OUTLINE 
• of 
ULTRA-VIOLET 
THERAPY 
By / 
A. J. PACINI, M. D. 
» ' * 
Second Edition 
1923 
Poole Bros. 
Chicago Copyright 192/, by 
A. J. PACINl/M. D. 
Oak Park, III. Curare, Cito, Tuto, etJucunde Contents 
Page 
Introduction 5 
CHAPTER I 
General Principles 7 
CHAPTER II 
Air-Cooled Lamp 23 
CHAPTFIR III 
Water-Cooled Lamp 34 
CHAPTER IV 
Regional Actinotherapy 47 
CHAPTER V 
Regional Actinotherapy 67 
CHAPTER VI 
Fractional Actinotherapy 77 
CHAPTER VII 
General or Systemic Actinotherapy .90 
CHAPTER VIII 
Intensive Actinotherapy 123 
CHAPTER IX 
Bactericidal Actinotherapy 138 
CHAPTER X 
Abiotic Actinotherapy. 156 
CHAPTER XI 
Actinotherapy in Metabolism 169 Introduction 
STATURAL history is everywhere replete with 
cf ? indisputable evidence that there exists always 
s|!J a mutually reciprocal relation between an 
SsJlj organism and its environment. On the basis 
of these mutual relations Darwin propounded and 
defended the theory of evolution that has done much to 
reorganize the scientific attack in the study of the prob- 
lems of life. 
It is not unnatural to suspect that there must be an 
influence that accrues as a result of a constant immer- 
sion in the actinic photosphere that envelopes our planet; 
and if we observe the many phenomena that are in 
constant progression about us, we can see at once innu- 
merable and striking examples of what Loeb has so 
beautifully termed “slavery to light.” 
With the perfection of methods for producing ultra- 
violet energy there has come a correspondingly great 
increase in the purposeful clinical application of the 
same; and there exists today a rather tangible science 
that indicates with reasonable clinical accuracy the 
unusual therapeutic benefit that can be derived from 
ultra-violet usage. 
As in all scientific endeavors, there are some few 
individuals who stand* out pre-eminently conspicuous in 
this field; and I may mention Professor Wm. Bayliss, 
Professor Robert W. Wood, J. E. Barnard, the officers 
identified with the office of the Surgeon General, United 
States Public Health Service, Dr. Janet Clark, Dr. Alfred 
F. Hess, Dr. P. G. Shipley, Dr. E. A. Park, Dr. G. E. 
Powers, Dr. Geo. M. MacKee, Dr. Geo. C. Andrews, 
and Dr. W. T. Bovie. To all of these I have applied 
5 6 
Introduction 
directly or indirectly for scientific assistance which I have 
obtained through personal communications and through 
the study of their scientific memoirs; and I take this 
opportunity of expressing to them my deep gratefulness 
for such of their work that is quoted verbatim in the 
accompanying pages. 
It is a difficult matter to present a subject that is so 
vast and so little organized as ultra-violet therapy in a 
fashion that pretends to logical sequel; but the nearest 
approach has been made, it is thought, by offering a 
discussion of the general principles involved; the qualities 
of the air-cooled or biologic ultra-violet energy; the 
qualities of the water-cooled or bactericidal ultra-violet 
energy, and the various broad divisions of therapy*, such 
as are everywhere practiced by those better skilled in 
the application of this radiation. Wherever it has been 
possible to include a statement of the principle underlying 
therapeutic application, this principle has been men- 
tioned; for, if these principles are well understood, any 
condition not mentioned in the pages but similar to some 
such as are mentioned, may be attacked with ultra- 
violet therapy with a degree of confident expectancy 
that results from a knowledge of the modus operandi. 
I would be ungrateful if I failed to mention the fact 
that my association with the scientific personnel of 
the corporation with which I am identified has done 
much to stimulate my efforts in the scientific pursuit of 
the value of ultra-violet in its biophysical application. 
Oak Park, Illinois 
October, 1922 Chapter I 
GENERAL PRINCIPLES 
UARTZ LAMPS: Quartz lamps represent, 
(simply, a mercury arc in a vacuum contained 
in a quartz generator. 
They are supplied for clinical use in two quite 
distinct forms: an air-cooled lamp and a water- 
cooled lamp. 
Perhaps the most important part of the modern quartz 
lamp equipment is the tube, which in its modern form 
has assumed a high degree of engineering perfection. 
A diagrammatic representation of the modern uviarc is 
as follows: 
Anode end 
C#1* bod* mntf. 
An oetm e/H/ 
Fig. A. Air-Cooled Tube 
Cathode and 
Fig. B. Water-Cooled Tube 
Diagrammatic Explanation of Construction of Both Types of Uviarc 
7 8 
Ultra-Violet 
A. Quartz stem of seal structure 
B. Connection of quartz stem and seal grading 
C. Connection of seal grading and seal coating 
D. Tip of seal coating 
K. Anode seal guard (air-cooled tube) 
F. Tungsten electrode (air-cooled tube) 
G. Cathode mercury pool 
H. Anode target 
J. Cathode chamber 
M-N. Luminous portion 
O-P. Level of mercury during operation (air-cooled 
tube) 
X-Y. Level of mercury when cold (air-cooled tube) 
These modern uviarcs represent a marked accom- 
plishment in the construction of ultra-violet generators, 
and the important relation that these tubes bear to the 
progress of ultra-violet therapy is in every way similar 
to the acknowledged progress that was made possible 
in the field of X-ray endeavor through the advent of the 
Coolidge hot cathode X-ray tube. 
Essentially, the uviarc is a direct-current device, 
and must be supplemented by whatever means that will 
insure a direct current when operated on an alternating- 
current supply. It is possible to construct the uviarc 
that will operate on alternating current without the use 
of rectifiers; but for clinical purposes the expense of such 
tubes, and their unusual electrical limitations, make 
them relatively inefficient for general adaptation. 
Air-Cooled Lamps: In its most recent form the air- 
cooled mercury vapor lamp assumes the appearance 
indicated in the accompanying illustrations, the first of 
which shows an outfit for operation with direct current, 
and the second, an outfit for operation with alternating 
current. T h e r a p y 
9 
Rotary Casing Type, counterweighted, with RHEOSTAT control 
for DIRECT current 
In the direct-current outfit there is supplied a ballast 
resistance which must always be included for its steady- 
ing effect on the light. In the alternating outfit, in 
addition to the ballast resistance there must be furnished 
a means for rectifying the alternating supply. This is 
accomplished through use of a tungar rectifier which, 
together with the ballast resistance, is included in a 
separate unit as indicated in the illustration. 10 
Ultra-Violet 
Rotary Casing Type, counterweighted, with RECTIFIER control 
for ALTERNATING current 
Water-Cooled Lamp: Water-cooled mercury vapor 
lamps are similarly built for operation on direct or alter- 
nating supplies, and are illustrated below. 
