A WORKING MANUAL OF HIGH FREQUENCY CURRENTS NOBLE M. EBERHART, M. D., Ph. D., D. C. L. 'ormerly Head of the Department of Physiologic Therapeutics, Medical Department of Loyola University. Formerly Professor of High Frequency, Illinois School of Electrotherapeutics. Formerly Head of Department of Electrotherapy, Chi- cago College of Medicine and Surgery. Formerly Attending Physician Cook County Hospital. Formerly Professor of Electrophysics Post Graduate Medical School, Chicago; etc. of Chicago and Illinois State Medical Societies; American Medical Association; American Medical Editors’ Associa- tion; Victoria Institute or Philosophical Society of Great Britain; etc. Vuthor of “Practical X-ray Therapy”; “Brief Guide to Vibra- tory Technique,” etc. Eighth Edition; Revised and Enlarged. CHICAGO NEW MEDICINE PUBLISHING CO., 25 E. Washing-ton St. COPYRIGHT 1911, BY NOBLE M. EBERHART. COPYRIGHT 1913, BY NOBLE M. EBERHART. COPYRIGHT 1915, BY NOBLE M. EBERHART. COPYRIGHT 1916, BY NOBLE M. EBERHART. COPYRIGHT 1919, BY NOBLE M. EBERHART. COPYRIGHT 1920, BY NOBLE M. EBERHART. COPYRIGHT 1921, BY NOBLE M. EBERHART. COPYRIGHT 1923, 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 most 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. VII 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 is based upon twenty-two years ’ practical experience involving the daily use of High Frequency Currents and upon seventeen years’ experience in teaching the subject. My indebtedness for data furnished is acknowl- edged to Drs. W. B. Snow, W. H. King, H. E. Waite, F. de Krafft, R. A. Black, E. C. Titus, H. F. Pitch- er, S. Stevens, R. E. Farmer, and Messrs. F. H. Swett, J. B. Wantz, Wm. Meyer, Samuel T. Hut- ton, Edward 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 Wm. Stahl. THE AUTHOR. 25 E. Washington St., Chicago. 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. 13 II. The Development of the Current; Ley- den Jars; Plate Condensers ; Electrical Oscillation. 22 III. Types of Apparatus; D’Arsonval Type Tesla Transformer; Impedance; Ou- din’s Resonator; Measuring the Cur- rent. 30 IV. Various Forms of Vacuum Tubes; Ef- fects of Different Vacua; Insulated Tubes; Fixed and Adjustable Socket Handles; Spatulate Tubes. 44 IX Chapter. Page. V. Physiological Action of the Current; High Frequency Burns; Offsetting Tendency to X-ray Burns. 59 VI. 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; Figura- tion; Auto-Conduction; Auto-Conden- sation ; Portable and Home-Made Pads; Surgings; Water Spray; Local Auto-Condensation; Indirect Sparks; Taking the Blood Pressure. 69 VII. Special Technique for Ear, Eye, Nose, Rectum and Prostate, Scalp, Throat, Urethra and Vagina. 134 VIII. Practical High Frequency Therapy, Dis- eases and Symptoms Alphabetically Arranged with Methods of Treatment. 150 IX. Ozone; Nature; Physiological Action; Methods of Administration; Diseases in Which It Is Indicated. 267 X Chapter. Page. X. High Frequency X-ray; Its Scope and Limitations; Resume of Skiagraphic and Therapeutic Technique. 275 XI. Diathermy; Electro-coagulation; Ther- mo-penetration. 285 XII. High Frequency in Dentistry. 300 Glossary. 313 Index. 317 XI 12 eberhart’s manual of Fig. 1—Large Combined Tesla, D’Arsonval and Oudin Type Coil. 13 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- quency current is an alternating (oscillating) cur- 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- tions, but not necessarily in the same time. Oscilla- EBERHART’S MANUAL OE 14 tory currents periodically reproduce similar series of waves as shown in Fig. 3. Their frequency is very high and is the reciprocal of period. It is 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 cycle. 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 and polarity, and we represent it by a waved line (Fig. 3), the waves above the line being pos- itive waves or alternations and those below the line negative waves. Let us call the line zero in volts and the crest of the wave 110 volts. The current starts at zero, reaches the maximum positive voltage and then HIGH FREQUENCY CURRENTS 15 Fig. 2—Portable High Frequency Coil. 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 cycle. 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 16 EBERHART'S MANUAL OF 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, 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 is 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 current let us suppose that it takes one one-hun- dred-and-twentieth of a second for any one of the alternations in Fig. 3. Then two alternations or one cycle would take two times one one-hundred-and- HIGH FREQUENCY CURRENTS 17 ALTERNATING, OSCILLATING fid,. 3 ONE. CYCLE. Fig. 4. Fig. 3—Alternating and Oscillating Currents. Fig. 4—Analogy Between Cycle and Circle. KBERHART’S MANUAL OF 18 twentieth, which equals one-sixtieth of a second, and this is the period of the current illustrated. If it 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 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 25 cycles, 125 cycles, 133 cycles, etc. 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- crease 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 gross muscular contrac- tion. HIGH FREQUENCY CURRENTS 19 Fig. 5—Higli Frequency Coil, Giving All Modalities. 20 EBERHART’S MANUAL OE 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 cannot be recognized by the auditory nerve as sound or by the eye as light. In these higher frequencies the contractile effect is expended upon the individual cells making up the tissues instead of on individual muscles. This I call cellular massage and it is one important rea- son why high frequency currents produce such a marked benefit on nutritution and metabolism. As 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, HIGH FREQUENCY CURRENTS 21 Fig. 5a—Prismatic Pay Type of Portable Coil. but this would cause considerable confusion at pres- ent and so the original nomenclature is adhered to. 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 high frequency current. 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. 22 Eberhart’s manual or 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. The Leyden Jai* or Condenser. The Leyden jar was discovered in 1775 by Musschenbroek, and takes its name from the City of Leyden. It consists of a HIGH FREQUENCY CURRENTS 23 glass jar covered on both the outside and the inside with tin foil. (Fig. 7.) These coverings only ex- tend part way to the top of the jar. A chain from the cover of the jar connects with the inner layer, terminating above in a small rod with a ball tip. This is for the purpose of charging the jar by con- tact with the charging source or discharging it if this knob is brought nearly or quite in contact with a metallic conductor touching the outer layer. The peculiarity of the Leyden jar consists in the fact that when a charge of electricity is placed upon one of its layers, another charge of opposite polar- ity immediately appears on the other layer of the jar. For instance, if the inner layer receives a positive charge, a negative one will be found on the outer lead foil and vice versa. These charges will be held for some time unless something occurs to connect the two layers and al- 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 getting to one another, does not prevent their exercising 24 EBERHART’S MANUAL OF Fig. 6—High Frequency Effleuve (Spray) in the Treatment of Indolent Ulcer. HIGH FREQUENCY CURRENTS 25 an attraction upon each other; or, to speak more precisely, the one charge induces an opposite charge on the other layer. Fig. 7—Leyden Jar. A substance which separates two charges of elec- tricity in a condenser while still permitting them to have an influence on one another, is called a di- electric. Other di-electrics than glass are mica, vul- 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 other form known as the plate condenser. 26 EBERHART’S MANUAL OF 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, Fig. 8—Section of Jar. Fig. 9—Section of Plate Condenser. 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- resents a cross section of a plate condenser. Electrical Oscillation. When a Leyf en jar or other condenser is discharged through an idr 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 t l e case. At this time Professor Henry announced in reality there was a series of sparks passing back and forth be- HIGH FREQUENCY CURRENTS 27 tween the terminals of the spark gap. This phe- nomenon has received the name electrical oscilla- 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. As 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, the 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 arcs 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. 28 EBERHART’S MANUAL OF Fig. 10—Large High Frequency Outfit. HIGH FREQUENCY CURRENTS 29 Fig. 10a—Portable Coil. Electrical oscillation is the keynote in the thera- peutic application of high frequency currents, al- though it was nearly forty years after its discovery before anyone thought of applying the principle in the treatment of the human body. 30 EBERHART's manual oe 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 all machines represent one or the other or a combina- tion of these types. In connection or combination with them, a third instrument, the resonator of Oudin, is in such com- HIGH FREQUENCY CURRENTS 31 Fig 11—A Complete and Convenient Portable Outfit. 32 Eberhart’s manual oe mon use that it also calls for special description. In speaking of high frequency currents, to be specific, we should always state the form of current used, as D’Arsonval high frequency, or Tesla high fre- quency, etc. The D’Arsonval type of apparatus as it is man- ufactured today consists of a combination of the D’Arsonval solenoid and an improved type of the Oudin resonator. The Oudin current derived 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 same general lines as is the D’Arsonval and has the same wide range of usefulness but the general char- acteristics of the current are different in that the Tesla type of apparatus delivers a high potential, low milliamperage current. HIGH FREQUENCY CURRENTS 33 If every physician employing high frequency ap- paratus was aware of this difference it is the au- thor’s opinion that many cases of misunderstanding and dissatisfaction would be cleared away. In other words the milliamperage reading of the meter is not an indicator of the capacity or power of the apparatus. This means that 500 milliamperes of Tesla high frequency current are 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 “D’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-electric (auto- condensation cushion) has also entered into this dis- cussion. It has been proved that either type is cap- able of producing results and in consequence thereof the author does not feel capable of choosing him- self as the sole arbitor in deciding which is bet- ter. He, however, for the past few 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 34 Eberhart’s manual oe 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- 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 outer layers of the jars was placed a solenoid or 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- HIGH FREQUENCY CURRENTS 35 sity in order to obtain the D’Arsonval current, and it therefore constitutes this type. (See Fig. 13.) 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 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- quency current. Keep in mind the fact that the 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 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 36 Eberhart’s manual of Fig. 13—Diagram of D’Arsonval Type. HIGH FREQUENCY CURRENTS 37 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 extraor- dinary 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- cept the amperage is less. Fig. 14 shows one method of evolving the various currents. Administration of the D ’Arsonval Current. There are three principal 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 38 Kberhart’s manual op Fig. 14—Diagram of Tesla Type. HIGH FREQUENCY CURRENTS 39 the operator, the method is still called direct appli- 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 XI. Refer- ring 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 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 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 40 KBERIIart’s manual op 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 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 HIGH FREQUENCY CURRENTS 41 included, the sharper the resulting spark, and vice versa. Fig. 15—Diagram of Oudin Resonator. Measuring High Frequency Currents. High fre- quency currents cannot be measured with an ordi- nary meter. For D’Arsonval currents the method customarily employed is the use of a hot wire me- 42 Eberhart’s manual of ter. This is really a thermostat instead of an elec- trical device. It is based upon the fact that the passage of the high frequency current gives rise to heat and this heat causes expansion in a platinum Fig. 16—New D’Arsonval Type Meter, wire and thereby deflects the needle in proportion. A type of meter now in general use is shown in Fig. 16. Other methods of measuring these currents are by Gaiffe and Meylon’s induction amperemeter, which “measures the repulsive force between the original current and the current which it induces in a coil attached to the indicator.” HIGH FREQUENCY CURRENTS 43 Fig. 17—Portable High Frequency Apparatus, Giving All Modalities. 44 EBERHART’S MANUAL OF 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 in high frequency work have been made in almost every conceivable form to enable them to be ap- plied to the 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 discs become thicker and the stria- HIGH FREQUENCY CURRENTS 45 tions fewer, and the color changes from a rose-pink 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 inflammation. 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 contains not only blue and violet, but also some ul- 46 EBERHART S MANUAL OE Fig. 18—Interrupterless Transformer, with Resonator Employed in Giving Auto-condensation. HIGH FREQUENCY CURRENTS 47 Fig. 19—An Efficient High Tension Coil. 48 EBERhart’s MANUAL OF Fig. 20—Tubes and Handles. Condenser Electrode. Fig. 21—Insulated Tubes. HIGH FREQUENCY CURRENTS 49 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 conclu- 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 in treating face and scalp. No. 2 is the rectal tube; 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 50 EBERHART’S MANUAL OF Fig. 22'—Various Types of Tubes. account of the ridges around the depression, ena- bling it to be used where it would be difficult to place the body tube. Insulated Tubes. The advantage of the insulated tube which I have been in the habit of calling the high frequency currents 51 Fig. 23—Vacuum Tubes. 52 Eberhart's manual or 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 current 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 trying the experiment referred to, I am sure the physician will resort to the use of insulated tubes for rectal and other orificial work. HIGH FREQUENCY CURRENTS 53 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; 13, 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 if 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 is shown in Fig. 24. It is of spring steel and accommodates tubes of varying diameters. Author’s Spatulate Tubes. I have recently de- signed the tubes shown in Fig. 27. They end in a flattened spatulate extremity. In the body tube the end is at an angle with the main tube, thus making 54 Eberhart’s manual oe Fig. 24—Author’s Latest Adjustable Handle. HIGH FREQUENCY CURRENTS 55 it much handier to use than the regulation type of body electrode. The vaginal, prostatic and rectal tubes are similar in shape, but are straight. They vary only in size and are made both plain and insulated. Fig. 25—Indexed Portable Outfit. The physician who has been using vaginal and prostatic tubes will readily perceive the advantages of the larger flat surface. Either of these tubes will be found quite satisfactory for surface applications. Non-Vacuum Tubes, lined with a silver coating, producing really a condenser effect, are now in com- mon use. They are especially useful in diathermy. 56 EBERHART’S MANUAL OE Fig. 26—Marble Top De Luxe Outfit. HIGH FREQUENCY CURRENTS 57 Fig. 27—Author’s New Spatulate Tubes. 58 EbErhart’s manual of Fig. 27a—Portable Outfit with Cautery and Diagnostic Attachments. HIGH FREQUENCY CURRENTS 59 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 hyperstatic transformer the primary yields a D’Arsonval current and the secondary one similar to that of a resonator or Tesla secondary. When vacuum tubes are applied locally there is soon produced redness and hyperemia, with all of the resultant benefits on nutrition. 60 Eberh art's manual op In short, the fundamental value of high frequency currents is their beneficial effect on all nutritive processes. Incidental to this we have increased oxy- genation 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 applied by means of the glass vacuum electrode is as follows: A mild current with tube in contact is sedative. As the current is increased, or the electrode removed from the surface, allowing a spark to pass, it be- comes first mildly stimulating, then strongly stim- ulating and finally caustic or destructive. The whole gradation of effect from sedation to cauterization 61 HIGH FREQUENCY CURRENTS being essentially a question of current intensity and length 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 oxidization and local nutrition. 3. Increase oxygenation of blood. 4. Increase intake of oxygen. 5. Increase output of carbon dioxide. 6. Increase secretions. 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- 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. 62 Eberhart's MANUAL OE 13. 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 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 cel- 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- HIGH FREQUENCY CURRENTS 63 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. 2. Increase glandular activity. 3. Increase temperature and bodily heat. 4. Increase oxidization and hemoglobin. 5. Increase 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. 64 EBERH ART'S MANUAL 0E 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- Fig. 28—Formalin Sterilizer. 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 HIGH FREQUENCY CURRENTS 65 tube when it is withdrawn. To avoid this, I make it a rule never to leave a vacuum tube in contact 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 “cold sore” result in the formation of a large vesicle which ruptured and poured forth an incredible amount of serum and was three weeks in healing. 66 Eberhart’s manual or 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 he 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 easily 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. The same point must be kept in mind when using the cataphoric electrode. HIGH FREQUENCY CURRENTS 67 Offsetting the 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 bums 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- creases 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 68 Fberhart’s manual 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- rent. Fig. 28a—Portable Outfit. This must not confound the reader with the action of strong sparks, which, as in fulguration, destroy arterioles, or produce an endarteritis similar to that caused by the X-ray. HIGH FREQUENCY CURRENTS 69 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 Lesions; for Relief of Pain; Cauter- ization; Orificial Technique; Catophoresis; Bi-Polar Tesla Technique; Selection of Most Suitable Form 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 which to discuss technique to those methods most commonly in vogue. 70 Eberhart’s manual or Classification of Technique: 1. Vacuum tube technique. (Tube excited by Oudin or Tesla currents.) 2. Fulguration. 3. 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.; (c) 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. 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. 71 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 in treating in certain areas. 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 of a size larger than 72 eberhart’s manual of the glass sound, as suggested in Chapter YII 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 guard against any possibility of spreading infection from one patient to another. In other words he would better follow some defi- nite system of sterilizing and disinfecting the tubes, and the nearer this is to surgical asepsis the better. 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 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 has 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. HIGH FREQUENCY CURRENTS 73 Do not use the same tube for specific and non- specific orifieial cases. This alone will do much toward lessening the danger of infection. As these tubes hear 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- 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, etc., it will suffice if the tube is immersed 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- 74 Eberhart’s manual oe lent, one of crethol, 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 carbolic acid, because equally satisfactory and not caustic if any of the full strength liquid accidentally comes in contact with the operator’s hands. 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 cases 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. HIGH FREQUENCY CURRENTS 75 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. I have spoken of using the same care that you would with a surgical instrument, although the 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- 76 eberhart’s manual of 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. 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 a “crank” 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 vac- 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 HIGH FREQUENCY CURRENTS 77 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 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, if I say I 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. With the Tesla type of apparatus and particularly with small machines, the spark is apt to be sharper 78 Eberhart’s manual oe in proportion, and is designated frequently as a “hot” spark. With these outfits it is 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 of 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- cians 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- turers of any form of apparatus. It will be found convenient for the manufacturer to state with the HIGH FREQUENCY CURRENTS 79 directions for auto-eondensation 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-eondensation. 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 effec- tiveness of 25,000,000. My unit of measurement for auto-condensation is based on the passage of 1,000 volts at the rate of 100 milliamperes in one minute of time. This unit I call the Eberhart and abbreviate it E. 80 Eberhart’s manual or We have two types of apparatus for auto-conden- sation, the one high voltage and comparatively low amperage; the other low voltage and high amper- age. In a general way I assume that the first rep- resents a current of about 50,000 volts delivered at a rate of 350 to 500 milliamperes as shown on a hot-wire meter. The second averages 25,000 volts, potential, and is ordinarily delivered at a rate aver- aging 750 to 1,200; 1,000 being a frequent rate. Ap- plying our unit it will be seen that 50,000 volts equal 50 E. for each 100 milliamperes meter reading, and if the meter reads 500, there would be delivered 5 times 50 or 250 E. for each minute of time, and this would give 2,500 E. in a ten-minute treatment. With the other machine 25,000 volts equal 25 E. per 100, and with meter at 1,000 would give 10 times 25 E. or 250 E. per minute, or 2,500 E. would require a ten-minute treatment. The manufacturer may state the voltage of his machine if desired, but the simpler way is to give the number of Eberharts to each 100 milliamperes meter reading. He should also state the average meter reading at which the apparatus is to be oper- ated. If he states the voltage, to compute a re- quired dose, multiply the meter reading by the num- HIGH FREQUENCY CURRENTS 81 ber of thousand volts, and divide this product by 100. This is the number of Eberhart units being given per minute and by dividing the dose as given in Eberharts by this, we have the number of min- utes required. Going back to our previous example: to give 2,500 E. auto-condensation on a machine of 50,000 volts with enough current passing to raise meter to 500, multiply number of thousand volts 50 by meter reading 500, and product is 25,000. Di- vide by 100 which is done by cutting off two ciphers and we have 250, which is the number of Eberharts per minute—250 goes into 2,500 ten times, therefore it takes ten minutes to give the required dose of 2,500 E. It will be seen that it' would be much simpler if 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 E. 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; 82 Ebirhart’s manual or 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 E. 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. 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, etc., with which the tube comes in contact or within sparking distance of, will be charged with the current and give rise to sharp and disagreeable sensations. If this cannot be avoided they should be removed. HIGH FREQUENCY CURRENTS 83 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 talcum powder or lay over the surface a very thin cloth, such as a handkerchief. In vaginal treatments no disrobing is necessary. General Technique in Skin Diseases and Surface Lesions. In applying the high frequency spark over the surface of the body, as in acne, eczema, etc., I employ a current of sufficient strength to produce a spark one-quarter to three-quarters of an inch in length. The discharge from the smaller Tesla coils is relatively sharper than from the resonator or larger Tesla outfits, and a shorter spark is used as the patient cannot tolerate quite as much current in these instances. With a vacuum electrode cap- able of delivering a spark of the length given, I do not try to make use of the full length spark, but 84 Eberhart’s manual oe keep the tube in light contact with the skin, thus giving a sufficient intensity of current but avoiding the pain that would result if the tube were held at Fig. 28b—Vacuum Electrode Technique. full sparking distance from the surface. The tube is passed rapidly back and forth over the area treated, and this will be accomplished in the easiest manner by holding the tube handle lightly with the HIGH FREQUENCY CURRENTS 85 fingers with the thumb extended along the handle. A side to side motion with the wrist will soon be- come a matter of habit to the operator and the tube will pass lightly over the surface without any sud- den jerk or elevations to cause annoying sparks. If the skin is moist and the tube sticks, it may be dusted with talcum or other dusting powder to obviate this difficulty. Another method is to place a thin cloth over the surface, which will enable the tube to be used smoothly and at the same time does not remove it far enough from the surface to make an unpleasant spark. Where itching is marked, the tube is raised from the skin and as sharp a spark applied as the patient will tolerate for a short period of time. This quickly relieves the itching, and also quickly produces the characteristic reaction of the current (hyperemia, etc.). In treating epitheliomas, lupus and any chronic ulcers, a spark is employed in the same manner, that is, as sharp as the patient can stand, but not for a l®ng period, say from two to three up to occa- sionally five minutes. Unless cauterization is sought, the tube should be kept moving rapidly over the surface and not allowed to expend its full effect 86 Ebebhart’s manual of steadily over any minute area. At the present time 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. 