseases of kidneys, liver, heart the blood in the arteries is sufficient to support a and brain, which we are accustomed to classify ac- | | | perpendicular column of mereury of from 110 to 120 | 4 \ Arteriosclerosis, formerly looked upon as the herit- _ creases to over 300. : i 7 / | : cording to the organ more particularly atfected. | : 2 millimeters In arteriosclerosis it sometimes in- age of old age, is now very common and greatly on The disease is usually divided into the functional | | | the increase because of our present mode of life with : : 3 and organic stages. The first would be the stage = q its strenuous efforts to gratify ambition; its ex- previous to the real hardening of the arteries and | | cesses and indiscretions in eating, drinking, ete. To- : the latter that in which structural changes actually i day there are many men young in years whose arter- ; | » 2 had. occurred. | | || les are thos th t . | ot ke ice tenn ee eee ule 3 In the functional stage there comes to be present i .probability of a sudden termination of their useful- - 3 ce = i oe a contracted condition of the artery, producing Ness. : ; thereby increased tension and raising the blood pres- iP The most prominent and persistent symptom of ae e : . : arteriosclerosis is high blood pressure. The circu- -_ sure. At this time this is the result of irritation i and spasm on the part of the muscular fibres and no \ i] latory system may be compared to an electrical plant, in which the heart is the central station or dynamo and must necessarily have a pressure suffi- cient to overcome the resistance in the circuit. Therefore, we have the pressure decreasing in the arteries, less in the capillaries, and still decreasing actual degeneration or permanent change in structure has appeared. Thus the disease develops gradually and without any particularly noticeable or alarming early symptoms. The theory is that toxins in the blood first cause irritation, then contraction or spasm of the arteries, which may be intermittent, but be- as the veins grow larger. Thus we have the com- 180 EBERHART’S MANUAL OF A [ come a more or less steady contraction, oe the pressure by narrowing the caliber of the artery and finally attaining the permanent changes of the second stage. The causes producing the original irritation are gout, uric acid, lead poisoning, syphilis, diabetes, excesses or abuses in eating, drinking, to- bacco, etc. There is faulty conversion of food prod- ucts into living cells with failure to properly elimi- nate poisons from the system and the absorption of the products of imperfect intestinal digestion (auto- intoxication). Of the errors in diet, the most common is the con- sumption of too much nitrogenous food, especially | red meats and substances rich in proteids. Other causes of arteriosclerosis are worry ; prolonged men- tal or muscular strain, and the after effects of in- fectious diseases. Although more common after the age of forty, no period of life is exempt; cases oc- eurring at the ages of eight, fifteen and twenty- eight years being on record. Whatever the treat- ment undertaken for the disease, there must neces- sarily be a regulation of habits to overcome the causes stated above The diet should be simple, all HIGH FREQUENCY CURREN’'S 181 - alcoholic beverages tabooed; tobacco should be pro- hibited or used sparingly.. Milk or buttermilk are allowed, especially the buttermilk made with. lactic acid ferments. Red meats are to be eaten sparingly, but plenty of vegetables are advised. | There has been a tendency on the part of many physicians toward the partial or complete elimina- tion of salt from the diet. The individual should take his time, and avoid all worry, haste and excite- ment. In addition, strict attention should be given to personal hygiene and regular but moderate exer- cise, baths, ete. It has been shown experimentally that in a normal subject, the blood pressure may be raised from five to ten millimeters by taking a cup of beef broth. Therefore, the necessity for curtail- ing the amount of red meat is apparent. One of our Chicago millionaires consulted two celebrated German specialists, Dr. Grodel of Nau- heim and Dr. Vogel of Ems. The directions given by each were almost identical, and I herewith give the combined list: ‘‘Two cigars daily, separately. Coffee, three- fourths milk, or dekafa. Chocolate. No tea. No r ~ " Re | 182 EBERHART’S MANUAL OF Turkish baths. Swimming all right. Horse-back | riding; slow horse. Slow golf. Automobiling at right. No stairs; no strain; no hurry. Eat coarse eraham bread like Nauheim. Never over-eat, it kills! No sweets. No cabbage, fresh bread or foods causing flatulence. Champagne and wines do the same (cause Aeralence’. Eat lightly and re often if necessary.’’ Although high blood pressure is the rule if the heart is dilated and there is a tendency to dropsy . and congestion, there may be a low blood pressure. In these cases it is necessary to be sure of the pulse pressure. (See Chapter VI under ‘‘Taking Blood Pressure.’’) The most important and constant . symptom, however, is high blood pressure. In Figs. 44 and 44a the process of taking the blood pressure is illustrated (For the technique of taking the blood pressure, see Chapter VI.) The electrical treatment of arteriosclerosis is the use of the high frequency current by auto-conduc- tion or by auto-condensation. The preliminary dose 18 2,500 E., and it should be given daily in the begin- HIGH FREQUENCY CURREN'’S 183 ning, and less than three treatments a week at the Start are useless. As the blood pressure approaches normal, the treatments may be reduced to three a week, then to twice a week, and if there is no tendency to a rise in pressure, then once a week. = — we ——— —- —- = — = == re SS _£ = == ==" : = = ; Se = ——— 2 = SS aa ———— SSS <4 246 eR coe TEANUAL OF : | HIGH FREQUENCY CURRENTS 247 | | oe it] 66 Ale sufficient to produce a one-half or three-quarter inch — Iremember the old oie ve peuralss, as ‘'the a ee | ery of a starved nerve for blood,’’ and certainly the i | Pe high frequency will supply this want. li. Ordinarily it should be passed back and forth over the painful area, in light contact with the skin. At In addition to the local treatment, auto-condensa- | tion or spinal sparks should be applied in accordance i with the state of the blood pressure. The diathermic currents on account of the heat i | generated are advantageously employed. See Chap- |) ter XI. | i | Various names have been given to indicate the q different forms of neuralgia as facial neuralgia, i] ovarian neuralgia, ete. i The treatment is essentially the same for all va- i rieties. : | | High candle power lamps may be used in connec- | tion with high frequency. | i | Neuritis. In neuritis we have an inflamed condi- - tion of a nerve, the pain simulating that of rheuma- . tism or neuralgia. Any nerve may be involved. Brachial neuritis 1s a common form. The high frequency current is positively curative in| in all cases, but must be used judiciously. in | Sharp sparks must not be employed at. first, but a mild sedative current should be applied. This | i | Fig: 54d—Portable Outfits. — aa means that the tube should not carry more than | i : —/ enough current to produce a quarter-inch spark and | times it is advisable to raise the tube and apply a S P Lee E : ve : be should then be kept in comparatively close contact sharply counter-irritant spark which will quickly ae | Sth the cantace. | : redden the surface. i | i 248 EBERHART’S MANUAL OF It should be explained to the patient that the first few treatments sometimes aggravate the pain. After this stage is passed mild or medium sparks ‘may be used, but if employed in the start the pain Qe Fig. 54e—Portable Outfit with Cantery and Diagnostic Lamp. often will be so great that the patient may abandon the treatment. | : I always give auto-condensation, 2,500 E., in con- | | | HIGH FREQUENCY CURREN’S 249 nection with the local application, unless the blood pressure is quite low. Many cases have been re- ported cured by this general treatment alone. Recently the diathermic or heat currents have been shown to be very satisfactory in the treatment — of neuritis. Obesity. The treatment for Obesity is auto-con- densation, 