In order best to appreciate the important difference 
that distinguishes the qualities of radiation which issues 
from the air-cooled and water-cooled type of quartz 
lamp, it is important briefly to review some of the char- 
acteristics of lamp operation together with a statement 
of the inherent properties of ultra-violet. Therapy 
11 
Water-Cooled Outfit, mounted on adjustable floor stand, with 
extension truss. RECTIFIER control for ALTERNATING current 
Ultra-Violet Generation: To produce ultra-violet 
energy the burner is tilted so that the mercury cathode 
flows to the tungsten anode and thereby produces an 
electric contact. This initial tilting is a deliberate short 
circuit of the current supply, so that the supply line 
should be heavily fused in order to avoid troublesome 
experience (at least 30-ampere fuses should be used). 
Immediately the arc is broken by allowing the burner 
to assume its original position, the electric current, 12 
Ultra-Violet 
Water-Cooled Outfit, mounted on adjustable floor stand, with 
• extension truss. RHEOSTAT control for DIRECT current 
instead of flowing through the metallic mercury, con- 
tinues to flow through the mercury vapor. Since the 
mercury vapor is at first cold, the resistance is quite 
high; and the light that is emitted fills the entire diameter 
of the generating tube and emits a low intensity of 
luminant. In a short time the mercury vapor becomes 
hotter and permits a greater voltage to be accepted by 
the tube. Three things are observed in this stage of Therapy 
13 
energy transformation; First, the voltmeter is seen to 
rise, indicating a greater voltage acceptance. Then, the 
luminant issuing from the tube is increasingly more 
brilliant. Finally the stream of illuminant in the tube 
shrinks away from the quartz walls of the generator, 
assuming the appearance of a narrow filament in the 
position of the central axis of the tube. These changes 
are collectively known as the “building-up” period, and 
represent certain characteristics in the effort for the 
entire electrophysical system to attain an equilibrium. 
During the building-up period, when the voltmeter 
reads between 20 and 40 volts, it is sometimes possible 
to discern a clicking sound issuing from the tube. 
This click is the result of a mercury hammer, and repre- 
sents the part in the building-up characteristic when 
the conditions are least stable. After forty volts is past 
the click usually subsides and the lamp promptly assumes 
its complete equilibrium. The final voltage assumed by 
the burner is dependent upon many factors; but the 
most important of these factors is the amount of resist- 
ance included in electrical series with the tube. The 
total building-up period requires from five to ten 
minutes; so that a lamp has not reached its equilibrium, 
which means its maximum clinical efficiency, until it has 
been lighted about ten minutes. 
Care of Burner: Mercury vapor burners are really 
complicated instruments of precision. They are fragile. 
They enclose a rather high vacuum that contains a 
quantity of metallic mercury which is easily shaken 
about in the tube. For these various reasons they demand 
intelligent usage, and it is fitting and proper that the 
prospective therapist become thoroughly familiar with 
the instructions issued by the manufacturer for the care 
and use of tubes. 14 
Ultra-Violet 
Above all, it is decidedly significant to observe that 
the final equilibrium of the operating lamp depends 
upon a neat adjustment of resistance, voltage, amperage 
and adequate ventilation. Failure to maintain this neat 
adjustment results in damage to the tube, just like 
failure to observe the characteristics demanded of an 
X-ray tube will result in unfortunate experience with 
its use. Follow the manufacturer’s instructions to the 
letter. 
Ultra-Violet Radiation: Under proper operating 
conditions the brilliant illumination emitted by the 
mercury arc furnishes a peculiar spectrum which may 
be divided into three portions, as follows: 
SOURCE 
INFRA- 
RED 
LIGHT 
ULTRA- 
VIOLET 
1. Mercury Vapor 
52% 
20% 
28% 
2. Sunlight 
80 
13 
7 
3. Arc Lamps (such as carbon).. . . 
85 
10 
5 
4. Incandescent Lamps 
93 
6 
1 
From the comparison submitted, it is observed that 
the quartz lamp provides a distribution of energy richer 
in ultra-violet than sunlight, other forms of arc lamps 
and incandescent lamps. 
Therapeutic Spectrum: The relative position that 
the quartz lamp occupies in the therapeutic spectrum 
of the clinician is revealed in the accompanying diagram. Therapy 
15 
Ott? X'RM 
IHtXXft 
\JU1KR 
X- EM5 
X-KM 
x-W 
Rf\\K0-TH6F(VPY 
VV-TCR-V lOUtf 
U<*h1 
UC,H1 
Evtcffco- 
C0RC,ULRT>OH 
mF*R- 
oi^1h«ky 
Ri<iW f«tautntY 
H\C,H FRtOkOtnt't 
lHLRR?eul\C 
5F£.CT^Uf«\ 
PH'fSIC.ftL 
€>?e.c“T^un 16 
Ultra-Violet 
Ultra-violet is intermediate between visible light 
and X-rays. 
It is customary to speak of radiant energy, which is 
energy transmitted by wave motion, in terms of units 
introduced by the physicist, A. J. Angstrom, and there- 
fore known as Angstrom units. The Angstrom unit is a 
measure of length and is one ten-millionth of a millimeter; 
or, as it is more often called after the suggestion of 
Stoney, a tenthemetre. The better to gain a concept of 
the relative figures for energies that are familiar, a table 
showing the approximate wave lengths of the various 
colors, near and far ultra-violet and of X and deep 
X-rays is given: 
Table Showing Approximate Relative 
Wave Lengths in Angstrom Units 
ANGSTROM UNITS 
Red 
6980 - 6630 
Orange 
6600 - 6000 
Yellow 
5830-5620 
Green 
5440 - 5000 
Blue 
5000 - 4570 
Indigo 
4490 - 4340 
Violet 
4280 - 3920 
Near Ultra-Violet 
3920 - 3000 
Far Ultra-Violet 
3000 - 2000 
X-Rays 
6-2 
Ultra X-Rays (deep therapy) 
1-0.1 
Quartz Lamp Spectrum: Quite accurate studies of 
the wave lengths issuing from the modern quartz lamp 
are now available. One of the most valuable charts, 
indicating the complete spectrum as it issues from the 
quartz lamp, is the one furnished by the Cooper Hewitt 
Electric Company, reproduced on opposite page: Therapy 
17 18 
Ultra-Violet 
The student of ultra-violet therapy should become 
more and more familiar with these individual bands. 
Each spectral band will be found to have a clinical 
significance and to convey an effect different from its 
adjoining band. It seems definitely established that 
one of the great future strides in the development of 
ultra-violet therapy rests with the biophysical elucida- 
tion of the individual merit of each spectral ultra-violet 
band; or, in the language of radiotherapists, selective 
filtration. 