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 HIGH FREQUENCY CURRENTS 87 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 greater 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 in Chapter V.) The technique is so peculiarly that of the special organ involved that it will be given under its appropriate heading in Chapter VII. It 88 EBfiRHART’S MANUAL OF 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- ried into the tissues is in solution, and cotton gauze or felt wet in the solution is placed in the depres- Fig. 29—Cataphoresis Electrode. 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 substances be- 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. HIGH FREQUENCY CURRENTS 89 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 cur- rent for use for these purposes that they are en- titled 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 ele- ments remain at or are drawn through the tissues toward the negative pole, and vice versa. Now, in using high frequency currents, which are alternat- ing, the attraction would be first in one direction and then in the other, and as a result practically nothing would be accomplished. The claim is made that the high frequency cur- rent drives substances into the tissues by “ molecular bombardment.” I maintain, however, that the cata- phoric action of the high frequency current is too feeble to commend it for general use, for which pur- pose nothing takes the place of the galvanic current. 90 Ebijrhart’s manual of The use of dental electrodes for cataphoric pur- poses has given good results. See Chapter X. It is really an electrical diffusion, rather than true cataphoresis. Bi-polar Tesla Technique. Ordinarily the vacuum tube is attached to one pole of the Tesla outfit. In some coils the sharpness of the spark is regulated by drawing off a certain amount of the current from the active pole by bringing the sparking rod near it, thus lessening the available current. If it is desired to intensify the action of the Tesla coil, the indifferent pole should be attached to the patient or grounded by connecting to a gas or water pipe. Selection of Most Suitable Form to Use. Where a local effect is more essential, vacuum tubes, metal electrodes, etc., are employed, but if a systemic or constitutional effect is desired, auto-condensation is to be selected, or the diathermic treatment may be used. 2. FULGURATION. Fulguration. A long, sharp spark for escharotic or destructive purposes was employed for a long time by high frequency operators, but the use of a metal electrode devised by Keating-Hart for this HIGH FREQUENCY CURRENTS 91 purpose, which he termed figuration, gave an un. usual impetus to the method. Figuration as employed at the present time may be considered under two forms: 1. Caustic or hot figuration, employed with D’Arsonval or Tesla apparatus, and giving a hot, caustic, or cauterizing spark. The D’Arsonval figuration is particularly suitable in orificial work, such as papilloma of the bladder, etc. The Tesla is especially advantageous in surface work, such as moles, warts and other superficial growths. 2. Dehydratory or cold figuration, 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. Dr. W. F. Clark of Philadelphia employs a method of cold figuration with the static machine, to which he has applied the term dessication. General Caustic Figuration. The technique which I employ for warts, moles and small growths is as follows: The figuration electrode is attached and the cur- rent turned on gradually, while the length of spark 92 EbErhart’s manual of Fig. 30—An Outfit Combining High Frequency with Numerous Other Modalities, Twenty-one in All. HIGH FREQUENCY CURRENTS 93 Fig. 31—Application of Vacuum Electrode to Chest. 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 an inch in length. This spark is hot, and actually sears 94 ebErhart’s manual of 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 Fig. 32—Fulguration Electrode. Fig. 33—Fulguration Electrode. 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 figura- 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 HIGH FREQUENCY CURRENTS 95 should be done thoroughly, and the growth will pre- 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 you remove too much you cannot place it back again. For more extensive work, local or general an- aesthesia is necessary. It is fair to state that very satisfactory caustic (hot) fulguration may be accomplished with small machines. In papillomata of the bladder, fulguration has been particularly valuable. Fulguration of Papillomata of Bladder. The hot or caustic fulguration may be employed, using wire insulated with rubber tubing, or the D ’Arsonval method, which is bi-polar, may be used as follows: One terminal of the apparatus is connected to the fulguration wire, which is passed through the cystoseope, and the other terminal is con- nected to an indifferent flat metallic electrode placed on the abdomen. The fulguration wire or 96 EBERHart’s manual 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 cystoscope, it should not be larger in gauge than No. 6 French. The patient is prepared with green soap and water and bichlorid, and the bladder distended with water. After the cystoscope is introduced, the tumor is brought into view and the figuration wire passed through the catheter channel of the cystoscope 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 the top of the tumor, an immediate blanching of the tumor is seen. This treatment can readily be car- ried out under the guidance of the eye, providing the insulation of the fulguration wire is intact; un- less the insulation is intact, a short-circuit in the cystoscope and subsequent burning out of the cysto- scopic lamp may result. HIGH FREQUENCY CURRENTS 97 After allowing the current to pass into the tumor for about twelve to fifteen seconds, the current is 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 case, 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 98 Eberhart’s manual or 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- ger of the bare wire causing a short-circuit in the cystoscope. 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. It is suggested that papillomata should be con- sidered malignant in all cases; that in all cases of HIGH FREQUENCY CURRENTS 99 long standing cystitis which has persisted even in the presence of careful treatment, or with the his- tory of frequent relapses, papilloma should be sus- pected, and the diagnosis confirmed or contradicted Fig. 34—Portable Outfit. by cystoscopy. It is the consensus of opinion that the fulguration method is followed by remarkable results, but as yet sufficient time has not elapsed for us to make a definite statement as to an abso- lute guarantee that this treatment will prevent re- currences. (Abstracted from an original article, 100 eberhart’s manual oe “Figuration Treatment of Bladder Tumors,” by Herman L. Kretschmer, M. D., of Chicago. Illinois Medical Journal, April, 1913.) 3. CONSTITUTIONAL (AUTO-CONDENSATION AND AUTO-CONDUCTION). Auto-conduction. In auto-conduction the patient is placed within a large solenoid or coil, constituting a cage. The patient is not in contact with this cage at any point and the high frequency currents in the patient’s body are produced by conduction. The cages are of several types, some in perpen- dicular form, and others in a horizontal position. In the latter, the patient is either placed on a board which slides into the cage, or the top of the latter is hinged like the cover of a basket. Some of the perpendicular forms are collapsible, others are fitted with a door, the patient standing or sitting on a stool. Small cages are also made into which the arm or leg may be introduced, thus producing localized auto-conduction effects. The dosage is the same as with auto-condensation. Owing to an inherent objection on the part of the human race to being incarcerated in a cage, even HIGH FREQUENCY CURRENTS 101 for a short time, this method of treatment, although excellent in results, is used comparatively little at the present time; furthermore, it has no advantage over auto-condensation. Fig. 35—Complete Portable Outfit. 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 other to the patient, who becomes in this manner the other condenser plate. eberhart’s manual of 102 The patient is insulated from the metal plate by silk floss, rubber, mica, glass, or other form of di- electric. Fig. 36. Fig. 37. 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 a couch or pad designed for the purpose and may include the whole body or be constructed to influence only a part of it. The original couch was in a form similar to that of a Morris chair (Fig. 38), the plates of zinc 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 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- HIGH FREQUENCY CURRENTS 103 ceives the charge whether one or both handles are grasped. 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 and has great penetration, so that a vacuum tube will light up within an area of several feet surrounding the patient. With this type the average meter read- ing to obtain satisfactory results is 350 to 500. It is seldom necessary or desirable to secure a higher reading. Lower readings, 150 to 200, would be used where it was desired to influence nutrition without particularly lowering blood-pressure. The other type machine has comparatively low voltage, but high amperage. It may be used with a thin pad if desired. The meter will read 750 to 1,000 on an average, and up to 1,200 or 1,500, accord- ing to the potential of the apparatus. Auto-eonden- 104 EbErhart’s manual OF Fig. 37a—Portable High Frequency, Telatherm Type. HIGH FREQUENCY CURRENTS 105 sation is measured in Eberharts, as stated in a pre- ceding section in this chapter. As long as the patient is in electrical contact with the handles, that is, perfect contact, no sensation is felt except occasionally a slight tingling or sen- Fig. 38—Auto-Condensation Couch with Oudin Resonator and Induction Coil. Original Type. Now Obsolete. sation of warmth. Sparks may be drawn from the patient, and these may be quite painful. In type No. 1 a vacuum tube held in operator’s hand will draw a spark from patient which is known as one form of indirect spark. In general, a feeling of warmth pervades the body after a few moments, 106 Eberhart’s manual oe Fig. 38a—Portable Outfit with Ozone Generator. HIGH FREQUENCY CURRENTS 107 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 outfit, 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 1903 I designed the first portable body pad, which folded together when not in use. It con- sisted 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 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 108 eberhart’s manual oe 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 Electricity, November, 1909, I make a few excerpts: “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 zinc or of sheet lead 1/32 of an inch 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 zinc and the edge of the glass. It should extend lengthwise HIGH FREQUENCY CURRENTS 109 Fig. 39—Thermolysis Outfit—See page 299. 110 IvBF.RHART’S manual op Fig. 40. Indirect Diathermy. Using the Non-Vacuum Electrode as a di-electric, producing local auto-condensation. HIGH FREQUENCY CURRENTS 111 to within six inches of either end of the glass slab. The zinc 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 is preferable to place him on a thin cushion upon the glass, for the sake of comfort. Fig. 41—Condenser Cushion for Chair. “Another method is to take a wooden table long 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 zinc attached to the under surface of this glass, always bearing in mind that the essentials of an auto-condensation pad are to have a di-electrie with a layer of condenser below it, and the patient at- Ebkrhart’s manual oe 112 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 zinc 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-electrie, although the cush- ions themselves, if they remove the body beyond the sparking distance of the charge on the zinc 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 chair, the two connected by a bifurcated conducting cord to the one pole, the zinc plates to the other. “Lastly, a pad may be constructed on the same plan as the one which I have designed, using one or more layers of sheet mica large enough to permit the body of the patient to rest on and making use of a layer of condenser (either lead or zinc) under- neath the mica, taking care that it does not extend near enough to the edge of the mica to allow the HIGH FREQUENCY CURRENTS 113 charge to leak over. On top of the mica place three or four layers of felt or cover with leather, as de- sired. Should the mica be insufficient to prevent some sparking through, it may be obviated by plac- ing another thin cushion on top of this pad.” The patient is placed on the couch or pad and con- nected to the apparatus before the current is turned on, and then the current turned off before the pa- tient lets go of the handles, thus avoiding all shock. If the patient questions whether he is getting any current or not a few sparks drawn from his body readily convinces him. Another form of treatment which the patient feels to the extent of strong muscular contractions may be made by introducing a spark-gap into the pa- tient’s circuit. This I describe in another section as D’Arsonval surgings. The value of auto-condensation depends upon its remarkable effect upon general metabolism (see Chapter V). In nearly all cases of hypertension the blood-pressure is lowered. Auto-condensation treatments average ten to thirty minutes in duration (2,500 to 7,500 Eber- harts), and should be given daily, or six times a 114 EbErhart’s manual oe week at first, in nearly all cases, gradually decreas- ing as improvement takes place. Less than three treatments per week at the start are, in my opinion, practically useless. Longer treatment may be given if the physician desires. Cautions. There is practically no danger of an over-dose of auto-condensation, the only danger be- ing in cases where the patient has a high tempera- ture that will be raised still higher, where a small dose, if any, is given, and in case of a pulse pressure below 20. See section Taking the Blood Pressure, and under Arterio-sclerosis, Chapter VIII. In low pulse pressure there is danger of obliterating the pulse by auto-condensation. Author’s D’Arsonval Surgings. I have alluded to the fact that placing a spark-gap in the patient’s circuit causes strong muscular contractions. The similarity between this and static “surging” caused me to apply the term of “D’Arsonval surging” to this form of treatment. I first noticed it when adjusting the sliding rod on a D’Arsonval-Oudin resonator. This rod enables the operator to balance the current between the coarse solenoid and the resonator, or “tune” the coil. Doing this with the patient on the auto-con HIGH FREQUENCY CURRENTS 115 Fig. 42—Author's D’Arsonval Surgings. Separating the Sliding Rod at A or Introducing a Spark-Gap Anywhere Between A and the Patient, Produces This Effect. 116 EBERHART’S MANUAL OF densation couch caused the latter to exclaim at the resulting muscular jerks. The effect of separating the point of this rod from the solenoid is to introduce a spark-gap in the pa- tient’s circuit and to lower the frequency to the point of causing gross muscular contractions. An outline of the method is shown in Fig. 42. It really is in line with the original experiments of D’Arsonval, who first doubled the number of solenoids, thus producing auto-conduction; then doubled the condensers, as in auto-condensation; and now this form doubles the spark-gap, the only remaining element employed in the D’Arsonval cir- cuit. High Frequency Water Spray. V. Laughter has devised an ingenious method of connecting the high frequency current to liydro-therapeutic apparatus in such a manner that the stream or spray of water emerging from the latter is charged with the cur- rent and when this strikes the body of the patient he receives the effect of the high frequency current as well as that of the water. Local Auto-Condensation. The “Plate Glass Method.” Various methods have been devised for applying auto-condensation locally over small areas. HIGH FREQUENCY CURRENTS 117 Sheets of rubber with a pocket in which to slip a flat lead or zinc plate are one form. A very popular way, known as the “plate glass” method (Fig. 42a), consists in using as an electrode a metal point or ball and applying the sparks through thick plate glass held in contact with the patient’s body. The glass is the di-electrie, the electrode corresponds to one plate of a condenser, and the surface of the body next to the glass the other. A special non-vacuum electrode is made which serves a similar purpose (Fig. 42.) Indirect Sparks. If a resonator is connected di- rectly to a patient with a metallic electrode and a vacuum tube is then brought near the patient’s body sparks will fly from the latter to the tube. These are called indirect sparks. See Figure 43. Attaching the patient in a similar manner to one pole of the Telsa coil, while the tube held by the operator is grounded by connecting to water pipe or gas jet, accomplishes the same result. Another method of deriving an indirect spark and one with which I have been experimenting consider- ably during the past two years is obtained from the patient when lying on the auto-condensation pad. I use a high-voltage, low-amperage type of ma- chine with a thick pad. Enough current is turned 118 Eberhart’s manual of Fig. 42a—Local Auto-Condensation. on to give a meter reading of about 250 (125 E). A vacuum electrode is held in the operator’s hand and the length and strength of spark tested by touching the metal handle which the patient is holding, before the tube is applied to the patient’s body. The current is then raised or lowered to pro- vide a suitable intensity and length of spark, after HIGH FREQUENCY CURRENTS 119 which the electrode is applied to the portion of the body to be treated. The spark is drawn from the patient’s body, is disruptive in character, and is par- ticularly suitable for various skin diseases, having also the advantage of the patient’s nutrition and general metabolism being benefited by the auto-con- densation which accompanies it. In other words, it is both local and general in its effects. Taking the Blood Pressure. As a knowledge of the patient’s blood pressure is vitally necessary to the physician using high frequency current it is important that he should have an instrument for its rapid and accurate determination. The instru- ment used for this purpose is called a sphygmoma- nometer and a number of satisfactory machines are on the market. The diaphragm type is shown in Figs. 44 and 44b. The mercury type is shown in Fig. 44a. Its action depends on opposing the pressure of a column of mercury with the pressure of the blood in an artery. For this purpose the brachial artery, in the arm above the elbow, is selected. A cuff or band containing a rubber sack is fas- tened around the arm above the elbow, with that part from which the rubber tube emerges lying in 120 Fbfrhart’s manual of front over the artery. Ordinarily the sleeve is rolled up before the band is applied, but if the clothing is thin this is unnecessary. A small rubber hose runs from the cuff to the machine, which has a U-shaped tube containing mercury, with a gauge be- tween. The zero mark on the scale is placed on a level with the top of the mercury. A rubber bulb is attached by a small tube to the machine, and the physician holds this bulb in one hand, while with the other he keeps a finger on the pulse in the patient’s wrist. The bulb is now com- pressed and immediately air fills the cuff and the column of mercury begins to rise. The operator con- tinues to slowly inflate the cuff until the pressure of the latter shuts off the blood in the brachial artery and the pulse can no longer be felt at the wrist. When this occurs the pressure of the column of mercury has balanced the pressure of the blood in the artery and the reading on the scale opposite the top of the column is the patient’s blood pressure. In using the instrument, it is customary to force the mercury a little above the point where the pulse ceases to be felt and then wait two or three seconds until the column settles to the point of the reap- pearance of the pulse. By doing this one, two, or HIGH FREQUENCY CURRENTS 121 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 variation of 10 millimeters up or down would not Fig. 43—Indirect Sparks. necessarily imply abnormal pressure, but 140 or more would be presumptive of the presence of or tendency to arterio-selerosis. Another instrument for accurately determining blood pressure is the tycos diaphragm type of instru- ment, shown in Fig. 44. 122 EBERHART’S manual OF Fig. 44—Taking Blood Pressure with Diaphragm Type of Sphygmomanometer. HIGH FREQUENCY CURRENTS Fig. 44a—Taking Blood Pressure with Mercury Sphygmomanometer, of the type in use by the U. S. Government for a number of years. The mercury in this outfit is non-spillable. 124 eberhart’s manual oe This is not a mercury instrument, but the read- ings are obtained by indirect, internal pressure on sensitive diaphragm chambers, so sensitive indeed that every action of the heart is shown plainly by the hand on the dial, as the hand works co-ineidently with the heart. With this instrument the observer can accurately determine complete blood pressure. By that we mean maximal or systolic; minimal or diastolic, and pulse pressure (the difference between the two). The cor- rect method of taking blood pressure readings with this instrument is explained later on, and is accom- plished with either the dial or mercury type of sphygmomanometer. It is probably well to verify or compare the diaphragm type occassionally with an- other sphygmomanometer because of the possibility of its getting out of order without showing the error on the dial itself. An error is quickly apparent in the mercury type of instrument because the mercury must balance at zero when not under pressure. 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 HIGH FREQUENCY CURRENTS 125 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 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 contra- indicated. 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 from 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 con- dition is compensated (or the pulse pressure could not be normal), and, therefore, a circulatory equilib- rium is established, and in these cases any further reduction of systolic blood pressure must be accom- panied by a corresponding decrease in diastolic pres- sure or compensation will be interfered with. Of course, if the systolic was reduced to 160 and the diastolic remained 140, compensation would still 126 EbErhart’s manual oe 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 auto-condensation both systolic and diastolic pres- sures decreases, if not always the same reduction, at least without the pulse pressure going below 20, the treatment may be persisted in until the systolic pressure is 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 raise it slightly, that pulse pressure may be at least 25. 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. See further discussion and examples under Arterio- sclerosis, Chapter VIII. HIGH FREQUENCY CURRENTS 127 There are two methods of determining blood pres- 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 far, the most practical method of accurately deter- 128 Eberhart's manual of mining blood pressure, as the dangers of personal equation are greatly lessened. (See Fig. 44e.) 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 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 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 ob- served, when the pressure is first increased on the brachial, as soon as a slight pressure is placed on the artery, a pistol-shot tone is heard, and will con- tinue with but little variation throughout the ob- servation. When this condition exists it is abso- lutely necessary to resort to the oscillatory method. It is also necessary to use the method by oscillation when the pulse is feeble. HIGH FREQUENCY CURRENTS 129 Having now accurately determined both systolic and diastolic pressure, we compute the pulse pres- sure. Pulse pressure is obtained by subtracting the dias- tolic from the systolic, for example: Fig. 44c—Auscultation Method. Systolic pressure, 120; diastolic pressure, 90; the difference, pulse pressure, 30, and, as previously stated, it should not be less than 20, and would also indicate a pathological condition as probable if over 55. The diastolic blood pressure should be approxi- mately two-thirds of the systolic and the pulse pres- sure should be approximately one-third of the systolic. 130 eberhart's manual of Iii 35,000 cases the average systolic pressure was found to be: Children’s pressures—2-5, 80; 5-10, 90; 10-15, 100- 110. 15—20 118. 40—45 128. 20—25 123. 45—50 130. 25—30 124. 50—55 132. 30—35 125. 55—60 134. 35—40 126. 