2,500 to 7,500 E., or more. Patients lose from four to fourteen pounds per month in some instances. . In those that do not show as great an actual re- duction in weight there seems to be a re-distribution, So to speak, of the fat, which greatly increases bodily comfort. Superfluous fat is a result of imperfect metabolism and that is why auto-condensation is beneficial. Cormelles has noted a greater tolerance of thyroid extract after auto-condensation has been employed. Vibration is indicated and the method of Bergonie with special faradization chair. Opacity of Cornea. (See Corneal Opacity.) Orchitis. In the acute form we seldom have an opportunity of employing these currents, although with a portable coil it may be possible to do so if there is electricity in the patient’s home. In sub-acute orchitis the vacuum tube is used with a mild effleuve or spark. : Guilleminot recommends the diathermic current, one pole over the testicle and the other over the spermatic cord. The X-ray ig advised, protecting 250 EBERHART’S. MANUAL OF the other testicle with lead-foil or treating through a speculum attached to a protective shield. | | Otitis. In all forms the application of a mild cur- rent through a vacuum tube inserted in the ear will be found beneficial, alone or in connection with other methods. | | , In chronic suppurative otitis the X-ray 1s advised, -also an ozone spray. This latter is sometimes ad-. ministered through an eustachian catheter. Ozena. Atrophic Rhinitis. Application with the nasal tube, and the inhalation of ozone, summarize the methods of treating this disease with high fre- quency. : Papilloma. The technique of fulguration for the destruction of papillomata is given fully in Chap-- ter VI. | ; Paralysis. In general the treatment of this symp- tom calls for the application of the vacuum tube along the course of the paralyzed muscles, employ- — ing a current strong enough to produce a half or three-quarter inch spark. Part of the time keep the © tube in contact with the skin and part of the time raise it above the surface to get the effect of the spark. Bi-polar Tesla treatment 1s excellent and also D’Arsonval surgings (see Chapter VI). The value of galvanism and faradism must not be forgotten and vibration is certainly useful. Paralysis Agitans. Cases of paralysis agitans ben- HIGH FREQUENCY CURRENTS 251 4 efited by auto-condensation or auto-conduction have been reported. 2,500 to 7,500 E. or more. Two cases which I treated for a short time did not show any perceptible improvement. | Paralysis, Infantile. (See Infantile Paralysis.) Paralysis of Sphincter Ani. Tousey reports marked improvement produced by fifteen treatments. Rectal applications and sparks to spine. Pelvic Abscess. Use the vaginal vacuum tube for seven minutes, repeating daily or twice a day; also mild applications externally over pelvic region. Diathermy advised. See Chapter XI. Pelvic Adhesions. Intra-vaginal vacuum tube treatment and mild spark over abdominal area. Three to six treatments per week. Vibration advised in conjunction. The D’Arsonval current is preferred ~ by some operators either by the direct method or by auto-conduction, while others prefer the bi-polar — Tesla current. Pelvic Exudates. The same technique is followed as in pelvic. adhesions. Periostitis. The vacuum tube carrying a medium intensity of current is passed lightly back and forth over the diseased area for from five to ten minutes, three times a week, followed by a few minutes’ ap- plication of the X-ray, or the high candle power light. Condenser electrodes are preferred by some oper- ators. 252 EBERHARTS MANUAL OF Pharyngitis. . In the acute form diathermy is use- ful in combination with customary remedies, or the — vacuum electrode may be employed. : | In the chronic form the spark may be used to de- stroy the follicles in the throat. See Fulguration, Chapter VI, for technique. Fig. 54f—Portable High Frequency. Phlebitis has been relieved by mild vacuum tube applications, keeping the tube in light contact with the skin. Customary methods should be kept up at the same time. — Piles. (See Hemorrhoids. ) Pityriasis. Follow the general technique given for skin diseases in Chapter WAS. 8 Pleurisy. Treat through a layer or two of lore ing, using a medium intensity of current (one-quar- ter or one-half inch spark) and apply over both the front and back of the chest, keeping up the treat- HIGH FREQUENCY CURRENTS 253 ment for a long time until marked reddening of the skin indicates a proper degree of counter-irritation. Three treatments a day if necessary in the begin- ning, in conjunction with usual medicinal methods. Chronic forms call for ozone and usually for the X-ray. Pneumonia. The high frequency treatment of pneumonia is the same as that employed in pleurisy, as given in the preceding section. In addition the inhalation of ozone by ozonizing the air of the room is absolutely essential and always should be em- ployed from the start. It is much more sensible to administer this form of oxygen throughout the disease than it is to ad- minister oxygen as a last hope in extremis. | Post-fracture Conditions. The local application of the vacuum tube discharge in conjunction with vibra- tion is of great benefit in restoring a normal condi- tion of the parts. Its physiological action clearly indicates its value here. : Post-operative Conditions. Here the current may be applied as given in the preceding section or it may be employed by means of auto-condensation or a general vacuum tube application for its tonic effect. 2,000 EH. daily at first; later two or three times a week. Proctitis. In the chronic forms of this disease the direct D’Arsonval current (diathermy) is advised, using a metal electrode in the rectum, while a metal- Spenser See eee _ - ane ETT EEE SSE TRT EOE TE " atk me tes oe es a TET TIE —— ee oe a a ee = —~— ————— ——————— — = = = = - - — ——~- ———— - _— a ih - sme — aparece cemeemetees a } SS ee Se a ee " oi . a - a es eae amerasin saa ~~ eK. - 0 re rare = ee eee — ~ — = ———e__ eee = —— 254 EBERHART’S MANUAL OF lic electrode is held by the patient. Ten minutes, . three to six times per week. Vacuum electrodes with Tesla or Oudin eurrents may be used. Prolapse of Rectum. Use a mild spark over the prolapsed tissue which almost always will cause an. immediate contraction. If it does not, replace and follow with a seven-minute intra-rectal treatment. Three to six applications per week. Prostatic Diseases. The results following the high . — : frequency treatment of all forms of prostatic dis- ease are extraordinary. - Oe One authority found in a large series of cases over 85%: were cured. In my own experience the -ap- parent cures have been over 90% with no case in which perceptible improvement was not present. In enlarged prostate I was of the opinion that recent cases and those with an inflammatory infil- trate were all that could be reduced, but I have had positive reduction take place in a few cases of senile - hypertrophy and I believe the possibilities in these cases are worthy of investigation. The technique is described in Chapter VII. In Fig. 55 is shown a special form of insulated vacuum tube for prostatic treatment originated by Dr. Samuel Stevens. My spatulate tube is shown in Fig. 27. I use vibration in conjunction with high frequency in nearly all of my cases, and diathermy is advised in acute cases. Pruritus (Itching). This annoying symptom ordi- 4: HIGH FREQUENCY CURRENTS 255 narily is relieved by the high frequency effleuve or spark. Generally speaking the vacuum tube spark is employed as sharp as the patient will tolerate, but not for a long time. In other cases light contact with the tube is desirable, giving longer treatments than with the spark. In itching skin diseases the ne is very grateful to the patient and relief is immediate though often temporary. Pruritus ani, Treat with spark for 30 to 60 sec- onds and then use rectal tube for a six or seven Fig. 55—Special Prostatic Electrode. minute treatment. Three to six applications per week. Pruritus vulve. The vaginal vacuum tube is used first for seven minutes, followed by a medium spark externally over the itching surface. Daily treat- ments if possible. These cases frequently are caused