Ultra-Violet Absorption: As a beam of ultra- 
violet energy is permitted to fall upon a quartz prism 
and the ultra-violet spectrum projected upon a fluores- 
cent material, the various bands indicated in the above 
figure can be clearly visualized. During this visualization 
materials placed in front of the light before it reaches 
the prism will show their effect on the absorption of 
ultra-violet. By this means it has been definitely proved 
that near ultra-violet, or the region included between 
the wave lengths 4000 and 3000, is relatively more 
penetrating than far ultra-violet, which is the region 
between 3000 and 2000 Angstrom units. 
Janet Clark, in her “Physiological Action of Light” 
shows how the decreasing wave lengths present an 
increasing absorption. She combined the findings of 
Glitscher and Hasselbalch and presents the following 
curve, where it is seen that as the wave length approaches 
3000 Angstrom units, the absorption becomes less 
and less. 
These findings may be expressed in the form of a law 
as follows: that materials transmit less ultra-violet in 
proportion as the wave length diminishes. From the 
findings of Clark, Glitscher, Hasselbalch and others, and Therapy 
19 
on the basis of the law propounded, near ultra-violet 
may be designated as relatively penetrating; and far 
ultra-violet as superficial in its effect. 
Distinction Between Air and Water-Cooled 
Lamps: It has been generally taught that the air-cooled 
type is used for systemic irradiation, and the water- 
cooled type for focal or cavity work. 
A brief consideration of the fundamental physical 
principles involved will serve to make apparent a distinct 
differentiation between the two. 
When the electrical energy passes through the mercury 
vapor there is created a central stream of luminescence 
from which ultra-violet energy is emitted. This trans- 20 
Ultra-Violet 
formation of energy, like many transformations, is 
accompanied with the evolution of much heat. The 
heat volatilizes the liquid mercury in the cathode reser- 
voir and gives rise to a dense cloud of mercury vapor 
which envelopes the central luminescent beam; so that 
the rays must first be filtered through a mercury vapor 
mantle before passing the quartz in the air-cooled lamp. 
Remembering that the short ultra-violet wave lengths 
are less penetrable than the longer ones (just the reverse 
to the conditions that obtain with X-ray energy) it is 
obvious that the air-cooled lamp furnishes a dominantly 
long wave length spectrum. 
In the water-cooled type, the mercury mantle is 
quickly condensed, leaving the ultra-violet energy free 
to issue from the quartz without previous filtration 
through mercury vapor; so the spectrum from this type 
of lamp is relatively richer in short wave lengths than 
the corresponding air-cooled lamp. 
On the basis of this physical difference, and from the 
findings of Ward, Sidney Russ, Ritter, Herschel, Bec- 
querel, Draper and others, the comparison of the two 
energies shows: 
Ultra-Violet Energy 
(Mercury Arc) 
AIR-COOLED LAMP WATER-COOLED LAMP 
1. Near ultra-violet intensity Far ultra-violet intensity 
2. Biologic (dominantly) Abiotic * (dominantly) 
3. Chemically oxidizing Chemically reducing 
4. Relatively penetrating Relatively superficial 
5. Metabolic synergist Metabolic depressor 
*Abiotic-bactericidal. T h e r a p y 
21 
References 
1. Luckiesh, physicist of the Nela Research Laboratory, 
conveniently divides the visible spectrum into near and 
far ultra-violet regions. The air-cooled equipment 
furnishes a dominant excess of near ultra-violet 'inten- 
sity; the water-cooled equipment furnishes a relative 
preponderance of far ultra-violet intensity. 
2 and 4. Browning and Russ reported in the “Proceedings 
of the Royal Society of London” that near ultra-violet 
intensity has no marked germicidal action but pene- 
trates much skin (biologic effect) and far ultra-violet 
intensity has marked germicidal action but is much less 
penetrable. 
3. Ritter, Herschel and Becquerel propounded a law that 
has been accepted since 1872, that long wave lengths 
(near ultra-violet intensity) exert an oxidizing action 
as opposed to the reducing action of short wave lengths 
(far ultra-violet intensity). 
5. Rideal and Taylor in their “Catalysis in Theory and 
Practice” show that reactions by radiant energy may 
be either accelerated or retarded. Near ultra-violet 
intensity is an accelerator and acts as a metabolic 
synergist. Far ultra-violet intensity is a retarder or 
metabolic depressor. 
With this newer and biophysically established con- 
cept of the qualities of the ultra-violet regions, it is at 
once apparent that the empirically introduced standard 
of systemic and focal lamps for the air-cooled and 
water-cooled types has made for profound confusion 
and possibly injudicious application in the clinic. More 
properly, the lamps are biologic and bactericidal, and 
each one should be used systematically or focally, 
depending upon the pristine pathology of the lesion 
treated. 22 
Ultra-Violet 
Ultra-Violet Therapy: Ultra-violet therapy implies 
the application of air-cooled and water-cooled equip- 
ment for the derivation of certain clinical manifestations. 
Knowing the fundamental qualities that are a property 
of the wave lengths dominantly emitted by each lamp, 
and reviewing the great bulk of literature that has 
accumulated in this country and abroad on the clinical 
use of ultra-violet, it is possible to present certain out- 
lines of procedure that are accepted as efficient in accom- 
plishing clinical success. Chapter II 
AIR-COOLED LAMP 
HROPERTIES: It has been pointed out that 
the air-cooled lamp furnishes an energy char- 
acterized as: 
e=======_J 1. Near ultra-violet 
2. Dominantly biologic 
3. Chemically oxidizing 
4. Relatively penetrating 
5. Metabolic synergist 
These are its general effects obtained, presumably, by 
the action of the long ultra-violet rays that attack: 
(a) The surface cells, particularly their nucleus 
(b) The capillary blood 
(c) The capillary lymph 
(d) The nerve filaments distributed in the region 
When the energy is played upon a skin surface, it 
affects the structures just enumerated. As a result, 
two objective phenomena are observed: 
1. A hyperemia 
2. An erythema 
That a profound alteration of the capillary network is 
established promptly is determined as follows: 
Stroke the skin of the area treated as if eliciting the 
so-called “adrenal” reflex (Sargent’s white line). It will 
be noted that the skin blanches more or less promptly; 
then the streak appears red, and sometimes raised 
(dermographia). Expose the same surface to the air- 
cooled lamp, and while the exposure is in progress, re- 
elicit the adrenal reflex (so called). At first, one finds 
that the reaction time between the initial blanching 
(vasoconstriction) and ultimate reddening is markedly 
23 24 
Ultra-Violet 
lessened. This is the period of vasodilatation. But as 
the exposure is continued, it will be seen that the redden- 
ing quickly disappears and is again succeeded by a 
blanching. This is the second reaction, or period of 
vasoconstriction. 