60—65 136. It is well to remember that there is an ever in- creasing hardening of the arteries as one grows older, and a person of 65 or over can very easily have a blood pressure of 160 and still be a com- paratively healthy individual. At the same time if these changes were not taking place the blood pres- sure would remain the same, no matter what the age of the patient might be. Female pressure is 10 mm. lower than that of males. Any blood pressures, however, between the ages of 21 and 50, lower than 100 or higher than 150, can safely be termed patho- logical cases. Leading life insurance companies now insist on the examiner taking the blood pressure. Most of them reject applicants whose pressure is 160 or higher, whether any other reason is apparent or not; HIGH FREQUENCY CURRENTS 131 just as they do where the pulse is persistently above 90. An easy method of keeping the range of blood pressure in mind, which I have employed in my classes, is as follows: Consider 120 the normal. At 20 above or below, that is 140 or 100, the warning signal is out, and at 20 more either way (160 or 80) the brink of the precipice has been reached and a pathological con- dition, and probably a dangerous one, exists. -Low Normal High 80 100 120 140 160 Danger Point Warning Warning Danger Point It has been noted that enlargement of the heart or degeneration of the kidneys causes a comparative- ly high blood pressure and when both are present the pressure may be extraordinarily high, often 280-325, or higher than is provided for on many of the instru- ment scales. An increased determination of blood to the sur- face of the body lowers the pressure, and, con- versely, driving the blood from the surface raises the blood pressure. 132 EBERHART’S manual of It is important that the sphygmomanometer be used, as in one series of 1,000 tests it was observed that abnormal pressure existed in many cases that a competent and experienced observer failed to de- tect without. In taking the systolic pressure I have occasionally found that just as I had determined the pressure there would be a sudden increase, running up 5 to 20 millimeters. This I have concluded is due to a spasm of the artery, causing sudden contraction. Blood Pressure in Various Diseases. Some con- ditions in which high blood pressure is found are arterio-sclerosis; angina pectoris ; aneurysm of aorta, chronic bronchitis, cirrhosis of liver, constipation, brain tumors, dilatation of aorta, emphysema, glycosuria, gout, hypertrophy of heart, lead poison- ing, chills, meningitis, uremia and all kidney affec- tions except amyloid, suppurative or tuberculous. Low blood pressure is found in weak heart with dilated arterioles, Addison’s disease, aortic stenosis, asthma, chlorosis, dilatation of heart, hemorrhage, jaundice, mitral regurgitation, mitral stenosis, obes- ity, pyrexia, trypanosomiasis, tuberculosis, etc. Miscellaneous Suggestions. When a resonator is employed in connection with an induction coil on HIGH FREQUENCY CURRENTS 133 the direct current and a mercury interrupter is used, if it is difficult or impossible to secure a steady spark in the spark-gap of the resonator, it is a sign that the mercury in the interrupter is dirty and needs cleaning. With this same apparatus, the spark may be made sharper by increasing the number of turns of wire in use in the coarse or primary coil of the resonator. This increases the size of the solenoid and conse- quently its induction. This is true of any Oudin resonator having the sliding rod to regulate the size of the coarse coil. When-using vacuum tubes care should be excer- cised to prevent the connecting cord from touch- ing the patient, as annoying sparks will result. It is almost impossible to find a cord so well insulated that the high frequency current will not soon find its way through. Diathermy. The fourth division of my classifi- cation of technique involves the methods known un- der the several terms, electro-coagulation, thermo- penetration, direct D’Arsonval current and dia- thermy. The method of employment is given in Chapter XI. 134 EBERHARTS manual oe CHAPTER SEVEN. Special Vacuum Electrode Technique for Various Parts of the Body, Including Ear, Eye, Nose, Rectum and Prostate, Scalp, Throat, Urethra and Vagina. In order to avoid unnecessary repetitions in Chap- ter VIII, where particular diseases are considered, the method of using vacuum electrodes in treating various portions of the body is given herein, to- gether with an idea of the scope of the treatment in diseases of these organs. Technique in Diseases of the Ear. In applying the current to the ear, as in catarrhal deafness, etc., a small vacuum electrode is employed, plain and in- sulated types of which are shown in Figs. 20 and 21. These are used most conveniently in the author’s movable socket handle, which enables the patient to sit comfortably with the hands against the chest, the tube placed at such an angle in the handle that HIGH FREQUENCY CURRENTS 135 it is easily inserted into the ear and the cord con- necting to the apparatus hangs clear of the patient. (See Fig. 45.) Fig. 45—Treating the Ear. It is certainly a great improvement over the old method, which required the patient to hold the handle almost at arm’s length. 136 Eberhart’s manual of The electrode is placed in the ear and the machine started with a minimum of current. The strength is then increased in accordance with the tolerance of the patient to the point where the buzzing sound becomes annoying, or the tine sparks become too sharp. With the insulated tube, the sparks coming from loose contact with the external opening are avoided. A marked sensation of heat is noticed in the ear, and the best method of regulating the length of the treatment is to allow the tube to remain until this heat effect becomes a little uncomfortable, although I would never under any ordinary circum- stances continue the treatment longer than seven minutes. I designed a holder a few years ago which per- mitted treating both ears at the same time, but for all ordinary conditions this is scarcely necessary, as the additional time required in treating the other ear where both require treatment is not sufficient to interfere seriously. The conditions of the ear in which high frequency currents give the best results are catarrhal deafness; earache; tinnitus aurium, and chronic suppurative diseases (middle ear dis- eases). HIGH FREQUENCY CURRENTS 137 Special Technique in Treating the Eyes. For ap- plying high frequency currents to the eye, a double electrode is used, as shown in Fig. 46, which is in- serted in the handle and the socket bent so that the patient may hold the handle against the body and thus steady it, and at the same time keep the elec- trode in contact with the eyes, without taking any Fig. 46—Double Eye Electrode. chances of touching the cord connecting the elec- trode to the high frequency apparatus. This is shown in Fig. 47. The eyes are closed and the tube kept in light but firm contact with the lids. The current is turned on after the tube is adjusted and is turned off before the electrode is removed, thus saving the patient from any spark. The duration 138 eberhart’s manual oe of the application varies from three to ten min- utes. If only one eye is affected, only one lobe of the tube may be brought in contact with the Fig. 47—Treating the Eyes. eye and the other may extend out to one side of the head, or a special single eye tube may be used. One of the other vacuum tubes may be employed in treating the eye and kept in motion back and forth HIGH FREQUENCY CURRENTS 139 Fig. 47a—An Outfit Specially for Eye, Ear, Nose and Throat Treatment. 140 EBERHART’S MANUAL OF over the closed lid, or held in contact with it as preferred. This method with a fine spark has proved very effective in blepharitis. These currents are useful in atrophy of the optic nerve; catarrhal conditions of the eye; absorption of hemorrhages; inflammation of the retina, and in Fig. 48—One Form of Nasal Tube. connection with auto-condensation for the reduction of the blood pressure, they have given remarkable results in glaucoma. Blepharitis, trachoma, iritis, paralysis of the ocular muscles, and cataract, are other conditions in which they have been employed. Nasal Technique. The diseases of the nose that are specially suitable for treatment are all catarrhal conditions, including ozena (atrophic rhinitis), co- ryza, etc. Even in hay fever it has proved useful. The small nasal tube (Fig. 48 or Fig. 21, No. 13) is introduced and the current turned on very slowly. A mild current is all that is required and the length of treatment varies from two or three to seven min- utes. It makes very little difference whether the HIGH FREQUENCY CURRENTS 141 tube is inserted in the straight or the movable socket handle. If the upper or back part of the nasal cavity is to be treated, a tube having an insu- lated chamber to within possibly three-quarters of an inch or an inch of the end is preferable to the non-insulated tube. In acute inflammatory condi- tions the application of a vacuum electrode to the sides of the nose, externally, is advised. Technique in Treatment of Rectum and Prostate. In treating the rectum for fissure, hemorrhoids, ca- tarrhal conditions, etc., the insulated tube shown in Fig. 21, No. 8, should be used. The non-insulated tube is of much less value for diseases above the sphincter. The rectal tube may be employed in treating the prostate, although the tube specially designed for the latter purpose is the one shown in Fig. 21, No. 1, where the depression in the tube is supposed to be turned toward the anterior wall of the rectum, and receive into it a portion of the gland. My new spatulate tube used with one of the flat surfaces toward the prostate gives a larger contact surface, it being doubtful whether with the other tube the gland really ever fits into the depres- sion. In prostatic diseases of all kinds, the high frequency current has proved most efficacious, 142 EBERHART’S manual oE Fig. 49—Treating the Scalp. HIGH FREQUENCY CURRENTS 143 whether used alone or in connection with some other modality. In treating both the rectum and the prostate, my special technique consists in placing the patient on one side in the Sims’ position with the knees well drawn up. The electrode is lubricated, inserted in the movable socket handle and introduced into the rectum. The handle is then bent upwards in contact with the body and the patient takes hold of the handle, thus keeping the tube in place dur- ing the treatment. The duration of each treatment is seven minutes, and the tube is inserted always before turning on the current and the latter turned off before the tube is removed. Treatment through the rectum is very effective in posterior urethritis, also in diseases of the bladder. Occasionally in vir- gins it will be found desirable to treat uterine or vaginal conditions with the high frequency electrode in the rectum. The current penetrates surrounding structures to a much greater extent than one would suppose. The special technique for itching is given in Chap- ter VIII under Pruritis. Scalp Treatment. In treating the scalp, the body electrode, Fig. 49, is used. The electrode is moved 144 eberhart’s manual oe rapidly back and forth over the scalp, using a spark of from one-quarter to three-quarters of an inch or keeping the tube in light contact with the scalp. If too sharp a spark is used, the scalp will be sore after the treatment and tiny sores will be found. High frequency currents are indicated in all diseases Fig. 49a—Scalp Electrode. of the scalp, in falling hair, and some years ago I 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 resembling a glass rake is now in general use. (Fig. 49 a.) HIGH FREQUENCY CURRENTS 145 Throat Technique. The throat electrode is shown in Fig. 50. Any of the other electrodes may be used externally. In acute inflammatory conditions of the throat the low vacuum tube is preferable. The tube may be placed directly in contact with the mucous membrane of the throat or a spark allowed Fig. 50—Throat Electrode. to pass, according to the nature of the case. Sparks from the regular tube or from the fulguration point have been employed to destroy follicles in pharyn- gitis- or in place of nitrate of silver cauterization, and the fulguration point has even been used in the removal of the tonsils. Urethral Technique. When employing glass sounds (Fig. 20, No. 5, or Fig. 21, No. 12) within the male urethra, the patient is placed upon his back on the operating table. Whether the knees are flexed and the legs drawn up depends somewhat upon the individual case; ordinarily the legs are straight, but slightly separated. 146 Kberhart’s manual oe The sterilized sound is lubricated and introduced in the same manner that a steel sound would be used, taking care, however, not to use much force, on account of the possibility of breaking the tube. This has happened occasionally, through a prying or sidewise motion, or through a sudden jerk. ‘If the canal is too small to admit of the easy passage of the tube, steel sounds are used first to dilate the urethra to a sufficient size. In case a stricture is present and the whole canal cannot be dilated sufficiently to allow the glass tub* to pass the stricture, then it is introduced as far as the stricture and the treatment given. On subse- quent days it will be found that the stricture gradu- ally disappears until 'finally the glass tube will pass by it. When the urethral tube has been properly insert- ed, the socket of the holder is slipped over it, and the handle bent back over the patient’s abdomen. The patient takes hold of it and thus steadies the 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 connected to the machine and the current turned on. In this way the patient experiences no shock. HIGH FREQUENCY CURRENTS 147 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 of uterus and vagina, including leucorrhea, cervicitis, endometritis, etc. They are extremely valuable in specific vaginal diseases in conjunction with the usual method. Treatment through the vagina is also 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 and the lubricated tube in the author’s movable socket holder is inserted, and then the handle is 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 side- 148 EBERHART’S MANUAL OE 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 is 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 should 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 is used. (An old-fash- ioned glass one is better.) In cancer, the fulgura- HIGH FREQUENCY CURRENTS 149 tion tube may be used through the vagina to destroy the cancerous tissue. This may or may not require an anaesthetic. Fig. 50a—Body Electrode Application. One authority packs the vagina with moistened gauze with a metal electrode in the center and thus carries 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. 150 ebErhart’s manual of 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- eases 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, where auto-conden- sation is referred to, it is given according to the technique in Chapter VI; the same with fulguration, etc. Where special regional technique is advised, as for the prostate, vagina, etc., the directions in men FREQUENCY CURRENTS 151 Chapter VII are to be followed unless otherwise indicated. Where small Tesla coils are used with the vacuum electrode, it should he 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 giving a comparatively “cold” 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 with the skin and where it is not it is so stated in the text. In any of the cases calling for the spark the indi- 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- 152 eberhart's manual of tion or auto-conduction, the treatment must be much longer than that for a purely local effect. The aver- age duration of local 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, etc. 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- peres meter reading per minute to each 1,000 volts of potential. There are two types of apparatus employed, which I 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. HIGH FREQUENCY CURRENTS 153 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 350 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 larger dose, rather than to crowd the meter reading to a higher point. 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. 154 ebErhart’s MANUAL OF No. Eberharts per 100 Meter Reading No. Eberharts Minutes for 2,500 E No. 1 No. 2 No. 1 No. 2 Both Types Both Types 50 25 200 400 100 25 50 25 250 500 125 20 50 25 300 600 150 16.67 50 25 350 700 175 14.28 50 25 400 800 200 12.50 50 25 450 900 225 11.11 50 25 500 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 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 given 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- high frequency currents 155 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 under treatment for high blood pressure and pulse pressure went to 20 or below, I would either stop the treatment 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 metab- olism, the dose should average about 1,250 Eber- harts and should be given at a low meter reading (200 to 250 for No. 1; 400 to 500 for No. 2). If this 156 eber hart’s manual of 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- 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 lights 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 fulguration electrode, regu- lating the strength of spark in accordance with the toleration of the patient and treating from two or three up to six or eight minutes at a sitting, accord- ing to the amount of destruction required. A spark HIGH FREQUENCY CURRENTS 157 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 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- narily 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 talcum 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 158 ebKrhart’s manual of Fig. 51—Body Electrode Applied to the Face. HIGH FREQUENCY CURRENTS 159 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 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 160 ebErhart’s manual of 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 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 scars 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 fulguration point may be employed. Actinomycosis (Kay 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 length, 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). HIGH FREQUENCY CURRENTS 161 Adhesions. Where pelvic or other adhesions fol- low operations or inflammatory conditions, the high 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, or use the direct spark with patient on auto-condensation pad. In pelvic adhesions, the use of the vacuum electrode in the vagina in connection with the surface application will hasten results. Me- chanical vibration and diathermy is advised in con- nection. 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 sufficient value to warrant its employ- ment, if possible, in every ease, is my firm belief, eberhart’s manual of 162 particularly in cases where high blood pressure ex- 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 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, a high frequency current naturally suggests itself as an ideal remedy. The applications are made with the vacuum tube, HIGH FREQUENCY CURRENTS 163 Fig. 52—Treating Alopecia (Lloyd). ebErhart’s manual of 164 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 in 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 get the best results a daily treatment is advised, and two short treat- ments per day would not be too much. In connec- 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. Amenorrhea. That the high frequency current when applied through the vagina sometimes has an emmenagogue effect has been noted by several authors. I have occasionally observed the same ef- HIGH FREQUENCY CURRENTS 165 feet, 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, the 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 connection. In virgins, where the menstrual func- 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. 166 ebEr hart’s manual of Fig. 52a—Small Portable Outfit. HIGH FREQUENCY CURRENTS 167 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 corpuscles and the percent- age of hemoglobin, their employment in anemia, es- pecially of the chlorotic type, is quite as effective as iron tonics, and at the same time does not inter- fere with the joint use of the latter. The method of administering the current is 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 E. 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 eases 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. 168 eberhart's manual of 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 case, 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. Arteriosclerosis and High Blood Pressure. Arte- riosclerosis is a disease that is of the utmost im- portance, because it is the primary condition which results in so many diseases of kidneys, liver, heart and brain, which we are accustomed to classify ac- cording to the organ more particularly affected. Arteriosclerosis, formerly looked upon as the heri- tage of old age, is now very common and greatly on the increase because of our present mode of life with its strenuous efforts to gratify ambition; its ex- cesses and indiscretions in eating, drinking, etc. To- day there are many men young in years whose arter- HIGH FREQUENCY CURRENTS 169 ies are those of the octogenarian and forecast the probability of a sudden termination of their useful- ness. The most prominent and persistent symptom of arteriosclerosis is high blood pressure. The circu- 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 as the veins grow larger. Thus we have the com- plete round of circulation, the blood following the rule of water and of electricity and flowing from a higher to a lower pressure. Normal pressure of the blood in the arteries is sufficient to support a perpendicular column of mercury of from 110 to 120 millimeters. In arteriosclerosis it sometimes in- creases to over 300. The disease is usually divided into the functional and organic stages. The first would be the stage previous to the real hardening of the arteries and the latter that in which structural changes actually had occurred. 170 eberhart’s manual oe In the functional stage there comes to be present a contracted condition of the artery, producing thereby increased tension and raising the blood pres- sure. At this time this is the result of irritation and spasm on the part of the muscular fibres and no 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- comes a more or less steady contraction, increasing 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 HIGH FREQUENCY CURRENTS 171 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- curring 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 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, etc. 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. Eberh art’s manual of 172 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 Turkish baths. Swimming all right. Horse-back riding; slow horse. Slow golf. Automobiling all right. No stairs; no strain; no hurry. Eat coarse graham 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 flatulence). Eat lightly and more 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 eases 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.) HIGH FREQUENCY CURRENTS 173 The electrical treatment of arteriosclerosis is the use of the high frequency current by auto-condue- tion or by auto-condensation. The preliminary dose is 2,500 E., and it should be given daily in the begin- 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. A treatment every week or two should be maintained for some time in order to be sure of the permanency of results. It is not enough to force the pressure down and then suddenly abandon all treatment. It will re- quire on an average about 40 to 50 treatments to bring the pressure from 200 down to 140 or under, or to the point where only one treatment a week is needed. The pressure is taken before giving the treatment and if taken after shows an average reduction of about 10 to 12 millimeters. In a few hours the pres- sure is back nearly to where it was before, the net reduction being from one-half to two millimeters, according to the individual and the degree of pres- sure. When the pressure is over 200 I expect to get 174 eberhart's manual oe a net reduction of two millimeters for each treat- ment. Between 200 and 160 I look for an average of one and one-half points, while below 160 it will be from one down to one-half millimeter. In some cases it goes down steadily for 10 to 15 points, and then remains stationary for a week or two, and then down another series. Dr. John Ritter of Chicago has shown that the blood pressure, like the pulse, varies with the posi- tion of the patient, whether standing, sitting or lying down. Therefore, it should be taken on sub- sequent occasions with the patient in the same posi- tion. It should not be taken too often, say, once a week, as otherwise the gain is not specially noticeable. Occasionally, just as the pulse had been cut oft* by the pressure of the brachial artery and I had noted the systolic reading, the pressure would go up five, ten or twenty millimeters. This I have at- tributed to a spasm taking place in the brachial artery from too frequent taking of the pressure. At the end of ten treatments, if the blood pres- sure is not reducing in accordance with the rate given above I increase the length of the treatments, about one-half (3,750 E.), but do not increase the HIGH FREQUENCY CURRENTS 175 meter readings. After another ten treatments, if the reduction is sufficient, I lengthen the time to twice the original (making 5,000 E.), and so I keep crowding the dose until I get results or convince myself that it is impossible. Many operators fail because afraid to push the dose. When taking the pressure, take both systolic and diastolic, and note their difference, pulse pressure. In these cases we are only interested, as a rule, in low pulse pressure, and this should never remain long under 20. If it does we have carried auto-con- densation as far as it will do any good, and it must be stopped, as further treatment will entirely dis- turb compensation and endanger the patient. Ordinarily the systolic and diastolic pressures go down simultaneously, though not always the same number of millimeters. Occasionally the systolic goes down faster than the diastolic until the pulse pressure reaches 20. I then lessen the dose to 1,000 or 1,250 E., or skip a treatment or two, and if after this it remains at 20, or possibly goes down to 18, I stop the treatment altogether, whether the systolic is down to normal or not, and usually give some sharp sparks to spine to raise the systolic, and there- by also the pulse pressure, until the latter is above 20. 