by irritating vaginal or uterine discharges or by too acid urine. For the first use alkaline douches and for the latter give alkalies internally and see that plenty of water is drunk. Psoriasis. This is treated by the same technique as that employed in eczema. ee FEV ewer Tee = —— ——— — we —— = =e a i | i ie 2 a i | _ HIGH FREQUENCY CURRENTS 257 | 7 | | 256 EBERHART’S MANUAL OF | | ti Al | | : ; : - hundred and twenty-five, and in the longer cages : | : Purpura rheumatica. This form of purpura has | ~ the treatment required about two years. — i been successfully treated by auto-condensation. Rectal Diseases. Many diseases of the rectum ° e ° ° \ , Pyorrhea alveolaris. (Rigg’s Disease.) In this have been treated with apparent success, by means common but intractable disease of the gums the cur- rent is locally applied by means of special tubes. See Chapter XII. The disease is very difficult to cure and high fre- quency is beneficial because germicidal in character as well as nutritional. , Seven-minute daily treatments with tube. in con- tact with the gum, using adjustable socket handle so that the patient may hold the tube in place. See complete discussion of technique in Chapter XII. These cases always call for general treatment usu- ally of an antacid character. Auto-condensation is suitable on account of its constitutional effect and its marked influence on elimination. Ozone by inhalation or by means of the local use of an ozone spray is directly indicated. Pyosalpinx. Intra-vaginal applications of the cur- rent have proved effective in some cases of pyosal- pinx. Seven-minute treatments three or more times per week. Reynaud’s Disease. I have had no experience with this disease, but French operators report suc- cessful treatment. Auto-condensation was employed 2,000 E. or more. The number of seances varied from twelve to one of these currents. The general technique is given in Chapter VII. : Among the diseases are included proctitis, fissure, hemorrhoids, prolapse of rectum, pruritus ani, paral- ysis of sphincter, ete. The method of treating each is given under its appropriate heading. Renal Calculus. Dr. J. O. Chase reports the dis- solving of a renal calculus by means of auto-conden- sation. A metal electrode was placed over the ab- domen, instead of the patient holding the handles. 2,000 to 7,500 E. daily. Diathermy relieves the pain. Retinitis. The method employed is the use of the double eye tube as in Fig. 47, or using a tube with a mild amount of current in light contact with the eye-lids, eye-brows and temple. | In 1902-4 I treated successfully a. number oe dis- ~ eases of the eye with high frequency and X-ray, in connection with Dr. G. F. Suker, at whose sugges- tion these methods were employed. Among these was one ease of retinitis pigmentosa. Rheumatism. High frequency currents are of ex- ceptional value in muscular and in chronic articular rheumatism. In the acute articular form the results have not been so satisfactory. Articular rheumatism, also known as inflamma- tory rheumatism or rheumatic fever, is known at 258 EBERHART’S MANUAL OF the present time to be an infectious disease. Ordi- narily the attack is ushered in by a sore throat and the infection enters by way of the tonsils. It affects fibrous and serous tissues in particular and one reason for believing the disease infectious 1s the similarity between the symptoms and those of gonor- rheal rheumatism where a known infection causes the pain, ete. Frequently abscessed teeth are the foci of infection. I Rheumatism is often confounded with rheumatic sout. It quickly produces impoverishment of the blood (anemia), and this is one reason why auto- condensation has proved so beneficial. In the acute form, ‘both articular and muscular, the application of high candle power lamps is ad- . vised in connection with high frequency, and in thes chronic type, vibration is a valuable adjunct. Dia- . thermy recommended. In muscular rheumatism, of which lumbago, stiff neck, ete., are common types, the vacuum tube is used with either a mild or sharp spark and during the application the patient changes position fre- quently to keep the muscles on the stretch and to ascertain whether this posturing causes pain. The treatment is persisted in until relieved whether it be ten or thirty minutes. In chronic rheumatism the best treatment is auto- condensation, 2,500 to 7,500 E. daily, and vaccines. During the first treatments the symptoms may Deres somewhat aggravated, but after the second or third week improvement is steady and rapid. HIGH FREQUENCY CURRENTS 259 Vacuum tube treatments over the painful area may be used in connection with auto-condensation if desired, but a cure will result without this aid. Where the operator has no couch or pad prolonged mild treatments with the vacuum tubes may take the place of auto-condensation. In this case the application should last at least twenty minutes. The amount of uric acid in the urine is imme- diately increased by auto-condensation, which prob- | ably accounts for the aggravation of symptoms in rheumatism and gout where long treatments are given in the beginning. Dr. J. P. Sutherland, Dean of Boston University School of Medicine, furnishes the following report: ‘“‘The patient commenced treatment Dec. 24, 1905, but the first analysis was not made till Dee. 31, 1905.” : } * Per cent. of _ |. Ratio of Date. Total Urea. { Urea to Total Oe Uric Acid to Total Solids - Acid. Urea. ne ee eee | ee Dec. 31,'05 | 19.56 grammes; 29.8 per cent.| 1.44 grammes} 1 to 13.5 ——— — Jan. 9,°06|26.96 “ | 465 “ | 4.001246 « | 1 to 26.96 Jan. 13, "06 0732 <« {428 « 7649 1 to 354 Jan. 19,°06| | 26.24 « |402 « 667 1 to 39 (Normal about) (Normal .5) (Normal I to 45 per cent. about 35 ro 40) 260 i | EBERHARTS MANUAL OF Williams reports one case in detail where the: ratio of uric acid to urea was 1 to 51.5 before treat- ; ment. At the end of one. week it had increased to 1 to 63.5; and at the end of the second to 1 to 70.3, from which point it rapidly decreased, being 1 to i 64.8 at the end of the third week; fourth, 1 to 46.7; fifth, 1 to 41; sixth, 1 to 34.0. Patient’s weight. increased six and a quarter pounds during this time. Both of the cases cited show the remarkable ef- fects of auto-condensation in increasing elimination. — Rhinitis (Atrophic). (See Ozena.) Rigg’s Disease. (See Pyorrhea alveolaris. ) Ring-worm. (See Tinea.) Rodent Ulcer. The method of treating rodent uleer is the same as that employed for epithelioma, (devia): ? Scars. (Cicatrices.) Vacuum tube sparks have a softening effect on scar tissue. Even contact with the tube without sparking has a similar tendency (as in treating strictures). If the spark is made very sharp and therefore caustic or escharotic, or if caustic fulguration is used, the scar-tissue will be destroyed and pliable new tissue takes its place. For small sears about the face the application of a medium spark (one-fourth to one-half inch) is rec- ommended, the treatment repeated in five to eight days if fulguration 1s employed. See Chapter VI for technique. HIGH FREQUENCY CURRENTS 261 If a vacuum tube spark is used the treatment may be repeated daily or every other day until a suffi- cient degree of irritation has been set up. Sciatica. Apply the vacuum tube along the course of the nerve and over the lower part of the spine. Use enough current to produce a spark from one- half to one-inch in length, but ordinarily do not raise - the tube from the skin. Give a ten or even fifteen | minute application, repeating daily or every other day. I nearly always follow this with auto-condensation, 2,000 Eberharts. | Seborrhea. For dandruff or any seborrheic con- dition the vacuum tube is used, carrying enough current to give a quarter to a half-inch spark. It 1s then kept in light contact with the surface treated and passed back and forth about ten minutes; re- peating three to six times per week. Seminal Emissions. For nocturnal emissions sparks to the lower part of the spine are advised, followed by a seven-minute treatment of the seminal vesicles by means of the rectal tube. Sinusitis. In frontal sinusitis I have on a number of occasions applied the vacuum tube over the sinuses, keeping it in light contact, although