That is to say, short, mild exposures under the air- 
cooled quartz lamp are vasodilatory. Longer and more 
severe reactions are vasoconstricting. How purposefully 
to utilize these effects clinically will be discussed in the 
section on cardiovascular diseases. 
In addition to the changes in the capillary blood 
supply, which appear immediately, there occur also 
certain objective changes in the skin. When the exposure 
is brief and subintensive, a faint reddening appears; 
w'hen longer and more intense, a scarlet reddening; and 
when prolonged exposure and accentuated intensity is 
supplied, a reddening accompanied by blisters and des- 
quamation. These changes are accompanied by a certain 
amount of skin tenseness due to edema. It has been 
found that the degrees of reaction produced, called ery- 
thema, correspond to definite histological changes in the 
skin; so that the reactions are classed as: 
REACTION 
DESIGNATION 
1. Mild reddening 
2. Scarlet reddening 
3. Blistering 
Stimulative erythema 
Regenerative erythema 
Desquamative erythema 
These objective changes, the hyperemia and the ery- 
thema, are guides in the clinical application of the 
energy, and all therapeutic procedures orient themselves 
around these fundamental reactions. Therapy 
25 
However, in addition to the objective findings, certain 
subjective findings are likewise present, and these differ 
according to whether the erythemic reactions are 
produced: 
(a) Quickly 
(b) Slowly 
When the erythema is produced too quickly, the sub- 
jective findings are few. When the erythema is produced 
slowly, the subjective findings are many. In clinical 
work there are occasions when it is desirable to minimize 
the subjective findings and rely entirely upon the ery- 
themic reaction for the result. This is so especially in 
the focal treatment of skin lesions. Here, the effect 
desired is focused upon the superficial lesion. Since in 
this type of treatment one aims to produce given histo- 
logical changes in the cellular pathology of the skin 
lesion, this is best obtained by the use of a focal technic 
which we have elsewhere described as intensive. The 
characteristics of this form of treatment are: 
1. High intensity of ultra-violet 
2. Short tube-skin distance 
3. Short exposure time 
There are several ways in which this may be accom- 
plished. One method is to use: 
Volts 90 
Uviarc-skin distance. . 10 inches 
Time depending upon reaction sought, 
and reactivity of individual 
The determination of the individual’s reactivity is 
difficult. Many factors affect it; but particularly, they 
are: 26 
Ultra-Violet 
1. Endocrine type (light or dark) 
2. Sex 
3. Age 
4. Part rayed 
Speaking generally, light people respond more promptly 
than dark; females more than males; the young sooner 
than the old; and the regions usually protected from 
the light and of high nervous sensibility, quicker than 
other parts. But these factors are so variable as to 
preclude any definite statement of exposure time. From 
a large experience, it is found that the reactivity to the 
rays increases in the following order for the parts named: 
Part 
Relative 
Sensitivity 
Chest 
1 
Abdomen 
1 
Back 
1 + 
Groin 
1 + 
Anterior arm 
1 
Posterior arm 
U/4 
Posterior leg 
IK 
Anterior leg 
2 
Dorsum of hands 
5 
Palms of hands 
15 
Sole of feet 
25 
To the right is given a figure expressing a rough 
estimate of the relative sensitivity of the part. For 
example, an exposure that will produce in one minute a 
stimulative erythema upon the chest, will require, on 
the soles of the feet, 25 minutes. On the basis of this 
study, and similar ones, a very approximate exposure 
guide, for intensive technic would be: T h e r a p y 
27 
Intensive Irradiation 
Air-cooled lamp: Volts, 90; tube-skin distance, 
10 inches; central ray strikes surface at right 
angles; average approximate exposure values, 
in seconds. 
Erythema 
STIMULATIVE 
REGENERATIVE 
DESQUAMATIVE 
' 
LIGHT 
DARK 
LIGHT 
DARK 
LIGHT 
DARK 
Infants 
5 
8 
10 
12 
15 
20 
Children 
8 
10 
15 
20 
25 
30 
Female adults... 
15 
20 
20 
30 
40 
60 
Male adults. . .. 
20 
25 
30 
40 
60 
75 
These values are for surfaces whose sensitivity is 
designated “I” in the chart showing relative sensitivity of 
anatomic regions. For regions less sensitive, multiply 
the above figures by the relative sensitivity factor. For 
example: dark type, female adult requires 30 seconds’ 
exposure for regenerative erythema over chest, abdomen, 
back and groin. For dorsum of hand, this would be 
5 times 30, or 150 seconds. 
It is often desirable to focalize the rays even more 
circumscribed than the area obtained by chamois screen- 
ing. When this is desired, certain adapters and local- 
izers, which should form part of the equipment, are used. 
The more common air-cooled lamp accessories, and their 
uses, include the following: 28 
Ultra-Violet 
These metal localizing tubes present various diameters. 
They attach directly to the casing of the air-cooled lamp. 
The central ray issues from the localizing tube in the 
direction of the long axis. They may be used completely 
to cover smaller superficial lesions such as naevi and 
keloids; or in the treatment of orifices that have been 
dilated, using a speculum with the localizing tube intro- 
duced into the speculum. 
These obturated specula are designed usually for ori- 
ficial insertion. It will be observed that the angle of one 
is obtuse, so that the light issuing from this instrument 
strikes the surface at 45 degrees. As compared to the 
speculum with the round end instead of the oval end, 
because of the acute angulation (cosine law) the exposure 
time must be increased by V3. That is, what will be 
produced in two minutes with the round-end speculum 
will require three minutes’ exposure with the oval-end 
speculum. Therapy 
29 
From the discussion presented, it is seen that inten- 
sive focal air-cooled lamp technic is useful especially 
in superficial skin lesions, other than superficial infec- 
tions. It must be said, however, that when superficial 
destructive action is wanted, though the air-cooled lamp 
will suffice, the very abiotic or coagulative qualities 
(upon which the bactericidal property of the water- 
cooled lamp depends) of the water-cooled lamp are more 
efficiently used. The water-cooled lamp is always oper- 
ated at from 50 to 60 volts; and since, in skin work, it 
is used for its abiotic or destructive effect, the exposure 
time can be about five or more minutes, depending upon 
the part. So that we may use in dermatologic practice: 
For stimulative erythema—air-cooled lamp 
For regenerative erythema—air-cooled lamp 
For destructive erythema—water-cooled lamp 
In addition to the intensive technic, the air-cooled 
lamp (and the water-cooled lamp) is used for systemic 
effect. By systemic effect is meant the purposeful 
production of desired subjective changes useful in cor- 
recting the effects of certain forms of pathologic invasions. 
Systemic raying may be: 
1. Regional 
2. Fractional 
3. General 
Regional systemic raying means the irradiation of a 
given anatomic section of the body for the purpose of 
inducing remote or derived effects in viscera correlated 
to the skin surface by nervous and blood relations. 