176 Eberhart’s manual of I have met with occasional cases in which no bene- fit or only a very temporary reduction followed the use of auto-condensation. Increased determination of blood to the surface of the body lowers the blood pressure and, con- versely, driving the blood from the surface, raises it. Therefore, any remedy that increases peripheral cir- culation lowrers the blood pressure. In addition to the drugs employed for this purpose may be men- tioned electric light baths, oxygen baths, etc. In advanced cases care should be exercised not to re- duce the blood pressure too rapidly at first. We must not lose sight of the fact that either auto-condensation or auto-conduction, if capable of lowering blood pressure, is equally capable of pre- venting the development of arteriosclerosis when employed at the first sign of increased pressure. In brief, the effects of old age may be discounted. I voice the view of many authorities when I state that a man past forty, who is under considerable strain or carrying a heavy load in his business or profession, and who finds difficulty at times in con- centrating his attention, awakens in the morning more tired than when he went to bed, has occasional spells of dizziness or light-headedness, or notices HIGH FREQUENCY CURRENTS 177 occasional tingling or numbness in the extremities, owes it to himself to ascertain whether or not these symptoms are pointing toward the development of arteriosclerosis. If his fears prove groundless, well and good; but if evidences of arterial involvement are present, they will be discovered in time to pre- vent their untoward effects. Articular Rheumatism (See Rheumatism). Asthenopia. Use the body electrode carrying a spark from one-fourth to three-fourths of an inch, according to the sensitiveness of the patient, and keep the tube at full sparking distance. Pass it rapidly up and down the spine for three minutes. This treatment is satisfactorily applied through some layers of clothing, as the latter insure a defi- nite spark length. In women the corset should be removed if any steels are where they will be charged by the current. If a chain is worn around the neck it should be taken off. Follow the spinal treatment by an application of the same tube to the back of the head and neck for three minutes longer, then over the eyes for two or three minutes, keeping it in contact with the skin. Finally use the double eye tube, Fig. 6, for three minutes. Three to six treatments per week. 178 EBERHART’S MANUAL OE Ozone inhalations and vibration are useful ad- juncts. Asthma. The treatment of asthma may be by vacuum tube applications over the chest or by plac- ing a diaphragm so that a powerful effluve or fine sparks will fall upon the chest. The vacuum tube should be used with as sharp a spark as the patient will permit and is conveniently applied through the underclothing. Mechanical vibration is especially useful in con- nection with high frequency. Direct D’Arsonval application with one sponge to the back and the other moved back and forth over the chest is another method. Daily treatments of about ten minutes’ duration. A cure should not be expected. Ataxia (See Locomotor Ataxia). Atonic Dilatation of the Stomach. In this disease we have complete relaxation of the motor fibres of the stomach and the treatment must be that which will cause them to actually contract and regain their normal tone. The first cases treated by high fre- quency were those reported by Chisholm Williams. He employed the vacuum tube for five minutes lo- cally over the stomach, followed by auto-condensa- HIGH FREQUENCY CURRENTS 179 tion for ten minutes. This treatment was repeated daily. In one case a cure resulted in six weeks. This author also reported results in seventeen cases treated by Drs. Crobie and Bokenham. The results were proved by skiagraphs. One method that has been used in treating this disease has been to localize the effects of auto-con- densation by using the metal electrode and placing a piece of plate glass between the electrode and the stomach area. The plate glass is the di-electric. The electrode corresponds to one layer of condenser, and the gastric area to the other, thus obtaining the ef- fect of auto-condensation. (See Fig. 42a.) I have found general auto-condensation treat- ments (2,500 to 7,500 E.) were entirely satisfactory for this disease often combining with mechanical vibration. The sinusoidal current has proved of essentially equal value. While applying the general auto-condensation on the couch, it is possible to draw sparks from the body with the vacuum tube locally over the stomach at the same time with benefit. The foregoing treatment is equally effec- tive in atony of the stomach when dilatation is not present. Atrophic Rhinitis (See Ozena). 180 Eberhart's manual oe Atrophy of the Optic Nerve. The method of treat- ing this disease with high frequency currents has been by the use of the eye electrode, single or double, as required, the same being held in contact with the closed eyelid and the current allowed to pass for from five to ten minutes. The current is of a strength just short of producing painful sparks on the lid. In the place of the eye electrode, I have used the form shown in Fig. 21, No. 11, using a current that would not be capable of producing a spark of more than one-sixteenth of an inch, and keeping it in light contact with the lid while it is passed back and forth for several minutes. Another author sug- gests at the same time an application with a stronger current, keeping the tube in loose contact with the skin over the temple for about the same length of time. Daily treatments are advised. Baldness (See Alopecia). Barber’s Itch (See Sycosis). Bladder Disease (See Cystitis). Bladder, Papilloma of. See technique under Ful- guration, Chapter VI. Blepharitis. In a large number of cases of bleph- aritis a cure has resulted from the use of a very mild spark from the vacuum tube. Sometimes it has HIGH FREQUENCY CURRENTS 181 to be persisted in over a long period on account of a marked tendency to relapse. One case referred to me by Dr. Eager which had resisted all of the usual routine treatment improved rapidly under three ap- plications a week of the high frequency current in connection with the high candle-power light. Over sixty treatments were given, however, before the case was essentially cured. Fox treated 100 cases with no failures. The technique which I employ is as follows: I use the electrode shown in Fig. 21, No. 11, with just enough current to produce a stinging sensation when applied to my own eyelid, the fine spark from it being from one-thirty-second to one-sixteenth of an inch in length. I raise the upper lid by pressure with the thumb and apply this fine spark along the edge for two minutes, and then pull the lower lid down and do the same. Then while the patient closes the eye I pass the electrode over the whole surface of the lids for two or three minutes longer. A daily treatment is preferable, but three times a week will suffice. Blindness from Intra-Ocular Hemorrhage. In this condition the current is used to promote absorption, and as the blood pressure is always high, there is an 182 eberhart’s manual of indication for tiie use of auto-condensation or auto- conduetion for the purpose of reducing it. I report a most interesting case which occurred in the wife of a Methodist clergyman. She became suddenly blind in the left eye and applied to me for treatment. Not being an oculist I referred her to Dr. Good for diagnosis and he found on examina- tion that a considerable hemorrhage had occurred, thus obstructing the vision. An unfavorable prog- nosis was given. I treated the case in the following manner: The patient’s blood pressure was 156 and there were abundant signs of arteriosclerosis, so she was given first 2,500 Eberharts on the auto-conden- sation couch, after which the vacuum electrode (Fig. 21, No. 11) was rubbed gently over the closed eyelids, temple and supra-orbital region, using a mild current, capable of giving a slight stinging sensation when passing in loose contact with the skin. After this, very mild mechanical vibration was applied through my fingertips to the closed eye for thirty to sixty seconds only. Daily treatments were given and the result was little short of marvel- ous. Inside of two weeks the sight returned to the eye and a few weeks later it was stronger than HIGH FREQUENCY CURRENTS 183 before the hemorrhage occurred, as the patient had had some difficulty with this eye for many years. Blood Pressure. See Hypertension (High Blood Pressure), also Hypotension (Low Blood Pressure), and Arteriosclerosis. Boils. (See Furunculosis.) Brachial Neuritis. (See Neuritis.) Brain Fag. “Brain Fag” has come to represent a condition just one step removed from complete nervous prostration. It is common in business men, especially where too close attention to business has been accompanied by too little exercise. The favor- ite prescription has been a complete change of scene, such as a sea voyage. This treatment- is not always possible, and much may be accomplished by the use of high frequency currents, ozone, and mechanical vibration. The nature of the high frequency treatments should be in accordance with the patient’s blood pressure. If the blood pressure is high, auto-conden- sation or auto-conduction is clearly indicated, and 2,500 to 5,000 E. should be applied daily, or even twice a day if the case is urgent. Following this, the vacuum tube with a spark just strong enough to have a good tonic effect should be applied to the 184 eberhart’s manual of forehead over the eyes and to the back of the head and neck. The patient will nearly always complain of pain in the back of the neck, the pain so common in neurasthenia. In many of these cases the blood pressure is below normal and in these the use of auto-condensation or auto-conduction is distinctly contra-indicated. In- stead there should be the application of sharp sparks, say one-half inch or more in length, up and down the spine for four or five minutes, then over the abdominal region for three minutes more, finish- ing with the application over the eyes and back of the neck, as outlined above. In all cases, two or three minutes’ inhalation of ozone after the high frequency treatment is desir- able, or, if possible, the patient should install an ozone machine in his office and also in his sleeping room so that he is constantly breathing air charged with a large amount of ozone. (See Chapter IX.) When the blood pressure is low a mild, stimulating application of mechanical vibration along the whole spine is indicated, dwelling somewhat longer over the back of the neck. Bronchial Asthma. (See Asthma.) HIGH FREQUENCY CURRENTS 185 Bronchitis. High frequency currents are useful in acute bronchitis but circumstances usually render them unavailable. If, however, the physician has a portable high frequency outfit and there is elec- tricity in the patient’s room, he will find that a rea- sonably sharp spark over the chest and back, until they are well reddened, will give relief. This treat- ment may be repeated every hour until sufficient moderation of congestion is obtained. An ozone generator should be placed in the room to ozonize the air. This is really more important than the high frequency application. In chronic bronchitis the vacuum tube may be used over the chest and back, as in the acute form. At the present time in connection with the vacu- um tube application general auto-condensation is employed (2,500 E.) or it may be applied locally according to the “plate-glass” method described in Chapter VI. Here ozone is again clearly indicated, the preferable method being ozonization of the air in the room where the patient sleeps or works; this being superior to the temporary administration of ozone in the physician’s office. Treatments should be given daily at first, gradually dropping to two or three times a week. 186 eberhart’s manual of Callouses. Callosities of all kinds, including corns, are treated by the application of sharp high fre- quency sparks, either from glass or metal electrodes or by means of the regular fulguration point. Caus- tic fulguration is preferable. Cancer. (See Carcinoma.) Canities. (See Gray Hair.) Carbuncle. In treating carbuncle the high fre- quency currents are used as an adjunct to the X-ray, although they have proved effective when used alone. Enough current should be sent through the tube to produce a one-fourth to three-fourths inch spark and the tube should be kept in loose contact with the inflamed area and passed back and forth over it for ten or fifteen minutes. This should make an appreciable difference in the pain and promote an early ripening of the carbuncle. In cases where suppuration has already occurred the progress of the case may be hastened by the same technique. Carcinoma (Cancer). The best treatment for can- cer is the use of the X-ray in connection with sur- gery, but in many instances benefit is obtained from the local use of high frequency sparks. The present method of utilizing these sparks is by means of caus- HIGH FREQUENCY CURRENTS 187 tic fulguration. (See Chapter YI.) Anaesthesia may be necessary. In Fig. 53 is shown a case of cancer treated by Dr. Carreras by fulguration, a small portable coil being employed. The middle picture was taken three weeks after commencing treatment and the right hand picture in another three weeks. Fig. 53—Cancer Treated bv Fulguration. Three Weeks’ Time Between Successive Pictures. Cataract. In the early stages of cataract benefit may be expected from the high frequency current in a reasonable percentage of cases. It is applied according to the eye technique given in Chapter VII. Five minute daily treatments with not too great an intensity of current; tube in con- tact with the closed lids. 188 EBERHART'S MANUAL OE Catarrh of Bladder. (See Cystitis.) Catarrh of Bowels. (See Colitis and Enteritis.) Catarrh of Nose. (See Nasal Catarrh; also Ozena.) Catarrh of Womb. (See Endometritis; also Cer- vicitis.) Cellulitis. The red vacuum is preferable in treat- ing cellulitis. After freely incising the parts to establish drainage, apply wet dressings and then use the high frequency current through the dressings, five to seven minutes, repeating frequently. Occasionally in an early stage the application of the high frequency in connection with a high candle- power light may arrest the progress of the trouble; but if it does not do so quickly, the above method is advised. In this instance the current is merely an adjunct to our usual methods. Cerebral Hemorrhage. Dr. L. M. Bowes, who has had a wide experience in these cases, states: The prophylaxis consists in treating the underly- ing cause—arteriosclerosis, nephritis, chronic alco- holism or syphilis—which is described under the proper heading. When there are prodromal indications of hemor- rhage—headaches or dizziness in one whose arteries HIGH FREQUENCY CURRENTS 189 are liable to rupture—the patient should be placed in bed with the head raised and feet lowered. If there is hypertension auto-condensation or auto-con- duction is indicated. Give a brisk purgative followed by an enema. During the attack the patient should be kept abso- lutely in the position given above, with an ice-cap on the head and heat applied to the extremities. Hot baths should be absolutely forbidden. The absorption of the extravasated blood is pro- moted by the use of auto-condensation or auto-con- duction combined with the use of small doses of the iodides. For the paralysis the treatment should be the same as outlined under the heading of paralysis, re- membering that only the weak muscles should be treated. If the strong muscles are treated the con- tractions are liable to be increased. Cervical Adenitis. (See Tuberculosis of Glands.) Cervicitis. In inflammation of the neck of the womb, with or without hyperplasia, the use of the high frequency current through the vagina is very effective. The insulated vaginal tube is employed and care is taken to be sure that it is in contact with the cer- 190 eberhart’s manual oe vix. Seven-minute treatments, daily or every other day, using a current strength that would be capable of producing a one-half or three-fourths inch spark if the tube were not in contact with the body. A small tube, such as the nasal tube, may be in- serted in the neck of the womb in cases accom- panied by relaxation, where the mouth of the uterus is open. This tube must not come in contact with a metal speculum or it will charge it with the current. It must be insulated with rubber or sufficient dry gauze. A glass speculum of the old-fashioned tubu- lar type is preferable. The direct D’Arsonval cur- rent (diathermy), is also useful in this disease. (See Chapter XI.) Where the cervix is considerably enlarged, me- chanical vibration is advised. I have devised a uter- ine vibratode which is very convenient and service- able in treating these cases, because the vibrations may be limited to the desired area. It consists of a flexible uterine sound with a section of rubber tub- ing between it and the attachment to the vibrator to prevent undue force being used, and application is made directly to the cervix through an ordinary speculum. HIGH FREQUENCY CURRENTS 191 Chancroid may be treated with the spark from the vacuum tube or by caustic fulguration. One treat- ment should suffice and is superior to acid cauter- ization. Take care not to apply too long. One- half to one minute is usually sufficient. Sometimes I place the vacuum tube over the chancroid with two or three layers of gauze between, thus utilizing short but rather thick sparks. In this instance keep in contact for five minutes and repeat in eight to twelve hours. Where a soft chancre exists just within the meatus, treatment by means of the end of an ure- thral electrode is extremely satisfactory for apparent reasons. Treat for seven minutes and repeat twice a day in the start. Chilblains. Use a vacuum tube with a current strength capable of producing a quarter or half inch spark, but keep the electrode in contact with the skin. It may be held steadily over the chilblain or moved slowly about as desired. Treat for ten minutes or until relief is manifest and repeat daily or every other day until cured. In connection the soaking of the foot in a strong solution of acetate of zinc (tablespoonful to the quart) is advised. 192 EBERHART’s MANUAL OE If a porcelain bowl is used in the high frequency electrode may be placed in the solution after the manner of using the faradic current. Chloasma. (See Moles, Moth-patches, etc.) Chlorosis. (See Anemia and Chlorosis.) Chorea. In chorea general treatment with a sharp stimulating spark to the spine, abdomen and ex- tremities, taking about 15 minutes for the treatment and repeating daily or every other day, is advised. Auto-condensation alone, or in connection with the foregoing, is indicated; also mechanical vibra- tion and ozone. Chronic Ulcers. Use at first a sharp spark from the vacuum tube to get a stimulating effect, which is not only locally germicidal, but also converts the chronic condition into an acute one which will heal readily. Afterwards treat through two or three layers of gauze, with a tube in contact, capable of giving a quarter-inch spark. Fulguration, with mild spark may be employed. Cicatrices. (See Scars). Cold Extremities. I have included this symptom because it is so common and because the high fre- quency is really an ideal treatment for this con- dition. HIGH FREQUENCY CURRENTS 193 Vacuum tube applications to the extremities to the production of redness give an immediate result. In order that it may have a permanent effect, a tonic dose along the spine and over the abdomen is advised; the treatments to be repeated three times a week. Diathermy is also indicated. (See Chapter XI.) Colitis. (Inflammation of Colon, Mucous Colitis.) This is a condition which has not yielded to ordinary methods, but which has proved singularly amenable to the high frequency current. Several methods of employing it have been almost equally effectual. They are: 1. The vacuum tube with a current intensity ca- pable of emitting a half or three-quarter inch spark may be passed lightly over the bowel area, either in contact with the skin or through the underclothing. Duration, fifteen minutes. Repeat daily until im- provement takes place, and then continue three times a week until cured. 2. The Tesla current or the direct D’Arsonval (diathermy) applied with one electrode over the bowel and the other in the rectum. 3. Auto-condensation, either general or local or by the “plate-glass” method. (See Chapter VI.) 194 Eberhart's manual of Ten or fifteen-minute treatments daily or every other day. Auto-eondensation may be combined with any of the other forms. It is my preference—2,500 E. daily. Constipation. I believe mechanical vibration and the sinusoidal current are superior to high frequency in these cases, but the latter may be used advan- tageously. A vacuum tube application over the abdomen is indicated. The lower the frequency the more effec- tive the treatment. For this reason treatment with the small Tesla coils is especially satisfactory; also the use of pulsa- tory currents, (tube attached to one pole of X-ray coil). Considerable current should be passing through the tube, averaging an intensity capable of deliver- ing a spark of from one-half to one inch, but taking care to keep the electrode in close contact with the abdomen and thereby avoid any sparking. Ten minutes daily is advised first, later dropping to two or three times a week. Another method is to use the Tesla current or the direct D’Arsonval (diathermy) with one electrode on the abdomen (stationary or moved about), and HIGH FREQUENCY CURRENTS 195 the other in the rectum. Local auto-condensation commends itself and the author’s D’Arsonval surg- ings given with a pad or metal electrode over abdo- men, will give motor effects. Convalescence. In convalescence the general tonic effect of auto-condensation 2,500 E., or a mildly stim- ulating vacuum tube spark to the whole body, will aid the patient in regaining strength. Corneal Opacity. Applications are made with the eye tube through the closed lids or may be made directly to the cornea, taking care to have perfect electrical contact. Three to ten minutes at a treat- ment, frequently repeated. Corns. (See Callouses.) Coryza. For cold in the head a low vacuum tube carrying enough current to produce a half-inch spark is rubbed over the outside of the nose, along the supra-orbital region, and sides of the face. Ozone is inhaled directly from contact with the tube or by means of an inhaler. Intra-nasal application with the nasal electrode (See Figs. 20 and 21) is also advised. Two or three treatments a day may be employed if necessary. 196 Eberhart’s manual oe Cystitis. The effect of vacuum tube treatment through the rectum or urethra is remarkable in in- flammation of the bladder. In one case where many clots of blood were pass- ing with the urine, and had been doing so for some days, it was greatly lessened after the first treat- ment and entirely disappeared after the second. The urethra was too sensitive to admit the sound and the treatment was administered per rectum. The technique for urethral or rectal applications will be found in Chapter VII. A seven-minute treatment is given daily at first and then every other day. Two treatments a day may be employed if the physician thinks best. It is remarkable how fast the urine clears up in nearly all of these cases. In acute cases I always use the rectal technique but in old chronic cases I alternate with the ure- thral method. In women the vaginal technique is used. Local treatment over the bladder with the body tube is also beneficial, or diathermic currents with electrode in rectum and pad over bladder. A bi- polar Tesla treatment may be given in the same manner. HIGH FREQUENCY CURRENTS 197 Dandruff. (See Seborrhea.) Deafness. In catarrhal deafness the high fre- quency current in connection with mechanical vibra- tion will yield remarkable results in ninety per cent of the eases treated. Not that it may be expeeted to cure so large a per cent; but the degree of improve- ment will be so marked that both physician and patient will be well satisfied. The ear tube is used as outlined under ear technique in Chapter VII, the duration of the treatment being from two to seven minutes, according to the toleration of the patient. The current must not be too sharp. The sensation of heat will become so marked that the patient will tell you when to stop. If he does not, do not carry the seance beyond seven minutes, for either ear. Two treatments a day are not too many in the start, but this is seldom practicable and we must content ourselves with from three to six per week. Diabetes. In the earlier use of high frequency currents we were confronted by a variety of reports regarding the effectiveness of this treatment in dia- betes, but even those who gave adverse opinions concerning the disappearance of sugar, admitted 198 EBERHART’S MANUAL OE that there was improvement in the patient’s “sense of well-being.” I am willing to put myself squarely on record as believing auto-condensation to be the best single remedy we have for diabetes, and best of all, it does not prevent us from using at the same time all of the other measures which experience has shown us to be valuable. In my first cases I used auto-condensation without altering patient’s diet, or prescribing any internal treatment in order to determine exactly how much reliance might be placed on this method. All speci- mens of urine were sent to a reputable laboratory for examination so that no personal wish might in- fluence my judgment of results. In one of these cases the sugar and all accom- panying symptoms disappeared in the incredible time of six weeks. (There was six per cent of sugar in the beginning.) Three to six months has been more nearly the average time required. The sugar has not disappeared in every case, but in no case has there not been a perceptible decrease in amount and a general improvement where the treatment lasted over two months. HIGH FREQUENCY CURRENTS 199 One case died in four weeks, only ten treatments being given. The acetone increased and I predicted death within two weeks. A sudden and decided in- crease in acetone or its appearance when none has been present, I regard as an unfavorable sign usu- ually indicating a fatal termination within two or three weeks. One of my worst cases, where the patient could scarcely get to the office for treatment, made such a steady improvement that, in five months, the sugar had dropped from seven and a half per cent to oiip and three-tenths per cent; he had resumed work and was gaining rapidly in weight, and I was absolutely sure a complete cure would result, when he died suddenly. The cause was apparently the result of an excess in drinking (which had been forbidden), raising the blood pressure to the point of rupturing one of the arteries in the brain. Treatments should be given daily at first, starting with 2,500 E., and if improvement is not manifest within a week increasing to twice that amount or even more. The only exception is where there is an advanced case of arteriosclerosis with marked hypertrophy of the heart muscle, when the blood- pressure should not be diminished too rapidly. 