employ- ing a medium intensity of current. This was always in connection with vibration. The first time I gave this treatment it was for the 262 _ EBERHART’S MANUAL OF purpose of affording temporary relief until the— patient could arrange to consult a specialist, as its believed operative interference necessary. I almost | questioned my diagnosis when informed the follow- ~ ing day that the pain had practically disappeared.. © Subsequent experience shows that this result may — be obtained in a fair proportion of cases that are | seen early in the disease. If relief is not afforded by one or two treatments, : the sinus should be drained by a competent rhinolo- vist. Skin Diseases. The vacuum tube effleuve or spark ig one of the most useful agents in treating a num- ber of skin diseases. | The general technique 1s outlined in Chapter VI., while special methods are indicated under a num- ber of the diseases, to which reference may be made. The high frequency current should be in the office of every dermatologist. It benefits practically the same class of skin diseases that the X-ray has been employed in. Sore Throat. (See Pharyngitis and Laryngitis.) Sprains. Use a vacuum electrode and with a moderate intensity of current. Keep the tube in light contact while rubbed gently back and forth over the sprain. A long treatment ; fifteen or twenty minutes ; repeating in two or three hours if necessary. The direct D’Arsonval current (diathermy) 1s equally useful. In old sprains use a sufficient spark HIGH FREQUENCY CURRENTS 263 to produce marked reddening of the skin as counter- irritation 1s necessary. Sterility. General tonic treatment by auto-con- densation or by the vacuum tube is to be employed together with local treatment with the mild spark over the region of the ovaries or testicles. In women intra-vaginal treatments are indicated, and in men the use of the glass urethral tube has seemed to exert a beneficial influence, although results in these cases are uncertain. Stiff Neck. (See Torticollis; also Rheumatism.) Stricture of the Urethra. I have had excellent — results in a large number of cases of stricture treated by means of the urethral electrode. The general technique is given in Chapter VIL. Three to six treatments a week are advised. This method will not cure every case and galvanic electrolysis; dilation under anesthesia; or operative measures may be required. Sub-involution. The use of an intra-uterine elec- trade with the direct D’Arsonval current (diather- my), aS explained under metrorrhagia, is the method which gives the best results in sub-involution, al- though vaginal vacuum tube applications have proved efficacious. | Suppuration. Vacuum tube applications always tend to limit suppuration. | Where a suppurating area is accessible the ozone spray is the best application which can be made to it. Sycosis. In barber’s itch and other forms of syco- 264 EBERHART’S MANUAL OF sis the X-ray is our best method, but it may be ad- vantageously supplemented by application of the spark from the vacuum tube, used in accordance — with the tolerance of the patient. Mild fulguration also may be employed. | Synovitis. Treat as directed for sprains, that is, use vacuum tube without a spark, for a long sedative application in the acute form, or use the diathermic eurrent, 600 to 1,200 milliamperes. For the chronic case, short, thick, counter-irritant sparks are required. | ag Tabes Dorsalis. (See Locomotor Ataxia.) Throat Diseases. High frequency currents are useful in connection with routine methods in laryn- gitis, pharyngitis, ete. See Chapter VII for general technique. A number of throat electrodes are illus- trated in Figs. 20 to 23. Tic Douloureaux. Trigeminal neuralgia has been successfully treated by applications of the high fre- queney current, one operator reporting the cure of a case where resection had failed. Prolonged appli- cation over the course of the nerve with medium intensity of current, but without producing a spark. Tinea. In ringworm and in all forms of tinea the X-ray is the best treatment supplemented by vacuum tube applications, either by direct contact or by a reasonably sharp spark. i Tinnitus Aurium. The administration of the cur- rent through the ear tube as outlined in Chapter VII HIGH FREQUENCY CURRENTS 265 has proved curative in cases of ‘‘ringing in the ears.”’ I always employ vibration in conjunction with the high frequency. Tonsillitis. The throat has been treated externally with the vacuum tube in tonsillitis, following the method suggested under pharyngitis and laryngitis. It is only of value in connection with our usual methods, and is not advised as the sole treatment. Diathermy is recommended. ; Tonsillotomy. I have seen a number of reports of the successful destruction of the tonsils by means of fulguration. Judd says ‘‘For the removal of the tonsils we have in this agent an ideal method. It is bloodless, not very painful and avoids the danger of hemorrhage in fibrous growths.’’ hie Torticollis. Wry neck or stiff neck in an acute or sub-acute form is cured by vacuum tube applications along the sterno-cleido-mastoid muscle. A long application with a tube capable of emitting a half-inch or inch spark, kept in light contact with the skin or applied through a sufficient number of layers of cloth to get short, sharp, thick sparks. Trachoma is successfully treated by using the eye tube in connection with the X-ray, or using a tube exhausted to a vacuum high enough to give off some X-rays. | Tuberculosiss of Glands. In the treatment of tu- berculous glands, the vacuum tube spark is employed Se SS eS —= . = bicinee sic = SSS SS = 266 EBERHART’S MANUAL OF consecutive cases as symptomatically cured, this | HIGH FREQUENCY CURRENTS 267 | in combination with the X-ray. High frequency | bene about 75% | Oc : to give a short but comparatively thick spark. This _ _ frequency in this disease. i without X-ray is not advisable for this condition. aie | |e Any surface or condenser electrode may be used _ eal Ro rea an tenet or Ouse ge ae Na , | | ie See See with it vacuum tube or diaphragm applications of ee with an intensity of current capable of producing a high frequency |) ie | | . | : ee) | ae poone wigs OnE ane ada may be used a I am now convinced that either auto-condensation | E in hight contact with the skin or slightly separated a or auto-conduction is superior to other forms of high i" [: may be regulated by treating through a sufficient thickness of cloth. Five to ten minute applications. Ozone is especially effective in consumption and | ) | if I could only have one remedy I would prefer to ee er peeves seven ae es take my chances with ozone. It must not be limited | E treatment three times a week followed by the high ; nie Bhice. Wik ibe ait Ng frequency application. Ozone strongly advised. re mbelations at he Bayes OMce, Da : 1 a | of the patient’s room must be thoroughly ozonized, : IE Tuberculosis of the Peritoneum. Tuberculous so that he or she is constantly getting a suitable I il) peritonitis is treated by the local application of the amount in the air they breathe. If they can only i vacuum tube over the abdominal area or by localized i ~ respire one-half as much air as formerly, but that 1] . auto-condensation. The effleuve from a diaphragm _ amount by reason of the ozone is twice as powerful | NP clectrode may be used. | in oxidizing properties, the proper balance is main- il L I prefer general auto-condensation, 2,500 E. daily, | : tained. . : | | : with mild vacuum tube spark applied through a Williams observed that the use of auto-cctdensa- i if layer of clothing. Ozone indicated. tion was followed at first by an increase in symp- : i ag Tuberculosis (Pulmonary). In local forms of tu- toms. The expectoration increased, the cough was / i berculosis the X-ray is superior to high frequency ; mee frequent but easier; there was a lower morn- | ir but in pulmonary tuberculosis conditions are re- ing but a higher afternoon temperature ; and an | a versed and in auto-condensation and ozone we have average loss of weight of about a pound a week 7 | a two remarkably effective remedies which should be : i ozone shortens this first stage. understood better by the profession. After this period improvement