By fractional raying is meant the irradiation of the 
body in fractions, usually fifths, divided as follows: 
First day: The front and back of the feet, below 
the ankles 30 
Ultra-Violet 
Second day: The front and back of the legs, from the 
knees down 
Third day: The front and back of the legs, from the 
iliac crests down 
Fourth day: The front and back from a point on the 
level with the ensiform cartilage down 
Fifth day: The front and back from the neck down 
Levy and Gassul seem to have proved that intensive 
irradiation over the entire body at one sitting may lead 
to such reflex engorgement in all the viscera as to bring 
on hemorrhage if pathology coexists (as in pulmonary 
tuberculosis). Rollier appears to have realized this; and 
in America, LoGrasso at Perrysburg insists, with reason, 
that fractional heliotherapy is imperative in the success- 
ful control of tuberculopathies. 
By general irradiation is meant the exposure of the 
entire anterior and posterior surfaces of the body. 
In all these forms of systemic treatment—regional, 
fractional and general—-the effect sought is not confined 
to the skin. It is the biologic uplift that is induced by 
the rays. So that erythemic reactions are to be mini- 
mized. A low intensity treatment is obviously desired, 
and may be had by using: 
1. Low voltage 
2. Long tube-surface distance 
3. Long exposure time 
An excellent routine for this type of raying is to use: 
Volts 70 
Tube-skin 40 inches 
Time Depending upon individual 
Of course, the same rules of individual reactivity hold 
fast. But a good summary is: T h e r a p y 
31 
General or Systemic Irradiation 
Air-cooled lamp; volts, 70; tube-skin distance, 
40 inches; central ray strikes at right angles; 
average approximate exposure values, in seconds. 
Erythema 
Stimulative 
Regenerative 
Light 
Dark 
Light 
Dark 
Infants 
15 
20 
30 
40 
Children 
20 
30 
40 
60 
Female adults 
50 
60 
90 
120 
Male adults 
60 
90 
120 
150 
It is important to know that the rays must strike the 
surface at right angles. If less than a right angle is 
used, an increase in time must be allowed, according to 
a basic law, which says that the incident intensity varies 
as the cosine of the incident energy (for ultra-violet). 
When other than a right angle is used, the following 
table is used to compensate for the loss of intensity due 
to angular incidence of the energy: 
Angle of Incident Ray 
Fractional Increase of Time 
Required 
90 
0 
75 
1/10 
60 
1/5 
50 
1/4 
45 
2/5 
30 
1/2 
Example. A light-type child requires a stimulative 
erythema (systemic treatment). At right angles the 
time would be 20 seconds. At 45 degrees incidence, the 
time is 20 + % of 20, or 28 seconds. 
As the exposures are applied, the tolerance of the 
patient increases; so that each subsequent exposure must 32 
Ultra-Violet 
be increased in time to compensate for the tolerance 
established. Rule: The tables furnished give the initial 
exposure time. Each subsequent exposure is increased 
by an amount equal to the original exposure time. In 
mathematical expression, exposure time is increased 
arithmetically. 
Example. First exposure, intensive focal treatment in 
a light-type, male adult is a regenerative erythema 
requiring 40 seconds. Second exposure will require 80; 
third, 120; fourth, 160, etc. 
There are certain fundamental requisites that must 
be observed in the treatment of any given individual. 
1. Study the pathology of the case under consideration. 
2. Determine the type of lamp required to meet the 
issue best. (Air-cooled biologic, or water-cooled 
abiotic.*) 
3. Having determined the necessary lamp to be used, 
conceive the effect sought-. 
4. If focal, set the lamp for the given characteristics: 
Volts '. .90 
Tube-skin distance 10 inches 
5. If general or systemic, determine if the raying is 
to be: 
Regional 
Fractional 
General 
and set the lamp at 
Volts 70 
Tube-skin distance 40 inches 
6. Study the time required, which may be roughly 
approximated by weighing: 
*Bactericidal. T h e r a p y 
33 
(a) Type of individual (light or dark) 
(b) Part rayed 
(c) Sex 
(d) Age 
and may be gathered from the tables furnished. 
7. Build up the lamp to the required characteristics by: 
1. Tilting 
2. Adjusting rheostat control or rectifier 
control until proper voltage is reached 
8. Expose for the necessary time using an interval 
timer. 
The eyes of the patient and operator should be 
protected against the rays by the use of goggles. No 
clothing must be worn on the part treated. 
Immediately following the treatment, explain to the 
patient that a reddening should appear. The time 
required for the erythema to develop depends upon the 
reactivity of the patient, as does also the time that it 
persists. So long as the reddening is developing, addi- 
tional ultra-violet treatment is not necessary. But at 
the moment it begins to disappear, its physiological 
action is spent. That is the time for the second treat- 
ment. Therefore, have the patient carefully observe the 
development of the required degree of erythema and 
when he observes it to disappear, have him report for 
the second treatment. The rule is, initiate a reaction; 
then maintain it. By this means, the patient’s sensitivity 
becomes its own guide for treatment frequency. In 
general, with ultra-violet therapy, small doses often 
repeated are infinitely more effective than large doses 
applied at long intervals. Chapter III 
WATER-COOLED LAMP 
HROPERTIES: 
1. Far ultra-violet 
2. Dominantly abiotic (bactericidal) 
„ 3. Chemically reducing 
4. Relatively superficial 
5. Metabolic depressor 
The radiation issuing from this type of lamp is 
relatively more intense in short wave lengths than is 
the air-cooled lamp. This holds true only providing 
that the lamp is operated at a proper voltage—best 50, 
never more than 65. Free and continuous circulation of 
clear water is imperative; continuous circulation to insure 
adequate cooling for the complete condensation of the 
mercury vapor mantle that filters out the short wave 
lengths; and clear water, because the stream passes in 
front of the uviarc so that any contained impurities will 
act as filters. When these precautions are observed, 
namely: 
1. Low voltage (50-65) 
2. Constant circulation of water 
3. Clear water (and clean lenses on the lamp) 
The lamp then furnishes an intense, far ultra-violet 
spectrum rich in abiotic wave lengths. Otherwise not. 
Of course, the best known property of far ultra-violet, 
or water-cooled lamp energy, is its bactericidal capacity. 
When operated under the conditions named, organisms 
34 Therapy 
35 
exposed at a distance of 200 millimeters from the lamp 
are killed in the following time intervals: 
Diplococci Seconds Required to Kill 
Gonococci 6 
Meningococci 6 
Staphylococci 
Pyogenes albus 10 
Pyogenes aureus 12 
Streptococci 
Viridans . 14 
Hemolyticus 18 
Mucosus 25 
Pneumococci 
Group 1 25 
Group II 20 
Group III 25 
Group IV 15 
Bacillus 
Influenzae 18 
Diphtheria 10 
Tubercle 12 
Leprae 15 
Colon 18 
Typhoid 18 
Dysentery types 20 
(For colonies grown from clinically obtained 
materials. The organisms were suspended in 
clear, sterile water.) 