200 Eberhart’s manual of When improvement is pronounced, decrease the dose and treat three times a week. In examining the urine the total amount for twen- ty-four hours must he collected and measured and a specimen from this examined; otherwise a test for the percentage of sugar will be valueless, for if half a dozen separate specimens are examined in a day, there will be given an equal variety of percen- tages. As diabetes is apparently a disease resulting from disturbed or impaired metabolism it is entirely rea< sonable to expect benefit from the administration of auto-condensation. I do not enforce a rigid diet, but a regulated one. Other operators have employed in place of the auto-condensation a vacuum tube spark over the abdominal area. Many find the X-ray of decided value, exposing over the liver. Diarrhea. One author says, “After preliminary treatment of the canal or being assured that no foreign matter remains in it, apply tonic dosage of high frequency current over the region of the solar plexus, stomach, intestines, liver and spinal nerves.” I note that he advises essentially the same method for constipation. HIGH FREQUENCY CURRENTS 201 As few cases of diarrhea come under the treat- ment of the electro-therapist I am not able to give a definite opinion, but would think a prolonged but soothing treatment over the abdominal organs pref- erable. Inhibitive vibration I know to be effective and would advise it in conjunction. Drug Additions. In drug habits I have found more benefit from vibration than from high fre- quency currents, but the latter may be used con- jointly. In alcoholism, a sharp stimulating spark over liver, solar plexus and fifth to ninth dorsal spinal centers is advised; also auto-condensation, 2,500 E. repeated three to six times per week, pro- vided blood-pressure is high. (It is usually.) In the cocaine habit use mild vacuum tube treat- ment to soles of feet: and to arms and legs to the point of marked reddening. If blood-pressure is low use stimulating sparks to the spine; if high give auto-condensation. In morphine or opium users give sharp stimulating spark over liver and solar plexus, with auto-condensation or spinal sparks ac- cording to whether the blood-pressure is high or low. 202 Eberhart’s manual or In all of these habits treat insomnia, constipation or other accompanying symptoms as advised under those headings. Dupuytren’s Contraction. For the contraction of the fascia in the palm of the hand known under this name, high frequency currents have been success- fully used by Herdman. Auto-conduction or auto-condensation, 2,500 E. three to six times per week with vacuum tube sparks locally for five minutes. Mechanical vibration indi- cated. Dyspepsia. The technique to be followed is es- sentially that outlined under atonic dilatation of the stomach. The best treatment is auto-condensation. 2,500 to 5,000 E. daily. It may be employed locally by the “Plate-glass” method (see Chapter VI), thus making it possible to utilize the small coils for the purpose. D’Arsonval surgings (see Chapter VI) are of equal value. Vacuum tube applications over stomach and solar plexus are advised if auto-condensation is not avail- able. The general tonic effect of ozone inhalations or of ozoning the air of room or office, makes it a useful adjunct. HIGH FREQUENCY CURRENTS 203 Earache. This symptom is frequently relieved by the application of the ear tube, using a mild current for from three to seven minutes, the benefit being apparently due to the heat evolved. Another method has been the use of a flat elec- trode over the mastoid. Ear Diseases. The principal diseases of the ear which are benefited by high frequency currents are: catarrhal deafness, tinnitus aurium and chronic middle ear affections. The method of treating each of these is given under its appropriate heading. Eczema. In the treatment of eczema the high fre- quency is an invaluable adjunct to the X-ray, but may be used independently of it with successful re- sults. This disease reacts to the X-ray very quickly so that care must be used in the number and length of exposures. The high frequency is applied accord- ing to the technique described in Chapter VI, under skin diseases, where the body tube or the tube shown in Fig. 21, No. 11, is used with a sufficient amount of current to produce a spark from one-fourth to three-fourths of an inch in length, but during the greater part of the treatment it is kept in light con- tact with the surface, or the treatment is applied through a layer of gauze. 204 Eber hart’s manual of Where there is intense itching it is found that raising the tube to produce a moderately sharp spark proves quickly effective and is very agreeable to the patient. As with the X-ray we must be care- ful and not treat the case too long at one sitting. From two or three to eight minutes daily or three times a week is advised; the shorter treatments should be given when used in connection with the X-ray. One of the high frequency X-ray tubes made to hold and apply to the surface in a manner simi- lar to that of the ordinary vacuum tube would un- doubtedly be especially satisfactory in these cases. An ozone spray (see Chapter IX) is recommended when available. Enlarged Prostate. (See Prostatic Diseases.) Endometritis. Treat same as cervicitis. Enteritis. In enteritis of a chronic character high frequency currents may be expected to benefit in the same way that they benefit all catarrhal condi- tions. In acute forms there is a question whether the current is of sufficient value to warrant its em- ployment when there are so many other agencies of equal or greater effectiveness that are more easily resorted to. HIGH FREQUENCY CURRENTS 205 The treatment advised would be tonic applications over the abdomen with the vacuum tube and a mild spark; or local auto-condensation, three to six treat- ments per week, of ten minutes each. Epididymitis. In acute forms a vacuum electrode applied with mild current and held in contact with the area involved or the use of diathermy is ad- vised. In either case a ten-minute application re- peated in two or three hours until relief is obtained. In the chronic form the same method is employed. The treatments are then given daily or three times a week. The X-ray is very effective in these cases, but on account of its tendency to produce sterility, it is sometimes objected to. The surrounding parts should be protected by a lead shield or the treat- ment may be applied through one of the narrow tubes or speculums connected with a tube shield. In my experience where there has been any con- siderable inflammation of the epididymis, that side is already inactive, and there is no special reason to hesitate about using the X-ray. Epilepsy. The high frequency current in connec- tion with the X-ray has been used in treating epi- lepsy with a number of apparent cures according 206 Eberhart’s manual of to several authors. The method employed is the use of a medium or high vacuum X-ray tube, placed at ten inches and used for five or ten minutes, followed by vacuum tube application over the brain, and along the spine for five minutes longer. Treatment is repeated three times a week. It is questionable in my mind whether there is sufficient benefit in these cases to warrant the use of tlie high frequency current. Epithelioma. In skin cancer our best non-oper- ative treatment is the X-ray, whether generated by high frequency apparatus or with the ordinary ma- chine. The high frequency in the form of figura- tion is also effective in the great majority of cases. Even the use of a very sharp spark, say three-fourths of an inch in length from a vacuum tube, has proved successful. Where the X-ray is used it has been my custom to give three exposures per week, of from seven to twelve minutes, with a low or medium tube, fol- lowed by two or three minutes’ application of as sharp a spark from the vacuum tube as the patient would tolerate. We also have in carbon dioxide snow an excellent remedy for these eases. After the glands have be- HIGH FREQUENCY CURRENTS 207 come involved the chance of cure by any method is greatly lessened. Erosions of the Cervix Uteri. These are treated with the vaginal tube, the insulated form being used, according to the vaginal technique described in Chapter VII, taking care to bring the tube in contact with the cervix. The treatment should last for seven minutes and may be repeated daily or every other day, as desired. Diathermy has been used in these cases, the patient holding a metal electrode connected to the other pole. No treatment should be given during menstruation. Exophthalmic Goitre. (See Goitre.) Eye Diseases. The specialist will find the high frequency current a very valuable adjunct to his armamentarium. Fox, in 1907, reported one hun- dred cases of blepharitis marginalis treated without a single failure. My own experience in this disease dating back to 1902 will bear this out. Iritis, retinitis, atrophy of optic nerve, conjunctivitis, tra- choma, glaucoma, incipient cataract, paralysis of ocular muscles, intra-ocular hemorrhage have all been treated by high frequency currents. The spe- cial technique for each of these diseases is given under the appropriate heading. 208 Eber hart’s manual of Favus. This condition, which yields so nicely to the X-ray, is also amenable to treatment by high frequency. A spark is employed as sharp as the patient will tolerate for from three to five minutes, three times a week. Fissure (Anal). So many reports of successful results in anal fissure have been made that there seems to be no doubt of.its efficacy. It has always been my opinion that as much benefit was derived from the stretching of the parts as from the heal- ing effect of the current. The rectal vacuum tube is employed as directed in Chapter VII and a seven minute treatment is given from three to six times per week. Flabby Breasts. It is claimed by Monell that a stimulating application with the vacuum tube to the relaxed nipple of the flabby breast will immediately show its beneficial effect. Frontal Sinusitis. (See Sinusitis.) Furunculosis. In treating boils a mild spark from the vacuum tube is employed over the affected area for ten or fifteen minutes. The treatment may be repeated two or three times a day if operator finds it advisable. It is well to cover a reasonable area surrounding the boil in order to prevent recur- HIGH FREQUENCY CURRENTS 209 rences, if the boil is discharging. Another method is to use the fulguration point with a sharp spark for a few seconds. This frequently aborts a boil if employed in the early stages. Operators using the Tesla coil have told me that they obtain better results when the paient is directly attached to one pole of the machine and the grounded vacuum tube or metal point held within a short distance of the surface treated, thus drawing the sparks from the skin (indirect sparks). Open boils heal readily under an application of the ozone spray. Gastritis. In chronic gastritis the high frequency treatment indicated is local or general auto-conden- sation, or the methods may be followed which are given under atonic dilatation of the stomach. Genito-urinary Diseases. The genito-urinary dis- eases in which these currents have proved useful include gonorrhea, gleet, prostatitis, cystitis, orchi- tis, stricture, etc. The directions for treatment will be found under these various headings. Glaucoma. As this condition is usually associated with high blood pressure as well as hypertension in the eyeball, the use of auto-condensation 2,500 to 7,500 E. daily to reduce blood pressure naturally eberhart’s manual of 210 suggests itself, and it was for this reason that I first employed high frequency currents. In conjunction with auto-condensation, I use the eye tube applied to the closed eye for five to eight minutes, when a very mild spark is employed over the eyelid, eyebrow and temple with any flat sur- faced vacuum electrode. I do not find any record of this condition having been previously treated by anyone else. There is, of course, no reason to omit any of the customary rem- edies used in these cases. The benefit is noticed fre- quently after a single treatment. Gleet. There are two methods that I have found equally satisfactory in the treatment of chronic pos- terior urethritis. The first is by employment of the urethral tube with the technique given in Chapter VII, taking care in the introduction of the glass sound not to break it and seldom extending the treat- ment over seven minutes at any one seance. The treatments may be given daily or every other day. The second method is to treat through the rectum with the rectal or prostatic tube, which I have found quite as effective, and much easier to employ and devoid of any danger from breaking of the tube. I have treated a large number of these cases, begin- HIGH FREQUENCY CURRENTS 211 ning as far back as 1902. The early eases were treated in eon junction with the X-ray, but on ac- count of the risk in using the latter, I have aban- doned it of late years and find high frequency cur- rents even more effective. Cases are cured frequently in from ten to twenty treatments; occasionally it has taken more than twice the latter number. Goitre. In simple goitre the high frequency cur- rent is applied with the vacuum tube, using an intensity capable of producing a half or three-quar- ter-inch spark. The tube should be kept in light contact with the surface of the skin, treating the sides of the neck as well as over the goitre itself. After five minutes of this treatment, raise the tube and use as sharp a spark as the patient will permit for two or three minutes. The X-ray is used always in connection with the high frequency and mechanical vibration also. About one-half of the cases are cured. In exophthalmic goitre the results are much better than in simple goitre. 212 eberhart’s manual oe The vacuum tube is employed in the same manner followed by auto-condensation, 2,500 E. X-ray and vibration recommended. Gonorrhea. In acute gonorrhea in the male the current is markedly beneficial. If the canal is not too sensitive the urethral vacuum tube may be used, but this is seldom possible. A method in vogue abroad is to wrap the penis in wet cotton or gauze and wrap lead or tin-foil around it, which is connected to the resonator or to the Tesla coil, or used with direct D’Arsonval cur- rent (diathermy). Another method is to use a glass tube containing boric acid solution and having a metal bottom to which the connecting cord is attached. A daily treatment should be given, and I have not hesitated to give as many as three in one day in some instances. In the female the vaginal tube is used or the vagina may be packed with moist gauze and a me- tallic electrode attached to the gauze. Usual methods of treatment may be carried out in connection with the high frequency. HIGH FREQUENCY CURRENTS 213 In sub-acute or chronic forms the vacuum tube method is preferable in either sex. In men, treat- ment through the rectum is effective. The precise action of high frequency in these cases is still in doubt. It may be the germicidal effect of the ozone liberated or the increased leucoeytosis es- tablished. With tubes of high vacuum the chemical rays emitted are entitled to credit. Gout. Auto-condensation or auto-conduction is the high frequency treatment for gout, as in all diseases resulting from disturbed metabolism. The urine is found to have immediately an increased amount of urea, while the excessive uric acid rapidly decreases to normal. 2,500 to 7,500 E. daily or three times a week is a proper dosage. A slight aggravation of pain may be present after the first few treatments, for which reason I sometimes start with a smaller dose and gradually increase. No treatments should be given during an acute attack. Arc light or electric light baths are bene- ficial in any stage. Where the vacuum tube is applied in these cases, it should be kept in close contact with the skin. 214 Eberhart’s manual of avoiding all sparking. Indirect spark during auto- condensation is very beneficial. Gray Hair. I discovered, accidentally, the action which these currents have in restoring the natural color to gray hair. This apparently is not limited to premature grayness. The chief drawback to the treatment is that it may have to be kept up for months and months. Vibration of the scalp to aid in increasing nutri- tion is desirable. The high frequency treatment consists in vacuum tube applications. From my original article on this subject, pub- lished in the American Journal of Clinical Medicine, November, 1909, I quote some paragraphs: “As early as 1902 I began using high frequency currents, usually in connection with vibration, in the treatment of various conditions of the scalp where the hair was thin or falling out rapidly. “Vibration was employed because of its stimulat- ing effects on the circulation, and high frequency sparks because of this same beneficial influence on the nourishment of the hair roots, and further on account of its germ-destroying action where bacteria were responsible for the falling hair. HIGH FREQUENCY CURRENTS 215 “The possibility that high frequency currents might be useful in restoring the original color to gray hair did not occur to me, and had it done so I should have thought it impossible in consequence of the fact that these currents have been used com- mercially in bleaching flour and other substances. “My first discovery of the ‘restorative’ effect on gray hair came about in an accidental manner. “I was treating a woman whose hair was falling out very rapidly, employing both high frequency current and vibration. Her hair was very black, but sprinkled over her head were three or four dozen gray hairs which were especially conspicuous by contrast. She asked me if it would do any harm to pull out the white hairs, and I told her that as long as she was losing so much hair anyway, she might as well pull out the objectionable gray ones. “After about two months of treatment the hair had practically ceased falling out and I noticed that there were scarcely any gray hairs. I thought she had been pulling them out and said so. When she replied that she had been afraid to do this despite my permission, I said to her that the treatment must be restoring the color and proceeded to investigate. The finding of a few hairs white at the upper end 216 Kberhart’s manual or and dark for a varying distance next to the scalp convinced me absolutely that my surmise was cor- rect. From that time on I have employed high fre- quency currents in all of these cases that have come under my care. ‘‘For a long time I believed that only in prema- turely gray hair any improvement could be ex- pected, but a recent case makes me think that if patient and physician are sufficiently persevering, results may be obtained in many instances where the gray hair is the natural result of advancing years. “The case referred to is one in which I have for somewhat over a year and a half been treating a very stubborn ease of lupus, situated behind the left ear. The patient, a man in the fifties, has gray hair which can scarcely be called premature. “The treatment for several months consisted in an application of high frequency sparks six days a week, preceded every other day by exposure to the X-ray; and even now that the patient is nearly cured he is still receiving two such treatments a week. “Kecently I noticed that around the ear where I had been applying the sparks there was a band of HIGH FREQUENCY CURRENTS 217 dark-brown hair about an inch in width. I thought possibly this was so all around the margin of the hair, but found it did not exist except over the area receiving the high frequency sparks, and a reference to a picture of the man taken when treatment was begun shows that at that time there was no apparent difference in the shade of the hair at this point. “All of this brings me to the conclusion that gray hair must be entirely a result of disturbed nutrition, preventing the carrying into the hair of the pigment that gives it its color. This pigment-carrying prop- erty, in all probability, depends largely upon the natural electrical currents which traverse various tissues and which when interfered with in the hair result in grayness. “Laying aside theory, results tell, and it is easy for anyone to prove the truth of my statements. The only drawback is the comparatively long time required. Some cases show results in two or three months, but six months is nearer the average. “In the case of naturally gray hair I fear few patients could be kept under treatment long enough, since in the instance cited, a year and a half elapsed before the change was noticed. 218 eberhart's manual of “The method which I have employed is first to use a rubber brush or soft rubber vacuum cup on a vibrator and for three or four minutes thoroughly massage the scalp; stroking from the edge of the scalp inward toward the center of the crown of the head, or else using short circular strokes and grad- ually passing from the margin to the center. Fol- lowing this, a glass vacuum tube is employed and passed rapidly back and forth over the scalp for five minutes, with as sharp a spark as the patient can conveniently tolerate. This is usually one about one-half or three-fourths of an inch in length. Too sharp a spark might make the scalp sore and even have a slight caustic effect, which is to be avoided. “Daily treatments are the best. I employ a simi- lar technique in falling hair. Keeping the tube in loose contact with the scalp is equally effective.” Grippe. (Influenza.) In connection with the usual medicinal treatment great benefit will be derived from the general application of the high frequency current and the inhalation of ozone. Ozone is particularly valuable in these cases, es- pecially where the patient can have an ozonizer in the room. HIGH FREQUENCY CURRENTS 219 Otherwise inhalations by means of any of the sev- eral generators, or in default of one, the vacuum tube held with the hand in contact with the vacuum will give a sufficient amount if brought near the nose. The general treatment is by tonic spark to spine and solar plexus; also mild treatment over eyes and sides of nose. (Intra-nasal with special tube is ad- vised in certain cases.) Hair, Falling. The vacuum tube applied as de- scribed under scalp technique in Chapter VII, es- pecially in conjunction with vibration, is very ef- fective where the hair is falling out. (See Alopecia.) Hay Fever. (Periodic Hyperesthetic Rhinitis.) Many reports have been made of the favorable in- fluence of high frequency in these cases. Direct ap- plications to the nose with the nasal vacuum tube and mild current, also using any suitable tube to stroke over the nose externally, as in nasal catarrh, is the customary technique with tonic spinal treat- ment or auto-condensation as indicated. Inhalations of ozone are of even greater impor- tance or still better ozonizing the air of the room. The patient should be examined for enlarged tur- 220 Eberhart’s manual oe binates or nasal polypi and if found they should be removed. Fig. 54—Areas Where Headaches Occur. The hyperesthetic areas in the mucous membrane should be destroyed, Fulguration sparks may be used for this purpose, although I see no advantage over customary measures. HIGH FREQUENCY CURRENTS 221 Headaches. Frontal or congestive headaches are relieved by using the vacuum tube with an intensity capable of producing a half or three-quarter inch spark and by passing the tube back and forth over the seat of pain. Keep the tube in loose contact and prolong the treatment until relief takes place, which will be five, eight or occasionally ten minutes. Inhibitive vibration in connection is advised, being fully as effective as high frequency. Only temporary relief may be expected in toxic headaches or in reflex headaches from organic dis- eases unless the underlying cause is ascertained and treated. In Fig. 54, taken from my “Vibratory Technique,” the areas where headaches occur are outlined. This will be useful in suggesting the probable line of treatment. Headaches at A or B are congestive or frontal. At A they may come from errors in refraction; frontal sinus disease or nasal disease. Stomach dis- eases also frequently cause pain at A. Constipa- tion A-B. Decay of front teeth A-B. Anemia; en- dometritis ; bladder diseases, C. Middle ear dis- ease ; throat disease; eye disease; decayed teeth, D-E. 222 Eberhart’s manual oe Womb disease; spinal irritation; nervousness, E. Ovarian reflex pains usually at C and E. Neurasthe- nic headaches involve the back of the neck. Heart Disease. One author says: ‘ ‘ Tesla currents are often of great value in organic heart disease in assisting nature to establish compensation. In later stages when compensation fails the current is pal- liative through its action on the vaso-motor system and its tendency to disperse dropsical effusion.” Treatments are given according to the indications shown by the patient’s blood pressure. If the lat- ter is high, auto-condensation is called for; if low sparks to the spine and solar plexus. Hemorrhoids. Outside of the use of fulguration for the removal of hemorrhoids, I am not impressed with the value of high frequency currents in these cases, despite a number of favorable reports. Of course they are palliative and relief may result from their treatment with the rectal electrode as directed in Chapter VII, under Rectal Technique. For well-marked cases my advice is operation. Whether they are removed by the knife or scissors, or whether by the electro-cautery, or by fulguration sparks, is a matter for individual choice. HIGH FREQUENCY CURRENTS 223 Local anesthesia will suffice for fulguration in these cases and the spark need not be a very long nor sharp one. More than one application may be necessary. Herpes Zoster. (Shingles.) Application of the vacuum tube discharge to the eruption in herpes is almost uniformly serviceable in hastening a cure. The tube should be capable of delivering a quarter, half or three-quarter inch spark, but should be used in loose contact with the surface or through a layer or two of gauze. Treatment should be applied to the nerves supplying the area. Repeat the applica- tion daily as long as required. Two to four treat- ments ordinarily are sufficient. Mechanical vibration advised and ozone inhala- tions for their tonic effect. High Blood Pressure. (See Hypertension.) Hyperesthetic Rhinitis. (See Hay Fever.) Hypertension. (High Blood Pressure.) This symptom is the most common one accompanying arteriosclerosis, and the technique of treatment is given under that heading. The technique of taking the blood pressure is de- scribed in Chapter VI. 224 Eberhart’s manual of High Blood Pressure always calls for auto-conden- sation, or auto-conduction. It also contra-indicates the application of sharp stimulating sparks to the spine, as these tend to raise it still more. Hypotension. (Low Blood Pressure.) In this con- dition we have the opposite to the preceding head- ing, and the treatment indicated is sharp stimulat- ing sparks to the spine and solar plexus, while auto- conduction or auto-condensation is theoretically contra-indicated, although with low pressure it does not seem necessarily to lower it, depending on the pulse pressure (see Chapter VI). Hysteria. Many operators have reported success- ful results in hysteria. Auto-condensation should be used if blood pressure is normal or above. If the pressure is below normal, as is often the case, sharp vacuum tube sparks to spine and abdo- men are advised. Impetigo. Treat according to the technique given for acne vulgaris. Impotence. The method of treating this condi- tion is by means of the vacuum electrode. Use the body or prostatic tube with enough current to pro- HIGH FREQUENCY CURRENTS 225 Fig. 54a—Portable Battery Outfit. 