was steady. al- though some attenuated tubercle bacilli were present long after all other symptoms had disappeared. My attention was directed to the use of auto-con- densation in this disease by Chisholm Williams’ book in which he reported thirty-two out of forty-three during the first three weeks. The concurrent use of | 268 EBERHART’S MANUAL UF On acount of the rise in temperature produced by auto-condensation we must be careful not to give too long a treatment at the beginning if the patient. is carrying a comparatively high temperature, for instance, 103 degrees or over, or is In an advanced stage of the disease. The reaction is similar to that from tuberculin. The rise in an already high temperature might be too great if a long treatment was given. For this reason it is a good plan to give five minutes on the auto-condensation couch or pad and then await the subsidence of the reaction before giving the second treatment. I would not employ more than from 1,000 to 1,250 E. in the first three or four treatments, after which the patient will quickly establish a toler- ance for the treatment and the dose may be increased to 2,500 EH. or more. As soon as this period is reached daily applications are urged and should be followed by spinal sparks to offset the blood-pressure reducing effect of the auto-condensation. In cases that carry very little temperature at the time of starting treatment, a ten-minute daily appli- cation may be made from the beginning. The direction for the use of ozone and reports of its remarkable effects will be found in Chapter LX. I have made it a rule to send the specimens of sputum to a reliable laboratory for examination, thus having the proof of the value of the treatment made by a distinterested party. HIGH FREQUENCY CURRENTS 269 The following gives a comparative idea of the im- provement taking place in an average case. Mrs. B., Jan. 2, 1908. Many tubercle bacilli pres- ent. Other organisms not numerous. Staphylococ-— ei; dipplococci of catarrh; fibrin, mucus; pus cells. April 8, 1908. Tubercle bacilli few, averaging about seven to the microscopic field. Bacilli deep- staining, showing extremely few vacuolated forms. Phagocytosis very prominent; clumping not promi- nent. Other organisms noticeably absent. — The specimen was so remarkable in the marked degree of phagocytosis and the absence of other or- ganisms that the physicians in charge of the labora- tory took occasion to call me up and ask the nature of the treatment employed. Two months later this patient was so well that she refused to continue the treatment, having re- eained her normal weight and strength, although an — occasional bacillus was still to be found. The value of ozone and of auto-condensation is so marked and so easy of demonstration that I am sur- prised the methods are not better known, and in eveneral use in institutions for the treatment of con- sumption. oe They possess the advantage not only of being cura- tive in themselves but also of not preventing the use of all the established methods of treatment in con- nection with them. They afford two additional non- interfering methods of equal value with any used, 270 EBERHART’S MANUAL OF and thereby increase the patient’s chances to that extent. Ulcers. (See Chronic Ulcers.) Urethritis. The directions for treating specific urethritis will be found under gonorrhea. Non- . specific forms yield to the same methods. Uric Acid Conditions. All methods of employing high frequency currents aid in eliminating both urea and uric acid, but auto-condensation and auto- conduction are especially effective. Their value can be tested readily and is easy to ascertain by a few urinalyses. Urticaria. (Hives.) Vacuum tube applications using a medium spark or with the tube in contact with the surface is the method of treatment. Speaking of the value of high frequency currents in skin diseases, Dr. C. W. Allen says in the Medical Record: ‘‘The vaso-motor effects may be _ well studied in urticaria. Here sparking the wheal pro- duced entire disappearance of the lesion, which is replaced in a few moments by a blanched area. Vascular redness soon returns, the area of this being larger than the lost wheal. The effect of contraction followed by dilatation is very marked. The spray soothes the itching. Internal measures are not to be neglected.’’ Uterine Diseases. Treatment through the vagina to the womb has been beneficial in cervicitis, endo- metritis, etc. The general technique is given in Chapter VII. High frequency currents are always HIGH FREQUENCY CURREN'TS 271 indicated in inflammation of any mucous membrane. See Cervicitis. Vaginitis, whether simple or specific, is treated ac- cording to the technique given under gonorrhea ‘in the female. | Varicocele. A medium spark applied over the scrotum has been used, also immersion of the scro- tum in a glass vessel with metallic connection to one pole of the D’Arsonval circuit, the other held in the hand. The current may be applied with two metal electrodes so placed as to include the varicocele be- tween them. My own opinion is that the only real cure for varicocele is the radical operation. Varicose Ulcers. ‘‘Long, thick, muscle-toning, high potential sparks over the affected limb; on the spinal centers, and upon the general muscle masses of the entire body for alterative, nutritional, circu- latory benefits are indicated.’’ (Monell.) Warts and other small growths may be removed by fulguration, as described in Chapter VI. Writer’s Cramp. This is an occupation neurosis variously known as piano player’s cramp, telegra- pher’s cramp, etc. It is the result of repeated use of the same muscles to the point of exhaustion and chronic fatigue. The vacuum tube is used with a current sufficient to produce a quarter or half-inch spark. The tube is kept in light contact with the skin and the application is made from the finger tips to and including the shoulder area, brachial plexus and upper spinal centers. For the latter the tube is 272 EBERHART’S MANUAL OF - - raised to obtain a stimulating spark, and I frequently employ the spark for the whole treatment. The use of vibration in conjunction is strongly urged. Three treatments a week. Many authorities advocate general eliminative treatment in connection, such as auto-condensation or electric light baths. Wry Neck. (See Torticollis.) HIGH FREQUENCY CURRENTS 23 CHAPTER NINE. . Ozone; How Produced: Physiological Action; Dos- age; Indications and Principal Diseases in Which It Is Employed. Nature and Production. Whenever an electric spark passes through the air, ozone is liberated. Ozone is known under the chemical symbol O, and is an allotropic form of oxygen. At the same time that ozone is liberated, nitrous and nitrie oxides are also produced. The less the perceptible spark accompanying the production of ozone, the less the amount of these objectionable oxides, and in admin- istering the ozone, it is necessary by filtration or otherwise, to dispose of these gases. Physiological Action. Ozone increases the oxy- genation of the blood and tissues, increasing Oxy- hemoglobin and also Increasing the number of red blood corpuscles. It is claimed that a decrease in white blood corpuscles is produced if they are above normal. In a strongly concentrated form, ozone is destructive in its effect on mucous membranes and even to life itself. Germs are destroyed by it and it has been shown capable of so thoroughly disinfect- ing sewage that the filtered water was pronounced suitable for drinking purposes. It is distinetly $n O74 EBERHART’S MANUAL OF deodorant and even a small ozonizer running in a room will quickly destroy the most objectionable odors. | In a Chicago bank an ozone machine was placed in a room where six employes were working. Their weight and chest expansion was taken at the time the machine was installed and again in sixty days. The result is shown in the following table: No. Nov. 6 Jan. 6 Nov. 6 Jan. 6 Nov. 6 Jan. 6 i LOT Se 128 2d 0. 36. bl. 32. 2 118. 121.5 Fa Oe OU: 3315) 31.5 3 130. 13025 «234.257 36:0 30. 30.5 Ae 8" 196.75 34.25 < 36.75. 730.9 30.5 D 131: e038.) 30. 37.9 30.5 3 be 6 118. 17250) ole. oa. 29. 