There is an interesting fact in connection with the 
treatment of water with ultra-violet rays, as follows: If 
to a sample of water that has been sterilized with the 
rays, fresh live bacteria are added, within an hour’s 36 
Ultra-Violet 
time practically 90 per cent of the organisms are killed. 
The action is called “residual effect.” It has found 
important clinical usage and is a unique finding that 
merits study and research. 
In living tissues and when the organisms are imbedded, 
the effect of the rays in destroying bacteria is indirect; 
but when the organisms are superficial, the effect is direct. 
The indirect destruction of bacteria is an action involv- 
ing certain immunity changes which affect: 
1. The serum 
2. The white cell count 
3. Focal inflammatory defenses 
That is, the serum (much like water irradiated with 
ultra-violet) acquires a higher germicidal capacity which 
it retains for some time following the exposure. The 
white cell count is affected, according to Janet Clark, 
depending upon the wave lengths of the energy, about as 
follows; 
Wave Length Leucocytic Response 
4000-3000 (near ultra-violet) Leucopenia 
3000-2000 (far ultra-violet) Lymphocytosis 
The inflammatory changes induced focally by far 
ultra-violet are the classic ones—rubor, tumor, calor. A 
large amount of blood is conveyed to the irradiated 
focus so as to produce a solar inflammation. It must be 
remembered that far ultra-violet is a protein coagulant; 
so that if an infected mucosal membrane is too strongly 
irradiated, an incrustation of coagulated protein is formed 
which serves to retain any purulent products underneath. 
Therefore, in raying mucosal surfaces for bactericidal 
effect, use only the shortest effective exposures that will 
insure bacterial destruction, but not tissue coagulation. 
This applies to the membranes of the nose, sinuses, T h e r a p y 
37 
genital tract and rectum. In treating infections that 
are superficially situated, it is, therefore, infinitely best 
to rely implicitly on the adage, “small doses often 
repeated.” On this basis, and using the actinic death 
points given for the various organisms, it is obvious that 
at distances of 200 millimeters, or less, the maximum 
exposure time necessary to kill the most resistant organ- 
ism listed (pneumococcus) is about 30 seconds. This 
time varies with the applicator used, and the amount 
of variation has been calculated from studies elsewhere 
presented (Hirsch’s “Urology”). It depends upon the 
applicator, and is about as follows: 
Applicator 
Use and Exposure Time for Bactericidal Effect 
Tubular localizers confin- 
ing the radiation to a circum- 
scribed area equivalent to 
the diameter of the localizer, 
y2 inch, Y*, inch and 1 inch. 
In connection with specula 
these localizers are used also 
for introduction into orifices. 
In this connection they find 
a field of utility in the treat- 
ment of cervical uterine in- 
fections and suppurative dis- 
charges. The tube 
has been recommended by 
some for gingivial irradiation 
in checking the purulent dis- 
charge of infected dental 
structures, and in pyorrhea. 
Coefficient, 30 seconds. 38 
Ultra-Violet 
This obturated speculum 
represents a convenient 
design for use in connection 
with the treatment of pros- 
tatic inflammation when in- 
troduced rectally. Owing to 
the angular orifice of the 
instrument, 90 seconds are 
required as a maximum ex- 
posure for bactericidal effect. 
Used, like the above specu- 
lum, for rectal and vaginal 
irradiation. The light is 
emitted at right angle and 
therefore requires only 60 
seconds for bactericidal effect. 
A 45-degree tipped quartz 
rod. Coefficient, 60 seconds. 
120-degree curved. Coeffi- 
cient, 30 seconds. 
Curved and flattened for 
an oval dispersion of energy 
in post pharyngeal irradia- 
tion. Coefficient, 30 seconds. Therapy 
39 
A short, blunt, pointed rod 
of high light intensity trans- 
mission used in connection 
with rhinitis, hypertrophied 
turbinates, ozena and allied 
pathologies. Coefficient, 20 
seconds. 
An ovilary tip quartz rod 
for urethral application. 
Coefficient, 60 seconds. 
An ovilary tip, fine focus 
pencil applicator useful espe- 
cially in focal pathologies of 
the eye, including ulcers, 
pannus, etc: Coefficient, 60 
seconds. 
A spatulate flattened 
quartz applicator for distrib- 
uting the light laterally over 
mucous membranes of the 
turbinates. Coefficient, 30 
seconds. 
A tonsil applicator, used 
also in pharyngeal irradiation 
for acute infections and for 
infection carriers. Coefficient, 
90 seconds. 
A full-curved applicator 
used by some for attacking 
dental pathology from the 
buccal aspect. Coefficient: 
60 seconds. 40 
Ultra-Violet 
A laryngeal and pharyn- 
geal applicator. Coefficient, 
60 seconds. 
When the water-cooled lamp is used for direct bac- 
tericidal effect, it is imperative that the energy reach 
the surface. It must make what has been properly 
called optical contact. Several expedients may be used 
to insure a maximum optical contact. An excellent 
expedient is to coat the mucous surface by spraying 
with a photosensitive material, such as: 
Gentian violet 
Methyl violet 
Fuchsine 
Methyl blue 
Methyl green 
The dyes may be dissolved in water or in glycerin; 
both solvents have a high ultra-violet transmission. 
About one part of dye in 1000 of solvent is ample. For 
a discussion of photo-sensitization, see “Principles of 
General Physiology,” by Bayliss. 
. Nascent halogens (chlorine, bromine and iodine) and 
oxygen are quite powerful disinfectants. These acidic 
ions are readily set free from their basic association by 
the action of far ultra-violet. 
Experiment: Procure a quartz flask. Half fill it with 
hydrogen peroxide. Set the flask and its peroxide in 
front of the water-cooled lamp window and ray the 
solution. Free or nascent oxygen is liberated which 
collects as bubbles on the walls of the flask. It is a wise 
practice to utilize this conjoint action in sterilizing a 
mucosal surface. For this, use: Therapy 
41 
1. Far ultra-violet energy 
2. Hydrogen peroxide 
3. Nascent oxygen given off by the peroxide 
under the action of the lamp 
Each of these agents is in itself highly bactericidal. 
Together, they offer a most cogent attack against any 
infection. 