226 eberhart’s manual of duce spark one-quarter or one-half inch long or more. Keep the tube in loose contact with the surface while it is passed back and forth over genitals, in- guinal and bladder region and to the lower half of the spine. With the spinal application raise the electrode to get reasonably stimulating sparks. Sometimes a special electrode is used which takes in the genitals, or they may be immersed in boric acid solution or water in a glass or porcelain vessel, and one pole of the D’Arson val current (diather- mic) in contact with the fluid, while the other elec- trode is in the patient’s hand or applied to his back. Ten minute treatments daily. Rectal applications for seven minutes are often beneficial. Incontinence of Urine. (Enuresis.) Apply a tonic spark to the lower part of the spine and also over the bladder area. In selected cases treatment through the rectum to influence the neck of the bladder is desirable, and were it not for the fact that these cases occur in children the methods outlined under cystitis would be indicated. 227 HIGH FREQUENCY CURRENTS Infantile Paralysis. (Anterior Poliomyelitis.) These cases call for the daily application of stimu- lating sparks to spine and over all of the paralyzed muscles. Use a spark one-fourth or one-half an inch in length, with body tube. Interrupted galvanism and vibration are of equal value and should not be omitted. The tonic effect of auto-condensation makes it desirable. D’Arsonval surgings (see Chapter VI), with the connection made directly to the ankles when the legs are affected, is of marked benefit because of the mus- cular contractions produced. Influenza. (See Grippe.) Insomnia. (Sleeplessness.) There are few cases of insomnia that cannot be cured by high frequency currents. The technique which I have found to be most satisfactory has been the use of a vacuum tube with sufficient current to produce a quarter or half-inch spark, which is kept in light contact with the back of the head and neck for about five minutes, fol- lowed by three or four minutes’ application over the eyebrows. 228 EBERHART'S MANUAL OF After this auto-condensation 2,500 to 7,500 E. I always use vibration in connection with high fre- quency and ozone is indicated. Patients often fall asleep while taking auto-con- densation; in fact, when using this method for other conditions you will often find your patients asking what it is that makes them so sleepy. I have cured so many aggravated and severe cases of insomnia with these measures that I am inclined to believe there should be no failures. One of the worst cases I have encountered was that of a man who found it necessary, on account of the sudden death of his brother, to work night after night until 2 :00 or 3 :00 o’clock in the morning in order to get through with his business. This and the shock of his brother’s death (he was killed by a car) caused such a state of mind and body that when it became possible for him to take plenty of time to sleep, it was found that sleep was impossible. At the time I undertook his treatment all of the customary measures had been exhausted and power- ful narcotics only gave a transient respite; in short, grave fears for the man’s mind were entertained. I refused to take the case unless the patient agreed to take daily treatments for six weeks. It was with- HIGH FREQUENCY CURRENTS 229 in three or four days of the end of this time before any improvement was manifested, but the second Fig. 54b—Combined IXArsonval, Oudin and Tesla Transformer Type Coil with Oil Immersed Condenser. course of treatments, covering the same length of time, entirely cured him. Intestinal Indigestion. With imperfect intestinal digestion we have indican present in the urine. 230 eberhart’s manual of Auto-condensation, either general or local, will cure these cases. The technique outlined under atonic dilatation of the stomach is equally useful here. The sinusoidal current also has cured many cases. The administration of suitable drugs does not con- flict in the least with the electrical treatment. The diet should be regulated carefully. Intra-ocular Hemorrhages. The high frequency current is applied through the eye electrode in con- tact with the closed lid for five minutes. The blood pressure is always high in these cases and calls for auto-condensation, 2,500 to 7,500 E. Daily treatments. Iritis. Treat as outlined under eye technique, Chapter VII. The current relieves the pain and re- duces the inflammation. In syphilitic iritis I have had especially satisfac- tory results in breaking up the adhesions which had formed. Keloid. Keloid may be destroyed by sharp sparks from the vacuum tube or caustic fulguration. The X-ray should be used in connection with high fre- quency. HIGH FREQUENCY CURRENTS 231 Drs. Frater and Frater, Shreveport, La., have re- ported remarkable results in one severe case. Laryngitis. In the acute form the application of a vacuum electrode to the throat externally, for five or ten minutes, either by loose contact or by a mild spark will greatly aid the customary medical measures. Ozone inhalations and diathermy advised. Leucorrhea. The treatment is by means of the vaginal vacuum tube according to the method out- lined in Chapter VII. Three to six treatments a week in connection with antiseptic and astringent douches will cure these cases. Tonic spinal sparks are advisable, frequently; also vibration. Leukemia. Prior to 1910 I believed high frequency currents were contra-indicated in leukemia because they increased leucocytosis. This I still consider true of vacuum tube applica- tions (except orificial), but some experiments with auto-condensation have convinced me that in it we have a valuable aid in this disease. 2,500 E. is the dose. The following case of splenic leukemia in an early stage, as shown by the blood count at the beginning 232 eberhart’s manual of of the applications and again a short time later, is one of the arguments that won my advocacy of the treatment. January 29, 1910, blood examination showed 3,360, 000 red cells (89%); hemoglobin, 60%; white cells, 9,580 (135%) ; color index, 9. Besides variations in the proportion of normal white cells there were many poikilocytes and of myelocytes. June 3, 1910, the red cells had increased to 4,200,- 000 (97%) ; hemoglobin, 90%.; white cells, 7,860 (100%) ; color index, 1. Poikilocytes and myelocytes entirely absent. I believe the X-ray is the best remedy we possess in alternation with arsenic, and there is no reason why auto-condensation should not be employed with both. Lichen Planus. Use a vacuum tube in loose con- tact with the lesion, following the general technique outlined under Skin Diseases in Chapter VI. X-ray in connection. Lichen Rubra has yielded to the same treatment as that for lichen planus. Lithemia. (See Gout.) Locomotor Ataxia. (Tabes Dorsalis.) Relief of pain and improvement in gait is accomplished in HIGH FREQUENCY CURRENTS 233 many cases of locomotor ataxia. I always employ heavy spinal vibration in connection with high fre- quency. Apparent cures in occasional cases where even the pupillary reflex has returned has caused me to believe that we sometimes diagnose cases of multiple neuritis as tabes. In multiple neuritis we have absence of the knee- jerk, and if the nerves of the eye were involved loss of pupillary reflex and diplopia might be pres- ent, which would apparently indicate locomotor ataxia, as the latter is the more frequently met with. This would also account for cases in which no evi- dences of syphilitic infection are obtained. In genuine cases of tabes a cure need not be looked for by this or any other method that we are at pres- ent acquainted with, but marked relief is not un- usual. I use as sharp sparks as the patient will tolerate, along the spine, over buttocks, abdomen and to the back of the legs, followed by ten or more minutes on the auto-condensation couch or pad, 2,500 E. Anesthetic areas call for short stimulating appli- cations of the spark and also of mechanical vibra- tion, while hyperesthetic places will call for pro- longed applications of mild sparks and vibration. 234 eberhart’s manual of Fig. 54c—Portable Fulguration Coil. HIGH FREQUENCY CURRENTS 235 Daily treatments at first; gradually decreasing to three times a week. Low Blood Pressure. (See Hypotension.) Lumbago. Immediate relief follows the use of either high frequency or vibration in this form of muscular rheumatism. With the muscles “on the stretch” apply sharp sparks over the painful area. As the pain eases have the patient assume a different position in order to again excite pain and proceed as before until any posture may be assumed. Customarily I precede the high frequency with prolonged (inhibitive) vibration, but the order is of no importance. Localized auto-condensation is a good method to employ; also direct DArsonvalization, that is, dia- thermy. In an acute case the treatment may be repeated every three or four hours if necessary. In chronic cases three to six treatments per week. The length of each treatment is regulated by the time required to afford relief. Do not stop until you do give relief. This may be ten minutes or it may be half an hour. The use of high candle power lamps producing a great deal of heat will be found effective in conjunc- tion with the above method. 236 eberhart's manual of Lupus. In lupus the Finsen light and the X-ray are probably superior to high frequency, but it has been so successful that it should be employed in con- nection with the X-ray. The technique consists in the use of a sharp spark to get its escharotic effect. Caustic fulguration may be used; as this is essentially the action of a sharp vacuum tube spark. Nodules are successfully destroyed by this method. Sometimes it is desirable to keep a tube of con- siderable intensity in light contact with the lupus instead of employing the sharp spark. When fulguration is employed await the result of one treatment, before another is given. When a short application of the spark is made it may be used after each X-ray treatment. The use of carbon dioxide snow is a quick and satisfactory method of treating lupus. Mastoiditis. (Mastoid abscess.) Ordinarily I would consider it unwise to resort to any method outside of surgery for mastoid abscess. I have succeeded in a few cases with the X-ray, and in a good many have employed the ray after operation, where the latter was not wholly success- ful and obtained excellent results and in these cases I made use also of the high frequency current in connection with the ray. HIGH FREQUENCY CURRENTS 237 A special tube for the mastoid is illustrated in Fig. 22 (the upper tube). The following quotation from Strong is pertinent: “In a severe case of mastoid abscess with cerebral and pyemic symptoms, a vigorous thirty-minute treatment with the white vacuum electrode applied externally and a metal electrode in the mouth of the patient, produced an absolute dispersion of the acute manifestions, the patient sleeping naturally inside of five hours. The next day the pus was withdrawn, and although cover-glass preparations showed count- less numbers of streptococci and staphylococci, but a few scattered colonies were obtained in a plate culture on nutrient gelatin.” Menopause. High frequency currents are particu- larly suited to alleviating the various nervous symp- toms that accompany “change of life.” The most satisfactory method is auto-condensa- tion, 2,500 E. three times a week. In the absence of an auto-condensation couch make application with a mild spark along the spine; to the back of the head and neck; and over the abdom- inal organs, taking fifteen or twenty minutes for the treatment. Special symptoms that are present call for the treatment outlined under the appropriate heading, such as constipation, headache, etc. Menorrhagia. (See Metrorrhagia.) 238 eberhart’s manual of Metrorrhagia. Treatment of this condition has been successfully accomplished through the intro- duction of a copper electrode into the cavity of the womb, protecting the vagina by means of a rubber tube. As these currents have shown an emmenagogue effect it is to be presumed that their opposite action in this case is due to the electrode being used within the uterus. The cases cited were reported by Franchon-Ville- plee in the Bulletin of the French Electrical Society, February, 1905. The direct D’Arsonval (diathermy) current seems best suited to metrorrhagia or menorrhagia. Migraine. Temporary relief in “sick headache” may be obtained by prolonged treatment over the seat of the pain, which usually involves one-half of the head. Use a tube capable of producing a half or three- quarter inch spark, but keep it in light contact with the surface. When treating through the hair, in women it may be necessary to let the hair down or to reduce the strength of the current because the thickness of the hair may cause too sharp a spark. Migraine is probably a toxic headache due to im- perfect metabolism (sub-oxidation). This clearly indicates the advisability of auto-condensation. HIGH FREQUENCY CURRENTS 239 Long treatments, fifteen to twenty minutes or even longer, if during the attack; if between attacks, fifteen minutes three times a week. Dose, 2,500 to 7,500 E. or more. Moles, Moth Patches, Etc. Caustic fulguration is used for moles or moth patches (chloasma). Use care and avoid destroying too much tissue. See technique for fulguration, Chapter VI. The indirect Tesla spark with the fulguration tube is preferred by many for the removal of moles and warts. Molluscum Contagiosum. The method of treating this skin disease is with the vacuum tube, following the general technique outlined in Chapter VI. Muscular Rheumatism. (See Rheumatism.) Myxedema. On account of its effect on metab- olism auto-condensation has been used in the treat- ment of myxedema. Daily treatments of 2,500 E. Nasal Catarrh. For this condition the nasal tube is used within the nose with a mild current, treating for three or four minutes on each side, followed by an application to the nose externally with one of the surface electrodes. Inhalations of ozone are of the greatest impor- tance. Nasal Diseases. Many diseases of the nose are benefited by the use of high frequency currents. 240 EBERhart’s MANUAL OF The technique is given under the appropriate heading, as ozena, etc. Fig. 55—Portable Outfits. A number of different nasal vacuum tubes are shown in Figs. 20-24. Nephritis. (See Albuminuria.) Nervous Debility. (See Neurasthenia.) HIGH FREQUENCY CURRENTS 241 Neurasthenia. Numerous cases of nervous ex- haustion have been reported cured by high fre- quency currents. When the blood pressure is high, auto-condensation, 2,500 E. daily, is usually suffi- cient. The average number of treatments required is from twenty-five to forty. When the blood pressure is low, auto-condensa- tion is contra-indicated and tonic sparks to spine, back of head and neck and over solar plexus are appropriate. Ozone is a desirable adjunct, and in selected cases, vibration. Neuralgia. Application for the relief of neural- gia are made with a vacuum tube carrying current sufficient to produce a one-half or three-quarter inch spark. Ordinarily it should be passed back and forth over the painful area, in light contact with the skin. At times it is advisable to raise the tube and apply a sharply counter-irritant spark which will quickly redden the surface. I remember the old definition of neuralgia, as “the cry of a starved nerve for blood,” and certainly the high frequency will supply this want. In addition to the local treatment, auto-condensa- tion or spinal sparks should be applied in accordance with the state of the blood pressure. 242 EBERHARX’S MANUAL OF The diathermic currents on account of the heat generated are advantageously employed. See Chap- ter XI. Various names have been given to indicate the different forms of neuralgia as facial neuralgia, ovarian neuralgia, etc. The treatment is essentially the same for all va- rieties. High candle power lamps may be used in connec- tion with high frequency. 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 is a common form. The high frequency current is positively curative in all cases but must be used judiciously. Sharp sparks must not be employed at first, but a mild sedative current should be applied. This means that the tube should not carry more than enough current to produce a quarter-inch spark and should then be kept in comparatively close contact with the surface. 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 often will be so great that the patient may abandon the treatment. HIGH FREQUENCY CURRENTS 243 I always give auto-eondensation, 2,500 E., in con- 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, and the use of the ultra-violet ray. 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 a sub-acute orchitis the vacuum tube is used with a mild effleuve or spark. 244 EBERHART'S MANUAL OF Guilleminot recommends the diathermic current, one pole over the testicle and the other over the spermatic cord. The X-ray is advised, protecting 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 is advised, also an ozone spray. This latter is sometimes ad- ministered through an eustaehian 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 YI. 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. HIGH FREQUENCY CURRENTS 245 Bi-polar Tesla treatment is 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- efited by auto-condensation or auto-conduetion 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 treat- ments. Rectal applications and spark 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 246 eberhart’s manual of 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. Fig. 54f—Portable High Frequency. 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. Phlebetis has been relieved by mild vacuum tube applications, keeping the tube in light contact with HIGH FREQUENCY CURRENTS 247 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 VI. Pleurisy. Treat through a layer or two of cloth- 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- 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 vi- bration is of great benefit in restoring a normal con- 248 EBERHART S MANUAL OF dition 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. 2,500 E. 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- lic electrode is held by the patient. Ten minutes, three to six times per week. Vacuum electrodes with Tesla or Oudin currents 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. 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. HIGH FREQUENCY CURRENTS 249 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. I use vibration in conjunction with high frequency in nearly all of my cases, and diathermy is advised in acute cases. Pruritis. (Itching.) This annoying symptom ordi- 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 spark is very grateful to the patient and relief is immediate though often temporary. Pruritis ani. Treat with spark for 30 to 60 sec- onds and then use rectal tube for a six or seven minute treatment. Three to six applications per week. Pruritis vulvse. 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. 250 eberhart’s manual of 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. Purpura rheumatica. This form of purpura has been successfully treated by auto-condensation. Pyorrhea alveolaris. (Rigg’s Disease.) In this 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. HIGH FREQUENCY CURRENTS 251 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. Raynaud’s Disease. I have had no experience with this disease, but French operators report suc- cessful treatment. Auto-condensation was employed 2,500 E. or more. The number of seances varied from twelve to one hundred and twenty-five, and in the longer cases the treatment required about two years. Rectal Diseases. Many diseases of the rectum have been treated with apparent success, by means of these currents. The general technique is given in Chapter VII. Among the diseases are included proctitis, fissure, hemorrhoids, prolapse of rectum, pruritis ani, paraly- sis of sphincter, etc. The method of treating each is given under its appropriate heading. Renal Calculus. Dr. J. 0. 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. 2,500 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 eyelids, eyebrows and temples. 252 eberhart's manual of In 1902-4 I treated successfully a number of 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 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 is the similarity between the symptoms and those of gon- orrheal rheumatism where a known infection causes the pain, etc. Frequently abscessed teeth are the foci of infection. Rheumatism is often confounded with rheumatic gout. It quickly produces improverishment 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 the HIGH FREQUENCY CURRENTS 253 chronic type vibration is a valuable adjunct. Dia- thermy recommended. In muscular rheumatism, of which lumbago, stiff neck, etc., 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 be somewhat aggravated, but after the second or third week improvement is steady and rapid. Vacuum tube treatment 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 tube may take the place of auto-condensation. In this case the application should last at least twenty minutes. Rhinitis. (Atrophis.) (See Ozena.) Rigg’s Disease. (See Pyorrhea alveolaris.) Ring-worm. (See Tinea.) Rodent Ulcer. The method of treating rodent ulcer is the same as that employed for epithelioma (q. v.). 254 eberhart’s manual of 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 scars 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 is employed. (See Chapter VI for technique.) 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-condensa- tion, 2,500 Eberharts. Diathermy indicated. 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 is HIGH FREQUENCY CURRENTS 255 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 si- nuses, 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 purpose of affording temporary relief until the pa- tient could arrange to consult a specialist as I be- lieved 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- gist. Skin Diseases. The vacuum tube effleuve or spark is one of the most useful agents in treating a num- ber of skin diseases. 256 eberhart’s manual of The general technique is 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) is equally useful. In old sprains use a sufficient spark to produce marked reddening of the skin as counter- irritation is 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 257 HIGH FREQUENCY CURRENTS by means of the urethral electrode. The general technique is given in Chapter VII. 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- trode 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. Diathermy indicated. Where a suppurating area is accessible, the ozone spray is valuable. Sycosis. In barber’s itch and other forms of syco- sis the X-ray is our best method, but it may be ad- vantageously supplemented by application of the sparks 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 current, 600 to 1,200 milliamperes. For the chronic case, short, thick, counter-irritant sparks are required. 258 eberhart’s manual of Tabes Dorsalis. (See Locomotor Ataxia.) Throat Diseases. High frequency currents are use- ful in connection with routine methods in laryngitis, pharyngitis, etc. See Chapter VII for general tech- nique. A number of throat electrodes are illustrated in Figs. 20 to 23. Tic Douloureaux. Trigeminal neuralgia has been successfully treated by application of the high fre- quency 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. Diathermy indicated. 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. Tinnitus Aurium. The administration of the cur- rent through the ear tube as outlined in Chapter VII 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. 259 HIGH FREQUENCY CURRENTS 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 growth.” 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. Tuberculosis of Glands. In the treatment of tu- berculous glands, the vacuum tube spark is employed in combination with the X-ray. High frequency without X-ray is not advisable for this condition. Any surface or condenser electrode may be used with an intensity of current capable of producing a one-half to one inch spark. The tube may be used in light contact with the skin or slightly separated to give a short but comparatively thick spark. This may be regulated by treating through a sufficient 260 eberhart's manual of thickness of cloth. Five to ten minute applications. The best method is to give a seven-minute X-ray treatment three times a week followed by the high frequency application. Ozone strongly advised. Also diathermy. Tuberculosis of the Peritoneum. Tuberculous peritonitis is treated by the local application of the vacuum tube over the abdominal area or by localized auto-condensation. The effleuve from a diaphragm electrode may be used. I prefer general auto-condensation, 2,500 E. daily, with mild vacuum tube spark applied through a layer of clothing. Ozone indicated. Tuberculosis (Pulmonary). In local forms of tu- berculosis the X-ray is superior to high frequency; but in pulmonary tuberculosis conditions are re- versed and in auto-condensation and ozone we have two remarkably effective remedies which should be understood better by the profession. 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 consecutive cases as symptomatically cured, this being about 75%. Previous to this time I employed the X-ray, using with it vacuum tube or diaphragm applications of high frequency. 261 HIGH FREQUENCY CURRENTS I am now convinced that either anto-condensation or auto-conduction is superior to other forms of high frequency in this disease. Ozone is especially effective in consumption and if I could only have one remedy I would prefer to take my chances with ozone. It must not he limited to inhalations at the physician’s office, but the air of the patient’s room must be thoroughly ozonized, so that he or she is constantly getting a suitable amount in the air they breathe. If they can only respire one-half as much air as formerly, but that amount by reason of the ozone is twice as powerful in oxidizing properties, the proper balance is main- tained. Williams observed that the use of auto-condensa- tion was followed at first by an increase in symp- toms. The expectoration increased, the cough was more frequent but easier; there was a lower morn- ing but a higher afternoon temperature; and an average loss of weight of about a pound a week during the first three weeks. The concurrent use of ozone shortens this first stage. After this period improvement was steady, al- though some attenuated tubercle bacilli were pres- ent long after all other symptoms had disappeared. On account 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 262 eberhart’s manual of 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 given 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 E. 