20). Indications. In one sense of the word, since oxy- ven is so essential, it might easily be claimed that ozone was indicated in any bodily ailment, and I am. of the opinion that its inhalation would be beneficial to the extent that pure air would be desirable, but there are some diseases in which it is of particular benefit. Among these are anemia; all diseases of the respiratory organs, including tuberculosis; in- fectious diseases; and all conditions where there 18 imperfect oxidation and impaired nutrition. An ozone spray has been demonstrated to be healing in all forms of ulcers, ete. Methods of Administration. As ordinarily em- ployed, ozone 1s administered in the form of inhala- HIGH FREQUENCY CURRENTS 205 tions in the doctor’s office, or by ozonizing the air of the room which the patient occupies. In em- _ ploying the ozone directly from the generator, it has been found necessary to filter it through noe tial oils in order to remove the nitrous and nitric oxides. Oil of pine two parts and oil of eucalyptus _ one part is a favorite form. In many instances it Seems to me to be much more sensible to administer constantly ozonized air than to depend upon occa- Fig. 56—Small Ozone Generator for Portable Outfits, sional inhalations. This is especially true in con- Sumption. Several ozone generators are illustrated herewith. Effect on Nutrition. The following is taken from reports by Doctors L’Abbe and Oudin before the Paris Congress for the study of tuberculosis: ae investigated the influence of ozonized air on nutrition in general, and especially in anemia or persons physically reduced. When the percentage of oxyhemoglobin is below normal (say 9%; to 10%) as 1s usually the case with tuberculosis patients ne halations of ozonized air for a quarter of an Hous increases it by 1%. The increase, temporary at first becomes permanent after a number of Hosni Dosage. It is claimed that large amounts of ozone are capable of producing death, and that rabbits i i p “This is necessarily accompanied, in the case of Y anemic patients, by more energetic oxidation, more | rapid combustion, which calls for more rapid re- newal of nutritive materials (increased metabolism) and from this there speedily arises an increase in appetite, which in some patients takes the form of a demand for food such as has been hitherto un- known to them, with return of strength, disappear- ance of complications, in short, restoration to health. “Out of twenty-eight patients weighed before and 276 EBERHART’S MANUAL OF . | . | HIGH FREQUENCY CURRENTS ony p ‘ i 2 | Fas: a 5 ° Bi: and one can affirm that at the end of two or three In view of the reputation and standing of the i: : | weeks’ treatment, the patient has reached a normal © : | physicians making this report, more than ordinary E i : : ; , ne figure. consideration should be accorded the statements il | after. treatment, including those in all stages of | tuberculosis, ie i One gained 1.1 Ibs. Six gained 3.3 lbs. | Three gained 4.4 lbs. Two gained 2.5 lbs. | | i One gained 6. lbs. One gained 6.6 lbs. | | Two gained 7.7 Ibs. Three gained 8.8 Ibs. a One gained 9.9 lbs. One gained 11. lbs. i: i E Two gained 15.2 lbs. One gained 19.9 lbs. i One gained 23.1 lbs. Two remained stationary. | ‘ ‘With the return of flesh there was a correspond- u | | i ing increase in oxyhemoglobin as follows: | Fig. 57—Ozone Generator for Office Use... | : | | | i tie gained 1%. “ Ten gained 37%. | have succumbed in ten minutes in an atmosphere i Five gained 114%. One gained 314%. | ‘ay containing eight milligrams of ozone to the litre | Four gained 2%. Six gained 4%. : a _ The proper proportion for therapeutic inhalation i | i Five gained 216%. One gained 5%. 2 . one, two or three milligrams to the litre. Inhalations | | Four were not examined.” | given in a physician’s office last from ten to twenty | - for tuberculosis, it is an und 278 EBERHART’S MANUAL OF minutes and may be repeated frequently. The indi- cation that the patient has had a sufficient dose 1s usually a slight sensation of lightheadedness. Tuberculosis of the Lungs. Daily inhalations of ozone in connection with auto-condensation. Ozon- izing the air of the patient’s room 1s the best method of employing ozone in this disease. H. de LaCoux, Chemical Expert to the Council of the Prefecture of the Seine, Paris, says: ‘In the application of ozone eniable clinical fact that the number of bacilli in the sputum diminishes after the second or third treatment, even before the al condition of the patient 1s improved.”’ gener nine cases of Dr. George Stoker, London, reports tuberculosis treated within a year at the Stoker Oxygen Hospital, of which eight were discharged with the disease definitely arrested. Dr. J. T. Gibson says in Advanced Therapeutics : ‘Tn advanced cases with cavities and much expec- toration, I think there ig no means of so much use as inhalation of ozone. It empties the lungs of detritus and pus, revivifying the blood, disinfecting the parts of the lungs reached, and after the first irritation of its use has passed off, there 1s nothing that gives the lungs the sense of rest and quiet as does this agent. I have seen the quantity of sputum lessened to a most remarakble degree, and fever dis- appear, and all symptoms improve by the use of ozone inhalations.’’ HIGH FREQUENCY CURREN'’TS 279 Sletoff has treated 1 : 47 cases of i ozone, with favorable results. i p y) 0 e ° Caille reports the favorable influence of ozone j syndy tl numb : fee a a eee and anemia as well Rie aes a and in his conclusion, Says in Seman ae oo ozone inhalations are exceed- e irom a therapeutic Standpoint, and Hitt give better a eu Se Bother results than any other form Chroni au ae ee Deafness and Tinnitus. Dr. Favs Si a aoe Throat Hospital and of the ee e ee , hag published a series of twelve Gece ae dry catarrh of the middle ear with ee in nearly all with tinnitus, which were a an ozone spray. Improvement, some- es remarkable, occurred in every case oe The technique consisted in passing the ozone ‘‘in oe en areae es SS See — — Sr eared peace A BEE Slims Sant hah RD Es Panes \ | I) | i i} | } i ; mH)|| | MM | vind _ 3 | . . I GH FREQUENCY CURRENTS 281 | Hh | il 280 EBERHART’S MANUAL OF || | | a gentle current through an eustachian catheter m0.) tre Been | | the middle ear for about four minutes at a time, the | eas nla. QOzonize the air in the roo | operation peing repeated several times @ week, daily | eo a oe the head of the nadente ur possible. ; ‘ enl ity ete. Tl i : ; Ly tl : : nree to ’ (Pertussis). The efficacy of a ae per week, preferably in ee aay inhala- | condensation or with vacu ee with auto um tube sparks : | : - Whooping Cough ozone 10 treating wh 9 cough has been attested by many authorities, amons them being Caille, | L’Abbe, Derecd, Doumer, Delherm, Bordier and | Oudin. In practically all of these cases the ozone was administered in ten to twenty minute inhala- Ozonizing the air in the patient’ s room should oopin tions. prove a better method. 1 experience rests . | Says L’Abbe: ‘My persona over 100 cases. Tn all I have obtained amelioration, prompt and rapid at first, and later a complete cure in a time ordinarily covered by a very light attack. Ozone is the remedy par excellence for whooping on cough.”’ : Asthma, Bronchitis and Hay Fever are benefited — . TInhalations comb ined with ozon- | Hig (60 Rost Ont ZOn1zZer, | | || | | or cured by ozone: | of the room is the method; the | Other Dise an ases. On accoun t of its oxidizi Ing prop- {| ization of the air | latter being more efficacious. have found that the use of a | erties, ozone should be a valuabl GO ; : ] uaple : ndensation in diabetes, gout pe roy Sut \ b 9 e Ge three months d the latter | ations have Hay fever victims | ‘room atomizer const HV Vi) prior to the expecte d | rom coming on. Dur | given great relief. | Insomnia. tH minutes, or havve patie ‘ozonizer in operation. | | Ml Its beneficial action in syphili by many physicians. yphils has been attested antly for two or attack has preve nte ing the attack inhal Daily inHalations for ten OF fifteen nt sleep in a room with an | i | | ai 3989 EBERHART'S MANUAL OF CHAPTER TEN. High Frequency X-ray; Its Nature; Generation and Therapeutic Indications. Explanatory. This is intended as an elementary chapter on the X-ray for the possessor of a small or portable high frequency outfit who wishes at times also to avail himself of its X-ray possibilities. Scope of Portable Outfits. Portable outfits are constructed on the Tesla type, and it 1s surprising how well some of them light up the xray tube. They are suitable for the treatment of skin diseases and all superficial lesions. This includes practically all of the conditions in which the X-ray is really ef- fective. For radiographic purposes the. manutac- turers only claim them to be capable of skiagraph- ing the extremities, although some of them make satisfactory pictures of thicker parts. Their porta- bility is at times of considerable advantage. They are not claimed to take the place of the larger equip- ment in the office of the radiologist, but bring the use of the X-ray and high frequency within the reach of many physicians who wish to employ it in connec- tion with their regular work. They are not suited to the requirements of the X-ray specialist. HIGH FREQUENCY CURREN'TS 283 Nature of the X-ray. The X-ray was discovered by Roentgen in 1895 It possesses the property of penetrating supposedly opaque bodies, but cannot be seen by our eyes, nor felt as it passes through the body. It is produced by means of a tube ex- hausted to a vacuum of one-millionth of an atmos- phere. The Tube. For high frequency coils a special X-ray tube is required. These are of various shapes, Some monopolar and some bipolar. One form is shown in Fig. 62. The metal disk in the center 1s called the target or anti-cathode and at this point the X-ray is generated. According to the degree of vacuum existing in the tube it is spoken of as high, medium, or low. The higher the tube the greater penetration its rays possess. : ee Adjusting the Tube. There are gauges for meas- uring the penetration of the tube. To accomplish results in X-ray treatment the rays must be stopped and absorbed by the area including the lesion treated. For this reason the higher the vacuum and therefore the greater the penetration of the rays the farther away the tube must be placed from the part treated. The average distance for a low tube is from 4 to 8 inches ; medium tube, 8 to 12 inches ; high tube, 12 to 20 or more inches. Protecting Patient and Operator. As an overdose of the X-ray is injurious, it is necessary to guard | : | : HIGH FREQUENCY CURRENTS 285 1 284 EBERHART’S MANUAL OF | | | | against indiscriminate exposure of the patient and ~ ee | also of the operator. nee The simplest method is the use of a protective es yi shield to encircle the tube, permitting the exit of the ne rays only through a small aperture that may be reg- | , ulated as required. | : | | | | In addition the use of leadfoil or sheet lead to : “4 cover all parts which are to be protected from the | ray 18 customary. | | —, eg The Fluoroscope. In order to see the findings of ; I the X-ray a screen is employed containing barium : a platinum cyanide, a substance which shines or fluor- esces when exposed to the X-ray. Interposing an | object between this screen and the X-ray tube pro- 1] duces a shadow on the screen commensurate with | the amount of the ray which has been prevented || a from reaching the screen. We have, therefore, a c shadow picture showing the relative density of the i object traversed by the X-ray. © | i} . ‘The Skiagraph. The rays act upon the bromide _ | | of silver gelatin coating on photographic plates in ie | the same manner as ordinary light. When a plate } || | takes the relative position of the fluoroscopic screen ie the resultant picture is called a radiograph, or skia- | graph, and affords a permanent record of the condi- | . tion shown. | | , | | oe The X-ray plates have a heavier coating than te EE ee er. ordinary photographic plates and are enclosed in i : 1 two envelopes so that they may be handled in day- } | light. The flaps on the envelopes are on the non- Fig. 60—Large Office Ozone Generator. ——= == SSS SS 286 EBERHART’S MANUAL, OF sensitive side of the plate. The plate is placed on the table, the part to be skiagraphed resting on the plate and the tube some distance above, the target being directly over the center of the part radio- graphed. Fig. 61—High Frequency Coil Giving All Modalities. As the rays diverge from the point on the target where they are produced, the image on the plate is always enlarged. The nearer the part is to the tube the greater the magnification. In order to obtain a picture without distortion of HIGH FREQUENCY CURRENTS 287 the image the following rule must be kept in mind: An imaginary line from the point on the target where the ray is generated to the center of the plate, must be perpendicular to the plate and pass through the center of the part skiagraphed. Fig. 63 shows the proper relationship of the tube, plate and hand for a skiagraph of the latter. The length of exposure is from a few seconds to Several minutes, according to the apparatus em- ployed and the density of the parts. A few ex- perimental pictures will enable the physician to de- termine the approximate time for his individual outfit. : The method for developing is the same as for or- dinary photographic plates, but takes much longer, averaging about ten to twenty minutes. Dental Films. For skiagraphs of teeth, a film is used. ‘Two small films wrapped in two opaque paper coverings is the way they are supplied to the doctor. The film is held inside the mouth, back of the teeth, the smooth side of the paper toward the tube. Head is adjusted so that the line from target to film ig in accordance with the rule given above. With small machines it will be necessary to experiment to get the time of exposure. It will average 30 to 60 sec- onds. The films are developed, washed and dried ; the one retained by the radiographer, the other be the patient. Diseases Grouped According to Technique. In treating with the X-ray the average number of = = a r e r g Sa RS e e o e : = = i = S S — — — e e s 289 PLATE Plate and Hand for a 3 e ph ion of Tube Skiagra it Os 1 HIGH FREQUENCY CURRENTS Fig. 63—Proper P — S S S S a c —— —_ _— _— —_ — — _ _ _ — _ _ _ _ — _ _ — EBERHART’S MANUAI, OF Fig. 62—High Frequency X-Ray Tube. 288 290 : -EBERHART’S MANUAL OF ' treatments is three per week. The length of ex- posure during the first two weeks should not be over five minutes each time to guard against possible idio- Synerasy to the ray. After two weeks the treatment may be lengthened to seven, or, in some cases, ten minutes, and con- tinued until improvement takes place or the charac- teristic reaction appears. In the former instance, the frequency of the treat- ment is gradually decreased; in the latter it is sus- pended entirely for a few treatments until the signs of dermatitis have subsided, when it is resumed as before, providing the evidences of disease have not disappeared with the reaction. With a low tube the tube-wall is from five to eight. inches from the surface treated; medium tube eight to twelve inches; high tube twelve to twenty inches. A number of diseases suitable for X-ray treat- ment are given herewith, grouped according to the vacuum of tube best suited to their treatment. The lower the tube the quicker the reaction produced. Some diseases are included under two headings, where it is a matter of choice, exter method yield- ing results. ou Tube, Acne, eczema, epithelioma; lupus, rodent ulcer. Medium Tube. Acne, blastomycosis, cancer (superficial), favus, goitre, hyperidrosis, keloid, nevus, pruritus, psori- asis, Sarcoma, sycosis, trachoma, tuberculous glands, neuralgia. tas oe : . HIGH FREQUENCY CURRENTS 291 High Tube. Alopecia areata, cancer (deep seated), leukemia. X-ray Burns. An X-ray burn or dermatitis is the result of an overdose of the ray. The earlier symp- toms are itching, redness and pigmentation. By Fig. 64—Portable X-Ray and High Frequency Coil. keeping these in mind it will be possible to avoid Severe burns. 2 Mild burns should be let alone and they will sub- side of their own accord. In severe forms the con- dition is an X-ray gangrene | or necrosis and ealls for surgical measures. 