In addition to the bactericidal action of the water- 
cooled lamp there is, also, a metabolic action contrary 
to that exerted by the air-cooled lamp. This has been 
discussed* under the title of Ultra-Violet Energy as a 
Metabolic Pacemaker, as follows: 
“When we come to the discussion of exactly how 
ultra-violet energy governs the chemical mechanisms of 
animal physiology, it is quite certain that at present 
the only scientific course is to admit that we do not 
know. But, considering the chemical action of the 
living machine in its broadest aspect, there seems to be 
no doubt that we may regard it as divided into two 
opposed processes. First, a group of synthetic reactions 
by means of which the products assimilated by the 
economy are converted into extremely complex carbohy- 
drates and proteins; and, secondly, the decompositions 
and changes which convert the carbohydrates and pro- 
teins into simpler substances. It has been customary to 
speak of the first group of reactions under the generic 
physiologic term ‘anabolism;’ and, similarly, the second 
group as ‘katabolism.’ Both together, anabolism and 
katabolism give us ‘metabolism.’” 
This building up and breaking down that takes place 
in the body is subject to certain fundamental principles 
of energetics; from the study of which we may conclude 
*Victor Service Suggestions for July, 1922. 42 
Ultra-Violet 
that the synthetic reactions involve the absorption, and 
the analytic reaction, the liberation of energy. Expressed 
diagrammatically, in the case of protein “metabolism,” 
we have: 
CO2 + H20 + NH3 
Amino-acids 
Polypeptides 
Peptones 
Albumoses 
PROTEINS 
Albumoses 
Peptones 
Polypeptides 
Amino-acids 
C02 + H20+ nh3 
Synthetic 
Energy Absorbed 
Analytic 
Energy Liberated 
Now, under usual conditions of laboratory experiment, 
a chemical reaction such as is represented above involves 
the liberation of much heat; and it is a dominant charac- 
teristic of “living” chemical reactions that they are not 
accompanied by much heat. This restraint in the 
liberation of heat is designated “chemical resistance;” and 
when the chemical resistance of the economy is lessened 
(as in disease) the chemical reactions furnish heat 
expressed objectively as pyrexia. 
So that chemical resistance determines the velocity 
of chemical reactions in the body. And the mechanism 
operating the reactions, for want of a better definition, 
may be called chemical force. 
Metabolism may in this manner be reduced to a 
chemical mathematical expression involving: 
1. Chemical force, or Fc 
2. Chemical resistance, or Rc 
3. Chemical velocity of reaction, or Vc T h e r a p y 
43 
In which we understand chemical force to represent the 
energy that builds up and breaks down; the resistance 
is the tissue tolerance that averts too hasty consumma- 
tion of the reaction, and the velocity is the speed of 
change representing the sum of the metabolic processes. 
They bear to each other the following relation: 
• F c 
Vc = Rc (1) 
Fc = Vc x Rc (2) 
from which 
And it is this equation in which the actinotherapist is 
fundamentally interested; that chemical force is the 
product of chemical velocity times chemical resistance. 
Such terms as constructive energy, chemical 
energy, used synonymously with ultra-violet energy, 
show an empiric attempt to describe the peculiar property 
of ultra-violet radiation; that of influencing chemical 
activity. For the therapist, it is highly scientific to 
regard ultra-violet energy as chemical force. And it is 
interesting to see how an increase in the value of chemical 
force influences the remaining factors of equation (2). 
Suppose values are assigned to the terms in the 
equation, as follows: 
Fc = Vc x Rc 
8 = 4x2 
Let this represent, arbitrarily, a clinical metabolic state; 
a velocity of four units acting against a resistance of two 
units. Increase the chemical force to twice the amount, 
say by adding ultra-violet energy (systemic irradiation). 
If the chemical force under these conditions becomes 
doubled, then one or all of three things may happen: 44 
Ultra-Violet 
1. The value for the velocity may increase 
2. The value for the resistance may increase 
3. Both values may increase. In figures, if 
Fc = Vc x Rc 
'= 8x2 
= 2x8 
= 4x4 
16 
It is not at all strange that this purely mathematical 
derivation should find clinical proof in the application 
of ultra-violet energy. Wherever metabolism is at fault, 
which means a perversion of the velocity (hypermeta- 
bolic) or resistance (hypometabolic) of the chemical 
reactions of the body, the chemical force can be purpose- 
fully modulated so as normally to rearrange the distribu- 
tion of energy in the economy; or in clinical language, 
to correct metabolism. 
In general, the long ultra-violet wave lengths (as 
derived from the air-cooled lamp) have to do with the 
acceleration of chemical velocity; the shorter wave lengths 
(as derived from the water-cooled lamp) increase chemical 
resistance. Hence the classification elsewhere pro- 
pounded*; that the energy of the air-cooled lamp is a 
metabolic synergist, and that of the water-cooled lamp, 
a metabolic depressor. 
From this basic premise the chemical pathologist at 
once visualizes the great applicability of this strange 
energy in the clinical service of the internist. When the 
metabolic transformation of any given class of foodstuff 
(such as fat, mineral salt, carbohydrate, protein') fails 
properly to complete its synthetic and analytic cycle, 
there is present, clinically, a metabolic disease: obesity, 
diabetes mellitus, amino-acid diatheses, rickets. This 
*Service Suggestions, Ultra-Violet Energy. Vol. XXII, No. 6, 
June, 1922. T h e r a p y 
45 
cyclic failure may arise from a number of pristine causes, 
all leading to a perverted balance of reaction velocity 
and resistance. And by correcting the balance through 
the intelligent selection of the proper quality of chemical 
force (ultra-violet energy), the cycle is in each instance 
brought to a satisfactory conclusion, which physiologi- 
cally expels the disease. 
Great is the truth of Sheppard’s eternal aphorism: 
“We are only at the beginning of the conscious utilization 
of the powers of light as distinct from the unconscious 
enjoyment of them.” A new era of therapeutic accom- 
plishment lies sealed in the secrets of biophotochemistry. 
Short ultra-violet wave lengths are quickly absorbed 
by whatever material. Even air, in thick layers, hinders 
their transmission. So that when the water-cooled lamp 
is used for its systemic action, the raying, to profit 
from the short wave lengths, must be at close range. 
Rule: Water-cooled lamp systemic raying must be at 
distances less than seven inches from the window of 
the lamp. 
As for the air-cooled, so for the water-cooled lamp, 
the dosage is governed by the erythema produced. We 
have established the bactericidal dose at 30 seconds. 
The systemic dose would be about as follows: 
Water-cooled lamp; volts, 50-65; tube-skin 
distance, 7 inches; each area covered by the 
distribution of illuminant at this distance 
receives the following time: 
Erythema 
Stimulative 
Regenerative 
Desquamative 
Light 
Dark 
Light 
Dark 
Light 
Dark 
Infants 
3 
4 
6 
8 
10 
15 
Children 
5 
6 
8 
10 
15 
20 
Female adults . .. 
10 
15 
20 
25 
30 
40 
Male adults 
20 
25 
30 
40 
50 
60 46 
Ultra- Violet 
Finsen observed that the relative exsanguination of a 
part made for increased tolerance to actinic radiation. 