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 IX. 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 disinterested party. The following gives a comparative idea of the im- provement taking place in an average case: HIGH FREQUENCY CURRENTS 263 Mrs. B., Jan. 2, 1908. Many tubercle bacilli pres- ent. Other organisms not numerous. Staphylococ- ci ; dipploeocci 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- gained 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- surprised the methods are not better known and in general use in institutions for the treatment of con- sumption. 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, 264 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-con- duction are specially 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 produced entire disappearance of the lesion, which is replaced in a few minutes by a blanched area. Vascular red- ness 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 neg- lected.” Uterine Diseases. Treatment through the vagina to the womb has been beneficial in cervicitis, endo- HIGH FREQUENCY CURRENTS 265 metritis, etc. The general technique is given in Chapter VII. High frequency currents are always 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 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 266 eberhart's manual of 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 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 267 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 03 and is' an allotropic form of oxygen. At the same time that ozone is liberated, nitrous and nitric 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 corpuscles is produced if they are above nor- mal.) In strongly concentrated form, ozone is de- structive in its effect on mucous membranes and even to life itnelf. Germs are destroyed by it and it 268 eberhart’s manual of has been shown capable of so thoroughly disinfect- ing sewage that the filtered water was pronounced suitable for drinking puposes. It is distinctly deo- dorant 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 1 127.5 128.25 35. 36. 31. 32. 2 118. 121.5 34.25 36. 31.5 31.5 3 130. 131.25 35.25 36.5 30. 30.5 4 123. 126.75 34.25 36.75 30.5 30.5 5 131. 138.5 35. 37.5 30.5 31. 6 118. 117.50 31.75 32.5 29. 29. Indications. In one sense of the word, since oxy- gen 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; infectious diseases; and all conditions where there is imperfect oxidation and impaired nutrition. An ozone spray HIGH FREQUENCY CURRENTS 269 has been demonstrated to be healing in all forms of ulcers, etc. Methods of Administration. As ordinarily em- ployed, ozone is administered in the form of inhala- 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 essen- tial oils in order to remove the nitrous and nitric Fig. 56—Small Ozone Generator for Portable Outfits. 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- sional inhalations. This is especially true in con- sumption. Several ozone generators are illustrated herewith. Dosage. It is claimed that large amounts of ozone are capable of producing death, and that rabbits have succumbed in ten minutes in an atmosphere containing eight milligrams of ozone to the litre. The proper proportion for therapeutic inhalation is 270 eberhart’s manual of one, two or three milligrams to the litre. Inhalations given in a physician’s office last from ten to twenty minutes and may be repeated frequently. The indi- cation that the patient has had a sufficient dose is usually a slight sensation of light-headedness. Fig. 56a—Inhaling Ozone. Tuberculosis of the Lungs. Daily inhalations of ozone in connection with auto-condensation. Ozon- izing the air of the patient’s room is the best method of employing ozone in this disease. H. de LaCoux, Chemical Expert of the Council of the Prefecture of the Seine, Paris, says: “In the application of ozone for tuberculosis, it is an undeniable clinical fact that the number of bacilli in the sputum diminishes after HIGH FREQUENCY CURRENTS 271 the second or third treatment, even before the gen- eral condition of the patient is improved.” Dr. George Stoker, London, reports nine cases of tuberculosis treated within a year at the Stoker Patented, Apr. 26, 1921 Fig. 57—New Type Ozone Inhaler. Oxygen Hospital, of which eight were discharged with the disease definitely arrested. Dr. J. T. Gibson says in Advanced Therapeutics: “In advanced cases with cavities and much expec- 272 EBERHART S MANUAL OF toration, I think there is 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 is nothing that gives the lungs the sense of rest and quiet as does this agent. I have seen the quantity of sputum Fig. 58—Room Ozonizer. lessened to a most remarkable degree, and fever dis- appear, and all symptoms improved by the use of ozone inhalations.” Sletoff has treated 147 cases of tuberculosis with ozone, with favorable results. Anemia and Chlorosis. In a paper read before the American Pediatric Society, Boston, Dr. A. Caille reports the favorable influence of ozone in a number of cases of chlorosis and anemia as well as other diseases, and in his conclusion, says: “In chlorosis HIGH FREQUENCY CURRENTS 273 and anemia, ozone inhalations are exceedingly valuable from a therapeutic standpoint, and give better and prompter results than any other form of medication.” Chronic Middle-Ear Deafness and Tinnitus. Dr. Stoker of the London Throat Hospital and of the Oxygen Hospital, has published a series of twelve cases of chronic dry catarrh of the middle ear with deafness and in nearly all with tinnitus, which were treated with an ozone spray. Improvement, some- times remarkable, occurred in every case. The technique consisted of passing the ozone in a gentle current through an eustachian catheter into the middle ear for about four minutes at a time, the operation being repeated several times a week, daily if possible. Whooping Cough. (Pertussis.) The efficacy of ozone in treating whooping cough has been attested by many authorities, among them being Caille, L’Abbe, Derecq, Doumer, Delherm, Bordier and Oudin. In practically all of these cases the ozone was administered in ten to twenty minutes inhala- tions. Ozonizing the air in the patient’s room should prove a better method. Says L’Abbe: “My personal experience rests on over 100 cases. In 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. 274 EBERHART'S MANUAL OF Ozone is the remedy par excellence for whooping cough.” Asthma, Bronchitis and Hay Fever are benefited or cured by ozone. Inhalations combined with ozon- ization of the air of the room is the method; the latter being more efficacious. Hay fever victims have found that the use of a room atomizer constantly for two or three months prior to the expected attack has prevented the latter from coming on. During the attack inhalations have given a great relief. Insomnia. Daily inhalations for ten or fifteen minutes, or have patient sleep in a room with an ozonizer in operation. Pneumonia. Ozonize the air in the room, keeping the machine near the head of the patient’s bed. Nervous Debility, etc. Three to six ozone inhala- tions per week, preferably in connection with auto- condensation or with vacuum tube sparks. Other Diseases. On account of its oxidizing prop- erties, ozone should be a valuable adjunct to auto- condensation in diabetes, gout, obesity, etc. Its beneficial action in syphilis has been attested by many physicians. HIGH FREQUENCY CURRENTS 275 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 if its X-ray possibilities. Scope of Portable Outfits. Portable outfits are constructed on the Tesla type, and it is surprising how well some of them light up the X-ray 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 manufac- 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- 276 EBERhart’s MANUAL OF tion with their regular work. They are not suited to the requirements of the X-ray specialist. 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 biopolar. One form is shown in Fig. 62. The metal disk in the center is 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. Adjusting the Tube. There are gauges for mea- suring 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. HIGH FREQUENCY CURRENTS 277 Fig. 60—Large Office Ozone Generator. 278 eberhart’s manual of Protecting Patient and Operator. As an overdose of the X-ray is injurious, it is necessary to guard against indiscriminate exposure of the patient and also of the operator. The simplest method is the use of a protective shield to encircle the tube, permitting the exit of the rays only through a small aperture that may be reg- ulated as required. In addition the use of lead foil or sheet lead to cover all parts which are to be protected from the ray is customary. The Fluoroscope. In order to see the findings of the X-ray a screen is employed containing barium 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- duces a shadow on the screen commensurate with the amount of the ray which has been prevented from reaching the screen. We have, therefore, a shadow picture showing the relative density of the object traversed by the X-ray. The Skiagraph. The rays act upon the bromide of silver gelatin coating on photographic plates in the same manner as ordinary light. When a plate takes the relative position of the fluoroscopic screen the resultant picture is called a radiograph, or skia- graph, and affords a permanent record of the condi- tion shown. HIGH FREQUENCY CURRENTS 279 The X-ray plates have a heavier coating than ordinary photographic plates and are enclosed in two envelopes so that they may be handled in day- light. The flaps on the envelopes are on the non- 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. 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 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. 280 eberhart’s manual of Fig. 62—High Frequency X-Ray Tube. HIGH FREQUENCY CURRENTS 281 Fig. 63—Proper Position of Tube, Plate and Hand for a Skiagraph. 282 EBERhart’s MANUAL OF 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 skiagraph 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 films is in accordance with the rule given above. With small machines it will be necessary to experiment to get the time exposure. It will average 30 to 60 sec- onds. The films are developed, washed and dried; the one retained by the radiographer, the other by the patient. Diseases Grouped According to Technique. In treating with the X-ray the average number 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- syncrasy 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 HIGH FREQUENCY CURRENTS 283 Fig. 63a—A Method of Applying Diathermy to the Chest. 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 284 eberhart’s manual of lower the tube the quicker the reaction produced. Some, diseases are included under two headings, where it is a matter of choice, either method yield- ing results. Low Tube. Acne, eczema, epithelioma, lupus, rodent ulcer. Medium Tube. Acne, blastomycosis, cancer (superficial), favus, goitre, hyperidrosis, keloid, nevus, pruritus, psoria- sis, sarcoma, sycosis, trachoma, tuberculous glands, neuralgia. 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 keeping these in mind it will be possible to avoid severe burns. 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 calls for surgical measures. 285 HIGH FREQUENCY CURRENTS 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, Doyon 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. Diathermy means “heating through”. 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. 286 EBERHART'S MANUAL OF 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 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 introduction 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 application, can be raised to a temperature of 110 to 140 degrees Fahrenheit, though many believe 110 degrees to be about the limit of skin and tissue resistance. HIGH FREQUENCY CURRENTS 287 Fig. 63b—Diathermy in the Treatment of Sprain or Contusion of the Knee. Experiments made by Lambert in 1912 show that 114.8 degrees destroyed sarcoma cells in twenty minutes. Loeb found 113 degrees destroyed them in thirty minutes. Saberton considered 113 degrees the highest that should be used in diathermy. Geyser uses 106 degrees in the treatment of cancer. Effects. 'On account of there being 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- 288 eberhart’s manual of tween the electrodes. The current can be concen- trated in this manner, 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 this current to exact measurement, so difficult to obtain when applying an ordinary high 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, making 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 tis- sues, thus the value of this current in all inflamma- tory conditions of joints, etc. When the cauterizing effect is desired, the active electrode is usually a metal point or a wire. In this HIGH FREQUENCY CURRENTS 289 Fig. 63c—Diathermy Applied in Non-union of the Humerus. form it represents one form of fulguration. It is 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 or D’Arsonval type meter. The whole theory of the heat regulation or distri- bution is easily comprehended by reference to figure 64. A and B represent two electrodes and the lines between, the heat waves generated by the passage of the electric current. In the upper figure, the electrodes being of the same size, the heat will be distributed equally be- tween the poles. 290 EBERhart's MANUAL OF In the middle figure, since B is the smaller elec- trode and all of the heat waves passing from A must pass through B, they will be condensed around B and that area will be much hotter than about A. In the lower drawing, if B is a mere point, as a needle or a wire, the concentration will be so great that tissues will be coagulated or fulgurated by the heat at B. Diathermy then becomes very simple. It is merely a question of adjusting the size of the electrodes so that the heat is delivered where you wish it and of the intensity desired. Voltage and Penetration. Recent experiments made on dead tissues and on dogs show that the low voltage, high amperage type of machine now in gen- eral use for diathermy is very satisfactory up to a thickness of about seven inches. For tissues seven inches thick or more, it does not possess the power of deep and complete penetration. In these instan- ces, when the voltage or pressure is increased, then the heat penetrates to the desired depth. For this, in the future, machines will probably be constructed where it will be possible to vary the voltage as re- quired in accordance with the penetration desired and the high voltage will be used through the trunk of the body, chest, hips, etc. Then dosage will be given in terms of voltage and amperage, instead of amperage alone. HIGH FREQUENCY CURRENTS 291 Range of Usefulness. Outside of their use in one form of fulguration as above referred to, they have been very successfully used in connection with deep Roentgen therapy in malignant growths, and in the Fig. 64—Showing How Size of Electrode Influences Intensity of Current. form of increased heat without carrying it to tissue coagulation, in arteriosclerosis, local or peripheral disturbances, 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. 292 eberhart’s manual of Technique. Formerly electrodes of metal covered with cotton, gauze, or other absorbent material mois- tened in normal salt solution were used in diathermy. At the present time, they are made of block tin, in various sizes, and when applied to the tissues are covered with soap lather. The reason for moistening them is to make perfect contact with the skin, other- wise small sparks passing where the electrode does not touch will cause pain and often annoying burns. Lead foil is also employed'by operators. The electrodes are always placed opposite one an- other so that the heat may be carried through the part to be treated. For instance, if it is the knee, one is placed on each side of the knee. One operator places one above the patella and one below the popliteal space, carrying the current diagonally through. If the right lung were to be treated, one electrode would be over the right side of the chest and the other over the right shoulder blade. The electrodes preferably are bound on, either with a bandage or with a rubber strip. An old inner tube from an automobile tire, thoroughly cleaned and cut in different sized strips, will be found very handy for this purpose. The meter must be in the circuit showdng the amount of current in milliamperes. Start the ma- chine slowly with low reading and gradually push the rheostat around until the meter shows 700 or 800 HIGH FREQUENCY CURRENTS 293 milliamperes passing and then gradually higher according to the toleration of the patient and result sought. Allow time for the gradual heating of the tissues below the skin. As a rule, the current should pass, in all, for some time; half an hour being an average time with many operators. The amount of heat may be tested locally by slip- ping a clinical thermometer under one of the elec- trodes. If too much current is employed suddenly, there is danger of burning the skin before the heat has passed to and heated up the deeper tissues. The foregoing applies to those cases where the heat is desired to be raised to the point of destroying ab- normal cells without injuring normal ones. This is physiological diathermy. When a metal point becomes the active electrode, the larger indifferent electrode must still be placed opposite to it. Coagulation or destruction (fulguration, cauteri- zation) of tissues is produced beneath the metal point, the depth of penetration depending on the amount of the current employed and the relative size of the larger electrode. This is surgical dia- thermy. A new method has just been introduced using separate points of attachment, one of ordinary volt- age and amperage for use in treating extremities; the other with higher voltage to get better and 294 EBERHART'S MANUAL OF deeper penetration in the thick parts of the body, such as chest, hip, etc. In using diathermy in the orifices of the body, the non-vacuum tubes are found to be of great service as the active electrode, the silver being a conductor and the glass a di-electric. A condenser effect main- taining even heat about the cavity is produced. A device for retaining electrodes in place, on the principle of a clamp, has been introduced recently. A general rule is to use not more than 100 milli- amperes of current to each square inch of surface of the smaller electrode. In most cases, 50 to 75 milliamperes per square inch will be ample. In very sensitive cases, a method has been em- ployed where the active electrode was held in the operator’s left hand and his right hand laid over the sensitive area. By gradually raising one finger after another the intensity was increased in pro- portion. In many instances, the action of diathermy is en- hanced by first using the radiant light, and in others by following the diathermic treatment with vibra- tion, faradism or sinusoidal current, or in combina- tion with high frequency sparks. Cautions. Go slow. Heat the tissues gradually. When anaesthetic areas exist or there are severed nerves, great care must be exercised as patient can- not warn you when the temperature is going too high. HIGH FREQUENCY CURRENTS 295 Be careful about the margins of the electrodes so that no elevations exist, in fact, always be sure of perfect electrical contact over the whole surface of the electrode. Have it well lathered and pressed down firmly and carefully secured in place. Pfahler’s Method in Malignancy. Dr. G. E. Pfahler (Journal Advanced Therapeu- tics, Dec., 1914) has accomplished remarkable re- sults by combining this method with deep Roentgen Fig. 64a—A New Electrode for Modified Diathermy. therapy in malignant growths. The work is done under an anaesthetic, as the pain is severe. In most of his cases ether wras employed, hut in mouth cases hypodermic injections of one or one and a half HMC tablets (hyoscine hydrobromide gr. 1/100; morphine hydrobromide gr. ; and cactoid gr. 1/64) were used. These in some cases had to be supple- mented 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 296 eberhart’s manual of 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 elec- trode on the inside, and then coagulate the entire diseased tissue. At first I depended upon the needle electrode to actually carve out the diseased tissue, but now I find it simpler to cut this away with a pair of curved scissors after coagulation, always cutting within the coagulated tissue. In this way there is no bleeding and the edges are completely 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.’’ Sprains and Fractures. Electrodes applied as usual on opposite sides, or sometimes one above and one below in the line of the circulation. Electrodes of same size. Start with 400 milliamperes increasing every four or five minutes up to 800, 1000 or 1200 milliamperes according to tolerance of patient. Aver- age duration of treatment twenty to thirty minutes, twice daily; daily or every other day as required. Adhesions, Fibrous Deposits About Joints. Use technique similar to that employed in sprains and fractures but let the treatment last half an hour, daily or every other day. HIGH FREQUENCY CURRENTS 297 Dental Trauma. Where the jaw is inflamed and swollen after extraction of teeth, the use of dia- thermy is very advantageous. Non-vacuum tube for active electrode, passed over the outside of the jaw, over the swollen or inflamed area. Pelvic Adhesions. Use large electrode to the back and small size over abdominal area involved. Start with 600 milliamperes and increase to tolerance. One Fig. 64c—Diathermy Electrodes. half hour every other day. In some cases use non- vacuum tube in vagina or rectum for active elec- trode. Rheumatoid Arthritis; Arthritis Deformans; Chronic Arthritis. The same general method is fol- lowed in all of these cases; using electrodes of the same area on opposite sides of the joints involved, 400 to 600 milliamperes to start with and then grad- ually increase to tolerance. By means of bifurcated cords, two joints may be treated at the same time. Half hour seances to each joint, daily or every other day. 298 EBF.RHART'S MANUAL OF Anterior Poliomyelitis. (Infantile Paralysis.) First use radiant light, then diathermy and follow with vibration, sinusoidal current, rhythmic faradism, in- terrupted galvanic current, or high frequency sparks, either direct or indirect. Three treatments a week. Sciatica. Large electrode under buttock of the affected side, other electrode over inguinal area, hip Fig. 64d—Military Model Diathermy Apparatus with Oil Transformer. and upper part of thigh. Half an hour treatment daily. Start with 600 milliamperes and increase to tolerance. On account of the thickness of the body, best treated with higher voltage if apparatus per- mits, otherwise penetration is likely to be insufficient. Miscellaneous Diseases and Conditions. Reports of the beneficial use of diathermy have been made in cases of angina pectoris; brachial and other forms of neuritis; neuralgia; lumbago; orchitis; etc. The HIGH FREQUENCY CURRENTS 299 technique is readily inferred and follows the general instruction given earlier in this chapter. Carcinoma. The indifferent electrode should con- tain approximately four times the square area of that of the active electrode. Geyser uses, in breast cancer, a piece of tin about three inches in diameter for the active electrode and cuts into the edges so that it can be fitted close over the tumor; the large electrode being over the corresponding shoulder blade. He uses 100 milliamperes of current to each square inch of the active pole and treats for half an hour to an hour daily until signs of toxemia appear, then he reduces the number but not the length of the treatments. He says 106 degrees is about the average temperature developed after ten minutes. Thermolysis. A method of using the diathermic current for the removal of superfluous hair has been devised recently, to which the term thermolysis has been given. In electrolysis, the hair follicle is cauter- ized and destroyed by the production of caustic soda by the action of the negative pole of the galvanic current. In thermolysis, we have fulguration of the follicle by the bi-polar method. A machine has been constructed with a special I) ’Arsonval or diathermic current in which the spark gap can be adjusted so finely that there is scarcely any perceptible spark. The usual platinum electrolysis needle is employed and introduced into the hair follicle, the patient holding a long metal handle attached to the other terminal. With the spark kept down, there is prac- tically no pain. About ten seconds is required to thoroughly fulgurate the follicle, when the hair is pulled out. Operators who have been accustomed to electrolysis will be bothered a little at first, as the hair is not loosened as it is with electrolysis and must be forcibly pulled out. Neither are there any hydrogen bubbles and the time is much shorter. 300 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 root-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. Pyorrhea early manifests itself by a slight reddening of the gums at the margins and a tendency to bleed on slight provocation. A large majority of patients having pyorrhea are anemic, and in these the gums, instead of being red, may have a yellow and discolored appearance and are apt to be flabby or receding instead of puffy. In the second stage of the disease, pus appears, attacking first the peri-dental membrane. Later the bony socket of the tooth may be slowly eaten away or 301 HIGH FREQUENCY CURRENTS L<'ig. 65—D’Arsonval Outfit for Diathermy. 