292 EBERHARTS MANUAL OF CHAPTER ELEVEN. Diathermic Currents. Characteristics and Synonyms. As long ago as 1899, Prof. D’Arsonval noticed that passing the D’Arsonval current through certain tissues of the body produced a higher temperature in these tissues. Nagelschmidt, Doyen and others confirmed these early observations, and the name diathermy was ap- plied to this method of increasing the temperature of the internal tissues of the body. The direct D’Arsonval current is used and dia- thermy is synonymous also with the terms thermo- _ penetration, electro-coagulation and electro-thermic coagulation. The application is always bi-polar. It really amounts to the application of electrically generated heat, which may be made to cover cer- — tain definite areas between the poles of the appa- ratus, and may be used to raise the temperature of the tissues or even carried to the point of coagu- lation with the formation and separation of a slough. In the latter case it is the equivalent of a surgical procedure. We are familiar with the action of the galvanic | current. If we pass this current through water, owing to electrolysis, the water is decomposed into HIGH FREQUENCY CURRENTS 293 hydrogen and oxygen which collect at the positive and negative poles respectively, or, if the current is passed through a solution of potassium iodide and starch, a dark color is immediately noticed at the negative pole, due to the decomposition of the po- tassium iodide and consequent action of the iodine on the starch solution. If we dip our hand into the water while the current is passing, there is a dis- tinct tingling sensation. If, now, instead of using the galvanic current, we pass the direct D’Arsonval current through the wa- ter or solution, no electrolytic action is apparent and the only effect is an increase of temperature in the solution, as is evidenced by the introduetion of a thermometer which shows the steady rise in tem- perature until the water boils. It is estimated that with the diathermic current the internal tempera- ture of the body, located between the points of ap- plication can be raised to a temperature of 140 de- grees Hahrenheit. Effects. On account of there peitie practically no skin resistance to the passage of the diathermic current, the current passes directly from one elec- trode to the other, heating the tissues that lie be- tween the electrodes. The current can be concen- trated in this matter, and is always under absolute control. This is of great value, as a little experi- ence will enable the operator to gauge the amount of current required to produce any given tempera- ture in the tissues and reduces the application of SS eee — ae . t SS Ee 294 EBERHART’S MANUAL OF this current to exact measurement, so difficult to | obtain when applying an ordinary eh frequency current. If electrodes of the same amount of surface are used on the opposite sides of a part, the same effect would be produced at each electrode or a uniform effect produced between the two, makine allowance for the fact that fatty tissues heat quickly and that bones are slow to heat, but retain their heat longer, while muscular tissues are slower to heat than either fat or bones. If we decrease the size of one electrode, since the same amount of current is passing, there will be a more intense heat over the area of the smaller elec- trode. If sufficient current is used the heat acts like the cautery, coagulating and destroying the tissue. By regulating the size of the electrodes the heat may be delivered wherever desired within the tissues, thus the value of this current in all indanamietory conditions of joints, ete. When the cauterizing effect is desired, the active electrode is usually a metal point or a wire. In this form it represents one form of fulguration. It is 3 employed in papilloma of the bladder. (The tech- nique is given under this heading in Chapter VI.) Diathermic currents are measured with the hot- wire meter. Range of Usefulness. Outside of their use in one form of fulguration as above referred to, they have heen very successfully used in connection with deep HIGH FREQUENCY CURREN’S 295 Roentgentherapy in malignant growths, and in the form of increased heat without carrying it to tissue coagulation, in arteriosclerosis, local or peripheral disturbanees, sciatica, neuralgia, lumbago, asthma, neuritis, headaches and rheumatic or other forms of arthritis. Many other conditions naturally sug- gest themselves where these currents may be em- ployed. : Technique. For increased internal heat, the method of the use of this current is as follows: Con- necting cords are attached to electrode of suitable siez or Shape for the part that is to be treated. ’ These electrodes are made either of solid dises, or a thin brass sheet covered with absorbent material. In order to make better contact they are first cov- ered with gauze saturated with a normal salt solu- tion, and the part to be treated is also moistened with this solution. The control of the current is easily maintained by using a meter and the exact amount that is applied can be. measured at all times. In general treatment, the current is slowly turned on until the meter shows from 700 to 800 milliamperes passing, and then it is gradually in- creased up to the tolerance of the patient. The operator should remember that it is better to com- mence with a small current and gradually and uni- formly heat the part between the electrodes rather than to start with a heavier current where the great- est effect is nearer the two electrodes, for if too much current is used, the tissues near the electrodes 296 EBERHART’S MANUAL OF will be heated beyond the point of tolerance before the tissues that lie deeply are heated as much as they : Should be, and burns will be produced. | In the second method, where coagulation and cau- terization are desired, the active electrode must be metallic, and if extensive work is to be done anaes- thesia is required. Dr. G. E. Pfahler (Journal Advanced Therapeu- ties, Dee., 1914) has accomplished remarkable re- sults by combining this method with deep Roentgen- therapy in malignant growths. The work is done under an anaesthetic, as the pain is severe. In most of his cases ether was employed, but in mouth cases hypodermic injections of one or one and a half HMC tablets (hyoseine hydrobromide gr. 1/100; ‘morphine hydrobromide gr. %4; and ecactoid er. 1/64) were used. These in some cases had to be sup- plemented by ether. He uses an instrument capable of generating 1,000 to 2,000 milliamperes. In removing a portion of a lip he uses a ball electrode inside, about three- eighths of an inch in diameter, and a needle-point electrode externally. He says: ‘‘I would outline the area of the diseased tissue to be removed by allowing the current to flow from this point toward the ball electrode on the inside, and then coagulate the entire diseased tissue. At first I depended upon the neeedle electrode to actually carve out the dis- eased tissue; but now I find it simpler to cut this away with a pair of curved scissors after coagula- \ HIGH FREQUENCY CURRENTS 297 tion, always cutting within the coagulated tissue. In this way there is no bleeding and the edges are com- pletely sealed off. ‘‘In destroying an extensive lesion in the cheek I used a flat electrode, one inch in diameter, on the inside and a point electrode on the outside. In de- stroying a portion of the tongue I have used two point electrodes. The electrodes are held in contact with the tissue.’’ Diathermy Electrodes. == 298 EBERHART’S MANUAL OF CHAPTER TWELVE. High Frequency in Dentistry. General Field of Usefulness. High frequency cur- rents are coming daily into more and more frequent use by dentists. They are employed in pyorrhea, in drying cavities, in devitalizing teeth, in sterilizing rott-canals, in bleaching teeth, in abscesses, in locat- ing devitalized teeth, and for the relief of pain. The — author is not a dentist, but has tried to give in this chapter a resume of current dental Opinion and — technique as gathered from various sources. Sev- eral dental electrodes are illustrated in Fig. 68. Pyorrhea. 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A Working Manual Of High Frequency Currents - 1916 Edition - Noble Murray Eberhart

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Turn Of The Century Electrotherapy Museum

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