302 eberhart’s manual of destroyed. The gum gradually recedes and the tooth becomes loose in its socket and painful to the touch. From this we can see at once indications for the employment of high frequency currents. A French authority says that it is necessary “to destroy the microbic and suppurative state of the gums, correct the depleted nutrition in the tissues and produce an over-active phagocytosis and increase the index of leucocytic destruction. For this result one uses high frequency currents with the greatest success in the two forms, the effleuve (spray) and the spark.” Gremeaux and Arnal (l’Est Dentaire, Sept., 1913) use the high frequency as follows: “One introduces the metallic fulguration electrode as far as possible between the loosened gum and the tooth, in order that the spark may reach all the recesses and puru- lent foci. During the operation, which lasts an average of a minute for each tooth, one sees the margin of the gum blanch and the pus bubble out at the neck of the tooth. When all of the recesses have been penetrated, the fulguration point is re- placed by a small vacuum electrode, which is passed over the external and internal surface of the gums for about ten minutes.” They wait three or four weeks to note results be- fore giving a second treatment, employing a rigor- HIGH FREQUENCY CURRENTS 303 ous antiseptic regimen in the meantime, consisting in brushing with an alkaline powder night and morn- ing, and numerous rinsings with boiled water, etc. About a week after the treatment the patient mas- sages the gums with the finger twice a day. In three or four weeks, if pressure on the gum shows pres- ence of pus, the treatment is repeated; otherwise the case is dismissed, with instructions to keep up the massage of the gums and antiseptic care of the mouth. One to three treatments were required in the cases treated. Dr. F. Morel (Bulletin du Syndieat des Chirur- giens-Dentistes de France, Sept.-Oct., 1910, Jan.- Feb., 1911) makes use of medicaments in connec- tion with the high frequency. He claims that the high frequency effleuve renders mucous membranes porous and facilitates the penetration of medica- ments, and that the simultaneous application of the solution and the current produces an electro-chemic effect. He decomposes by the currents a solution of potassium bichromate, claiming that the base will be taken up by the diseased tissues. After thoroughly removing the tartar from the teeth, he carefully irrigates with peroxide and evac- uates all of the pus. Then he paints the teeth and gums with the following solution, using a spatula to get it up as far as possible around the roots: R—Fluoride of Ammonia 1 gramme Chloride of Ammonia 1 gramme 304 eberhart’s manual of Chloride of Potash 1.5 gramme Salicylate of Theobromine.... 1 gramme Methyl Alcohol 50 centigrammes Distilled Water 20 grammes M.—Filter. This solution favors ionization and lessens the resistance of the tissues to porosity. A pad is then soaked in a ten per cent aqueous solution of bichromate of potash and held over four teeth and a vacuum electrode held over this for about fifteen minutes, with close contact. He only treats four teeth at a time. In advanced cases he uses a metal point and carries a few sparks up into the infected canals. The vacuum tube application is for cataphoric purposes, and one of the electrodes illustrated here- with having a cup to hold the saturated cotton may be used for this purpose. He repeats this treatment every second day, some- times giving three five-minute seances with eight minutes’ rest between. Usually four treatments pro- duce a cure; occasionally six, seven or eight have been required. During the whole course of treat- ment the patient washes the mouth six times a day with the following solution, using half a glass each time: Sodium salicylate 10 grammes Sodium fluorosilicate 2 grammes. Distilled water 1 litre HIGH FREQUENCY CURRENTS 305 Dr. Irwin Jirka applies methyl salicylate in these eases, driving it in with the vacuum electrode. He treats for eight minutes every other day. Reports a number of cases cured in three to fifteen treat- ments. Hubbel uses the cataphoresis electrode first and then the ball pointed pyorrhea electrode to mas- sage the gums for five or six minutes each, treating daily until improvement takes place. Desiccation, Metallic Ionization and Phoresis. I have been furnished with a translation of a paper by Dr. A. A. Nouel of Venezuela. This paper, read at the Dental Section of the Medical Congress at Caracas in 1911, is entitled, “Desiccation, Metallic Ionization, and Phoresis of the Canals in One Sit- ting with High Frequency Currents.” The author’s methods seem to be distinctly original. He speaks of using at first a coil and resonator and with this used iodide of potash because this chemical absorbed the ozone when the current was introduced into in- fected root canals. After four years of experiment- ing he found a method and a machine that enabled him to get simultaneously metallic ionization and thermopenetration. He says: “I have used the * * * high frequency coil, but even though the machine is just as efficient as other more powerful coils for fulguration with vacuum electrodes and with the ozone inhaler, in the desiccation of the canals, the current is found to be of too pronounced faradic character. 306 Eberhart’s manual of “I have also used several other types of high fre- quency machines, and found the one most suitable giving a smooth, high frequency current without any faradic sensation, such as is used in diathermy. In this case there will be felt by the patient nothing Fig. 68—Dental Electrodes. but a progressive increase of warmth, if there is no continuity of solution. If there is one, no matter how small, beside the progressive thermic increase, there will result an ionization of the canal in which a small arc will be established. This arc is formed between the walls of the canal and extends the full length of the electrode. HIGH FREQUENCY CURRENTS 307 “The electrode is connected by means of a flexible and well-insulated metallic conductor to the right- hand ‘auto-condensation’ terminal. The electrode handle may be about ten centimeters long, and made of either fine wood or ivory, with a metallic point similar to that of the broach holders employed in dentistry. Small pieces of either copper or zinc wire, as required in each case, will be fitted to the handle. In some cases, where no abscess is formed, I believe the copper is superior to the zinc electrode. To substantiate this statement, I have observed that after a diseased spot has been treated with a copper electrode no pain is felt if that spot is touched. “Before the current is turned on, it is better to thoroughly dry the cavity leading to the canal in order that the sparks may not be diverted, but will confine themselves to the length of the wire and walls of the canal throughout its length. “I firmly believe that the metal, during its ioniza- tion, is cataphorically introduced into the dentai canals through the apex, and that once in the pres- ence of the salts that form the composition of the blood, a chloride is formed, this being the reason why the periodontium and adjacent parts are irri- tated when zinc is employed. A zinc electrode is bene- ficial in ease of an abscess on account of the chemical composition formed by the zinc. “The ionized and ozonized copper is also intro- duced into the dental canals by means of the cata- 308 Eberhart's manual of phoric action of the current, thus forming a deposit of oxide or bi-oxide of copper, which will perma- nently act as a disinfectant. I shall later on explain the method through which its action is brought about. “Although a tooth may be profoundly infected (it is understood that I refer to a tooth without pulp), with inflammation of the periodontium, with an abscess or fistula, it can be ‘stopped’ in one sit- ting, fearing no ulterior difficulties, if this novel method is employed. “The technique is very simple: After the pulp chamber is open it is to be moistened with a small quantity of trikresol and iodoform or trikresol and formalin, after which the electrode is applied, being held at a distance of a half to one millimeter and moving it over the surface until the cavity is dry. A broach is now employed, being operated into one- half the length of the canal, drying with cotton and compressed air, not too warm; then the copper wire is introduced and the current turned on for five min- utes. The broach is now used again, this time reach- ing to the apex. The canal now being perfectly freed from the bits of pulp and other foreign bodies, is now thoroughly dried with cotton inserts. The copper electrode treatment is then repeated for five minutes, and, after this time has elapsed the tooth may be ‘stopped.’ HIGH FREQUENCY CURRENTS 309 ‘ ‘ The great efficacy of this "modality is supported by the fact that the dental canals constantly main- tain a certain humidity, which serves as an easy conductor for the introduction of the ionized metal, and permits the easy access of the flowing-in process of the ozone while being dried by the thermopene- tration, which goes to complete the oxidation and the consequent coating of copper, leaving it perma- nently deposited in a state of oxide or bi-oxide of copper. ” Abscesses. The dental technique advised by some operators consists in ten or fifteen minute applica- tions of a mild current in contact with the cheek, followed by the use of one of the cataphoresis electrodes containing cotton saturated with iodine and aconite solution. Duration of this application about eight or ten minutes. Jirka uses methyl salicy- late, and also speaks of formo-cresol, which I infer is used with the cataphoresis electrode. Drs. Barber and Van Valkenburg have reported a case where the copper wire was employed in treat- ing an abscess. Post-operative Pains. For the pains and soreness existing after extraction or after setting bridges or crowns, the use of the cataphoric electrode with any suitable solution has been recommended, followed by application of mild current with the ball-pointed pyorrhea electrode. 310 eberhart’s manual of Sterilizing Root Canals. Another method of ster- ilizing root canals is the touching of the pointed dental electrode (carrying current enough for a half- inch spark), to a broach which has previously been inserted in the canal. The broach carries the current into the canal. The direct D’Arsonval current may be used the same way. Bleaching the Teeth. Hubbel says: “Place your bleaching solution on a fibre of asbestos or cotton, placing it in the cavity of the tooth and applying the point of the electrode directly against this fibre, the cataphoric action of the current driving the solu- tion into the dentine, getting results much quicker than from ordinary measures. Care must be taken that the apex of the tooth is first stopped with gutta- percha so that there is no danger of the solution being forced through the apical foramen.” Diagnosing Live from Dead Pulp. The pointed dental electrode is used with a mild current, and the point applied to the cusp of the tooth. If the pulp is alive the patient will feel the current; if- he does not, the tooth is devitalized. Obtunding Sensitive Dentine and Devitalizing Teeth. “In obtunding sensitive dentine, a small crystal of carbolic acid is placed in the cavity and the pointed electrode is used in the generator, the current being toned down as mildly as possible. The point of this electrode is then placed against the cavity and held for from 30 to 50 seconds. Now, HIGH FREQUENCY CURRENTS 311 test the cavity, and if still sensitive, use the current for a half minute longer. You may now start to excavate, and if the one application of the carbolic acid does not last sufficiently long to complete the operation, place another tiny crystal in the cavity and apply as before. In the majority of cases, oper- ations have been rendered entirely painless by this method of treatment. “In devitalizing the teeth a small crystal of novo- cain is placed in the cavity, or, if no cavity is appar- ent, cut into the enamel with a very small stone, placing a crystal of novocain therein and dipping the tip of the electrode in adrenalin. Apply the high frequency current to this with a very mild flow of current the same as in obtunding sensitive dentine, using the current for about one minute. Drill into the teeth until as close to the pulp cavity as possible without unnecessary pain, and again apply a crystal of novocain and use the current for about a minute to a minute and a half, and in most cases it is then possible to cut into the pulp cavity. If the nerve is then sensitive, pressure anesthesia is advisable. The greatest trouble that we find in getting success from this treatment is the inability of the operator to successfully control his current, as it takes con- siderable practice in order to get the proper amount of stimulation. But, after some experimenting, it is possible to get results in the majority of cases.”— Hubbel. 312 EBERHART’s manual oe GLOSSARY. Names of Diseases and Terms Defined in the Text Are Omitted. Ampere. The unit of current strength or intensity. Anemia. A deficiency in quantity or quality of the blood. Arteriole. A small artery. Asepsis. Freedom from septic matter or infection. Atonic. Lacking tone. Atrophy. Wasting of a part. Bi-polar. Attached to both poles of the apparatus. Capillaries. Hair-like vessels connecting the arteri- oles with the smallest veins. Carbon dioxide. C02. A poisonous gas eliminated through the lungs. Carbon dioxide snow. Under high pressure the gas liquefies and on liberation the evaporation pro- duces snow-like crystals which are moulded and applied to a growth that is to be removed. It is frozen and separates in 10 to 12 days without leaving a scar. Cataphoresis. Driving a substance into the tissues by means of an electric current. HIGH FREQUENCY CURRENTS 313 Coagulum. A clot. Condenser electrode. A vacuum tube containing a metal disk which acts as one plate of a con- denser, the tube wall being the di-electric and the body surface in contact, the other plate. Shown in Fig. 21. Conductor. A material readily transmitting elec- tricity. Contra-indicated. Not indicated. Dermatitis. An inflammation of the skin; used to signify the inflammation produced by an over- dose of the X-ray, or X-ray “burn.” Di-electric. A substance separating two charges of electricity in a condenser, as the glass in a Ley- den jar. Diplopia. Double vision. Efifleuve. The fine spray from a vacuum tube or other electrode, too fine to be termed a spark. Electrolysis. Breaking up a compound into its ele- ments by means of an electric current. Electric analysis. Elimination. Carrying a substance out of the sys- tem. Endarteritis. Inflammation of the lining of an ar- tery. Escharotic. Caustic. Exudate. A substance deposited in or on a tissue, either by vital action or by disease. 314 EBERHart’s MANUAL OF Functional. Pertaining to the natural action of a part, which may vary somewhat without an ac- tual change in the structure of the organ or part. Hemoglobin. The coloring matter of the red blood corpuscles, containing iron. Hyperemia. An increased amount of blood. Hyperesthetic. Over-sensitive. Hyperplasia. Abnormal increase in tissue elements. Hypertrophy. Overgrowth. Hypertension. Above normal pressure. Hypotension. Less than normal pressure. Ion. A moving particle of electricity. Indican. A substance found in the urine as a result of imperfect intestinal digestion (from proteid putrefaction). Inductance. The phenomenon of induction. Induction. The generation of an electric current in a body by the influence of another electrified body. Inhibitive. Producing inhibition. Inhibition. Soothing or arresting a process or func- tion. Intra. Within. Intra-ocular. Within the eye. Intra-vaginal. Within the vagina. Lesion. A disease or diseased area. Leucocytosis. An increase in the number of white blood cells. HIGH FREQUENCY 'CURRENTS 315 Metabolism. The process of changing inorganic ma- terials into living cells. Milliampere. One one-thousandth of an ampere. The unit of dosage of medical electricity. Modality. Any one of the different forms of elec- tricity. Monopolar. Connected to one pole. Myelocyte. A pathological white blood cell found in leukemia. Neurosis. A nervous disease especially a functional one. Ohm. The unit of resistance to the passage of an electrical current. Orificial. Pertaining to one of the openings or ori- fices of the body. Oxidation. Combining or causing to combine with oxygen. Same as oxidization. Oxyhemoglobin. Hemoglobin charged with oxygen in the arterial blood. Phagocytosis. The destruction of harmful cells by cells called phagocytes which envelop and ab- sorb them. Physiological. Natural or normal. Plastic. Tending to build up or form tissues as a plastic exudate. Poikilocytes. Malformed, over-sized, non-nucleated red blood corpuscles present in pernicious and other anemias. 316 Eberhart's manual oe Potential. Electric pressure (measured in volts). Reciprocal. The reciprocal of a fraction is the in- version of it. Thus the reciprocal of *4 is 2-1 or 2. Serosanguinous. Serum and blood mixed. Solenoid. A coil of wire. Suppuration. Formation of pus. Suppurative. Tending to form pus. Supra. Above. Supra-orbital. Above the orbit or eye. Tension. 1. Electromotive force; potential. 2. Pressure, as the pressure of blood in the ar- teries. Thermostat. An apparatus registering heat expan- sion or regulating a mechanism through this action. Transformer. A coil that changes the voltage. If it increases it, it is called a “ step-up ” trans- former. Unipolar. Connected to one pole; same as mono- polar. Volt. The unit of electrical pressure. HIGH FREQUENCY CURRENTS 317 INDEX A Abscess, 156-309. — mastoid, 156-236. — pelvic, 245. Acne rosacea, 156. — vulgaris, 156. Actinomycosis, 160. Adenitis, see tuberculosis of glands, 259. Adhesions, 161-296. — pelvic, 245-297. Adjustable tube handle, 53. Albuminuria, 161. Alcoholism, 162-201. Alopecia, 162. Alternating current, 14. Alternation, 13. Amenorrhea, 164. Anal fissure, 208. — pruritus, 249. Anemia, 167-272. Aneurism, 167. Angina, 298. Anterior poliomyelitis, 227-298. Appendicitis, catarrhal, 168. Arteriosclerosis, 168. Articular rheumatism, 252 Arthritis, 297. Asepsis, 72. Asthenopia, 177. Asthma, 178-274. Ataxia, locomotor, 232. Atonic dilation of the stomach, 178. Atrophic rhinitis, 244. Atrophy of optic nerve, 180. Author’s auto-condensa- tion pad, 107. — D’Arsonval surgings, 114. — Spatulate tubes, 53. Auto-condensation, 39-101. — couch, 102. — local, 116. —• measurement of, 7 5. — pad, 107. — pad, home-made, 108. Auto-conduction, 100. B Baldness, 162. Barber’s itch, see sycosis. Basedow’s disease, 211. Bipolar Tesla, technique, 90. Bladder, disease, see cys- titis. Bladder, papilloma of, 95. Bleaching teeth, 310. Blepharitis, ISO. Blindness, 182. Blood pressure, 119-168. — in arteriosclerosis, 168. — in various diseases, 132. — high, 168-223. — low, 224. — method of taking, 119. Boils, see furunculosis. Brachial neuritis, 242-298. Brain fag, 183. Breasts, flabby, 208. Bright’s disease, 161. Bronchial asthma, see asthma, 178-274. Bronchitis, 185-274. Burns, high frequency, 63. —• X-ray, 284. C Callus, 186. Cancer, 186-299. Canities, see gray hair. Carbuncle, 186. Carcinoma, 186-299. Cataphoresis, 88-305. Cataract, 187. Catarrh of bladder, see cystitis. — bowels, see colitis. — nose, see nasal catarrh and ozena. —• womb, see cervicitis. Cauterization, 86. Cautions, 71-114. Cellular massage, 20. Cellulitis, 188. Cerebral hemorrhage, 188. Cervical adenitis, see tu- berculosis of glands, 259. Cervicitis, 189. Cervix, erosions of, 207. — inflammation of, 189. Chancroid, 191. Change of life, 237. Chilblains, 191. Chloasma, see moth- patches. Chlorosis, 167-272. Chorea, 192. Chronic ulcers, 192. Cicatrices, 254. Climacteric, 237. Coagulation, electric, 285. Cocaine habit, 201. Coil, Tesla, 35. Cold extremities, 192. Colitis, 193. 318 EBERHART’s manual of Colon, inflammation of, 193. Condenser, 22-25. —• cushion, 109. — plate, 26. Constipation, 194. Constitutional effect, 62- 63. Contraction, Dupuytren’s, 202. Convalescence, 195. Corneal opacity, 195. Corns, see Callus, 186. Coryza, 195. Cutaneous cancer, 206. Cycle, 13. Cystitis, 196. X> Dandruff, see Seborrhea. D’Arsonval current, 34. — administration, 37-285. — effects of, 285. — surgings, 114. — technique, 37-292. Deafness, 197-273. Definition of alternation, 13. — cycle, 13. — di-electric, 25. —• frequency, 14. — high frequency, 13. —• oscillation, 13. — period, 14. — periodicity, 16. — pulsatory currents, 16. Dental films, 282. — trauma, 297. Dentistry, high frequency in, 300. Devitalizing teeth, 311. Diabetes, 197. Diarrhea, 200. Diathermy, 133-285. Di-electric, 25. Dilation of stomach, 178. Dosage measuring, 40-76- 78 —• rough method of stand- ardizing, 76. Drug habits, 201. Dupuytren’s contraction, 202. Dyspepsia, 202. E Earache, 203. Ear diseases, 203. Ear technique, 134. Eberhart Unit, 78. Eczema, 203. Effects of vacuum tubes, 60. Electrical-oscillation, 26. Electric coagulation, 285. Electrodes, cataphoresis, 88-305. — fulguration, 90. — vacuum, 44-61. Emissions, nocturnal, 255. Endometritis, 204. Enlarged prostate, see prostatic diseases. Enteritis, 204. Enuresis, 226. Epididymitis, 205. Epilepsy, 205. Epithelioma, 206. Erosions of cervix, 207. Exophthalmic goitre, 211. Eye diseases, 207. Eye technique, 137. IF Favus, 208. Fissure, anal, 208. Flabby breasts, 208. Fluoroscope, 278. Frequency defined, 14. Frontal sinusitis, 258. Fulguration, 90-95. Furunculosis, 208. G Gaiffe’s meter, 41. Gastritis, 209. Genito-urinary diseases, 209. Glands, tuberculosis of, 259. Glaucoma, 209. Glossary, 313. Gleet, 210. Goitre, 211. Gonorrhoea, 212. Gout, 213. Gray hair, 214. Grippe, 218. H Habit, alcohol, 162-201. — cocaine, 201. — drug, 201. — morphine or opium, 201. Hair, falling, 219. — gray, 214. —• loss of, 162. Handles for tubes, 53. Hay fever, 219-274. Headache, 221. Heart disease, 222. Heat penetration, 285. Hemorrhoids, 222. Herpes zoster, 223. High blood pressure, 168- 223. High frequency burns, 63. — constitutional effects, 61-63. — defined, 13. — development of, 22. — measurement of, 40. — physiological action of, 59. — surgings, 114. — therapy, 150. — water spray, 116. — X-ray, 275. Hives, 264. Hot-wire meter, 41. Hyperesthetic rhinitis, 219-274. Hypertension, 223. Hypertrophy of prostate, see prostate diseases. Hypotension, 224. Hysteria, 224. X Impetigo, 224. Impotence, 224. Incontinence of urine, 226. Indigestion, intestinal, 229. Indirect sparks, 117. Infantile paralysis, 227- 298. Influenza, see grippe. HIGH FREQUENCY CURRENTS 319 Insomnia, 227-274. Insulated tubes, 51. Intestinal indigestion, 229. Intra-ocular hemorrhage, 230. — blindness from, 181. Iritis, 230. Itching, 249. X Keloid, 230. I. Laryngitis, 231. Leucorrhoea, 231. Leukemia, 231. Leyden jar, 22. Lichen, 232. Lightning tube not proof of high frequency cur- rent, 21. Lithemia, see gout. Locomotor ataxia, 232. Loss of hair, 162. Low blood pressure, 224. Lowi frequency currents, 18. Lubrication of tubes, 70. Lumbago, 235. Lupus, 236. M Malignancy, diathermy in, 295-299. Mastoid abscess, 236. Mastoiditis, 236. Measuring dosage, 40-76- 78. Measuring high frequency, 40-78-80. Medium frequency, 18. Menstruation, suppres- sion of, 164. Menopause, 237. Menorrhagia, 237-238. Meter, hot-wire, 41. Metrorrhagia, 238. Migraine, 238. Moles, 239. Molluscum contagiosium, 239. Morphine habit, 201. Moth patches, 239. Mucous colitis, 193. Muscular rheumatism, 253. Myxedema, 239. N Nasal catarrh, 239. — diseases, 239. — technique, 141. Nephritis, 161. Nervous debility, 241-274. Neurasthenia, 241. Neuralgia, 241-298. Neuritis, 242-298. O Obesity, 243. Opacity of cornea, 195. Opium habit, 261. Optic nerve, atrophy of, 180. Orchitis, 243-298. Orificial technique, 87. Oscillation, 13. — electrical, 26. Otitis, 244. Oudin’s resonator, 40. Ozena, 244. Ozone, 267. — methods of administer- ing, 269. — physiological action of, 267. P Pad, auto-condensation, 107. — Piffards, 107. Papilloma, 95-244. Paralysis, 244. — agitans, 245. — infantile, 227-298. — of sphincter, 245. Patient, preparation of, 82. Pelvic abscess, 245. — adhesions, 245-297. — exudates, 245-297. Period, 14. Periodicity, 16. Periostitis, 245. Pertussis, 273. Pharyngitis, 246. Phlebitis, 246. Piano player’s cramp, 265. Piles, 222. Pimples, 156. Pityriasis, 247. Plate-glass method, 116. Pleurisy, 247. Pneumonia, 247. Poliomyelitis, 227-298. Post-fracture conditions, 247. Post-operative conditions, 248. Preparation of patient, 82. Proctitis, 248. Prolapse of rectum, 248. Prostatic diseases, 248. — technique, 141. Pruritus, 249. — ani, 249. — vulvae, 249. Psoriasis, 250. Pulsatory currents, 16. Pulse pressure, 125. Purpura rheumatica, 250. Pyorrhea, 250-300. Pyosalpinx, 251. R Ray fungus, 160. Raynaud’s disease, 251. Rectal diseases, 251. — technique, 141. Rectum, prolapse of, 248 Red nose, 156. Resonator, 40. Restoring gray hair, 214. Retinitis, 251. Rheumatism, 252-297. Rigg’s disease, 250-300. Ringworm, see tinea. Rodent ulcer, 253. S Scalp treatment, 143. Scars, 254. Sciatica, 254-298. Seborrhcea, 254. Seminal emissions, 255. Sexual impotence, 224. Shingles, 223. Sick headache, see mi- graine. 320 Eberhart’s MANUAL OE Sinusitis, 255. Sinusoidal current, 18. Skiagraph, 278. Skin cancer, 206. Skin diseases, 255. — technique in, 83. Sleeplessness, 227-274 Sore throat, see pharyn- gitis and laryngitis. Sparks, indirect, 117. Sphygmomanometer, 119. Sprains, 256-296 Sterlity, 256. Sterilizing root-canals, 303. —■ tubes, 73. Stiff neck, see torticollis and rheumatism. Stricture, 256. Sub-involution, 257. Superfluous fat, 243. Suppuration, 257. Surgings, author’s, 114. Sycosis, 257. Synovitis, 257. T Tabes dorsalis, 232. Technique, bi-polar Tesla, 90. — classification of, 7 0. — diathermic, 292. — ear, 134. — eye, 137. — general, 83. — nasal, 141. — orificial, 87. — prostatic, 141. —-rectum, 141. — scalp, 143. — skin, 83. — special, 134. — throat, 145. — urethral, 145. —-uterine, 147. — vacuum tubes, 70-134. — vaginal, 147. Technique for auto-con- densation, 101-102. — auto-conduction, 100. — cataphoresis, 88. — cauterization, 88-90. — fulguration, 90. — oriiieial treatments, 87-141. — relief of pain, 86. — skin diseases, 83. — surface lesions, 83. —• taking blood pressure, 119. — vacuum tubes, 70-134. Teeth, treatment of, 300. Tesla coil, 35. — portrait of, frontis- piece. — transformer, 35. — type, 35. Therapy, high frequency, 150. —• ozone, 267. — X-ray, 282. Thermic penetration, 285. Thermolysis, 299. Throat diseases, 258. — technique, 145. Tic douloureux, 258. Tinea, 258. Tinnitus aurium, 258- 273 Tonsillitis, 258. Tonsillotomy, 259. Torticollis, 259. Trachoma, 259. Transformer, Tesla, 35. Tuberculosis. — of glands, 259. — of lungs, 260. —• of peritoneum, 260. — of skin, see lupus. Tubes, insulated. 50. — handles for. 53. — spatulate, 53. — vacuum, 44-61. —• various forms, 44. — X-ray, 276-284. Tuning coils, 40. Types of apparatus, 30. U Ulcers, chronic, 192. Urethral technique, 145. Urethritis, 264. Uric acid conditions, 264. Urticaria, 264. Uterine diseases, 264. — technique, 147. V Vacuum, blue or blue- white, 45. —• color, effect of, 45. — high, low or medium, 45. — red or red-pink, 45. Vacuum tubes, 44. — care of, 72. — effects of, 61. —■ lubrication of, 7 0. — technique with, 70- 134. Vaginal technique, 147. Vaginitis, 265. Varicocele, 265. Varicose ulcers, 265. W Warts, 265. Whooping cough, 273. Writer’s cramp, 265. Wry neck, 259. X X-ray, 275. —- burns, 284. — diseases suitable for treatment by, 282. — tube, 276.