Blood quickly absorbs ultra-violet and makes for a 
prompt erythemic reaction. There are two general 
methods of relieving the part of blood; by the use of 
adrenalin (useful in mucosal surfaces) and by the use of 
quartz lenses, such as are shown in the illustrations. 
When the lens is used, it is pressed firmly against the 
tissue so that obvious blanching is produced. The 
method is generally designated as “compression.” 
By a method of gently sweeping a lens over the surface 
of a part, a technic known as “ironing” has been intro- 
duced. It is not so good. Rays do not act accumulatively; 
so that the effect produced by keeping a lens in steady 
contact for 30 seconds is not the same as the effect 
produced by sweeping or ironing the part for the same 
length of time. 
There is another practice, in connection with water- 
cooled lamps, that demands critical comment: the use of 
special cobalt filters. Filters cut off short wTave lengths, 
so that when the blue glass is used, the direct bacteri- 
cidal quality of the rays from the water-cooled lamp is 
lost. Only the deeper penetrating wave lengths (or bio- 
logic fraction) come through the filter, which had, there- 
fore, better be used with the air-cooled outfit. REGIONAL ACTINOTHERAPY 
Chapter IV 
S' Y REGI0NAL ACTINOTHERAPY is meant 
the irradiation of a definite body region of 
the skin, which, through vascular and nervous 
====_== channels, is in intimate relation with a given 
viscus. Regional actinotherapy is, obviously, indicated 
in the pathology of pain, and plays a tremendously 
important clinical role. 
According to its origin, pain may be subjective or 
objective. Subjective pains have no discernible physical 
cause. They arise as a product of mental action from 
changes affecting the co-ordinating centers of the sen- 
sorium. A variety of conditions disclose subjective pain; 
emotional states, hysteria, depressions, compulsions and 
allied psychic and psychoneurotic disorders. Subjective 
pain is an indication for systemic actinotherapy, and will 
therefore be discussed under that section. 
Objective pain is the result of a demonstrable pathology 
and may be produced: 
1. In the centers, as in the brain or cord 
2. In the nerves, as the trunk or its terminations 
There are on the body surface certain well-defined 
zones which are related to visceral diseases; they were 
described first by Head, who, wdiile working in the 
London Hospital, observed that in different diseases of 
the viscera, zones of cutaneous hyperalgesia occur that 
coincide closely with the areas of distribution of herpes. 
Head had already shown that herpes was due to a 
disease of the posterior root ganglion. He therefore 
concluded that in the ganglion certain stimuli must be 
transmitted from the visceral fibres to those going to the 
47 48 
Ultra-Violet 
somatic areas, and produce an irritation of these fibres, 
so that even very light stimuli give rise to pain. With 
only slight modifications, these areas are acknowledged 
as correct today. 
To localize the viscus causing the hyperalgesic zone, 
the following analysis is pursued: 
1. Determine if in connection.with the viscus suspected 
of disease there is an associated hyperalgesia (by 
drawing a sharp point lightly over the skin and 
observing if hypersensitiveness is manifested). 
2. Outline the limits of the hyperalgesic zone and 
orient it with a cord segment. 
3. Ascertain what organs are suppl ed by this cord 
• segment. 
4. Examine the organ (or organs) for disease (X-ray, 
physical diagnosis). 
5. See if pain is intensified by manipulation of the 
organ. Therapy 
49 
TABLE OF CORD SEGMENTAL REPRESENTATION OF MOTILITY, SENSIBILITY AND REFLEXES 
(From L. F. Barker) 
Segment of 
Spinal Cord: 
Spinal Nerve 
Roots 
Muscles* 
Movements 
Cutaneous 
Sensibility** 
Reflexes 
Q 
Small muscles of the 
neck. 
Rotation and exten- 
sion of the head. 
C2 and C3 
1. Muscles of the 
neck; M. sternoclei- 
domastoideus. 
2. M. trapezius. 
1. Flexion and rota- 
tion of the head. 
2. Elevation of the 
shoulders. 
C2 Occiput; narrow strip 
along lower jaw; part of 
external ear. 
C3 “Sternomastoid zone.” 
C4 
1. Mm. scaleni; dia- 
phragm (N. phreni- 
cus). 
2. M. levator anguli 
scapulae. 
1. Costal and abdom- 
inal breathing. 
2. Elevation of scap- 
ula. 
(Head’s sternonuchal 
zone.) 1. Dorsal part, 
quadrangular area of 
regionuchae. 2. Ventral 
part, lateral region of neck; 
infraclavicular region, 
upper part of deltoid region, 
and part of suprascapular 
region. 
Dilatation of the 
pupil on pinching 
the skin of the 
neck (C4-7). 
c5 
1. M. supraspinatus; 
M. infraspinatus; M. 
teres minor; Mm. 
rhomboidei. 
2. M. deltoideus. 
3. M. biceps; M. 
coracobrachial is; M. 
brachialis internus; 
M. brachioradialis. 
4. M. supinator. 
1. Lateral rotation 
of upper arms. 
2. Lifting upper 
arms. 
3. Flexion of fore- 
arm. 
4. Supination of 
forearm. 
Small triangular area near 
the lower cervical spine; 
lateral surface of upper 
arm. 
1. Dilatation of 
pupil (C4-7). 
2. Scapular reflex 
(Cg-ThJ. 
*For plurisegmental innervation of muscles, see preceding table; here only the dominant segment is'given. 
**The names of the zones in quotation marks are those used by Head. 50 
Ultra-Violet 
TABLE OF CORD SEGMENTAL REPRESENTATION OF MOTILITY, SENSIBILITY AND REFLEXES 
(From L. F. Barker) • 
Segment of 
Spinal Cord: 
Spinal Nerve 
Roots 
Muscles* 
Movements 
Cutaneous 
Sensibility** 
Reflexes 
c6 
1. Mm. pectoralis 
major and minor; 
M. latissimus dorsi. 
2. M. teres major; 
M. subscapularis. 
3. M. serratus anti- 
cus major. 
4. M. pronator teres. 
5. M. triceps. 
6. Thenar muscles. 
1. Abduction and 
depression of upper 
arms. 
2. Medial rotation of 
upper arm. 
3. Fixation and 
rotation of scapula. 
4. Pronation of fore- 
arm. 
5. Extension of fore- 
arm. 
Small triangular area near 
lower cervical spine; radial 
surface of forearm and 
hand, including digits I-111. 
1. Dilatation of 
pupil (C„-7). 
2. Scapular reflex 
(C.-ThJ. 
3. Triceps reflex 
(C6-7). 
c7 
Extensors of hand 
and fingers. 
Flexors of wrist. 
Thenar muscles. 
Flexion and exten- 
sion of the wrist. 
Small triangular area near 
lower cervical spine. 
Radial side of forearm and 
thumb; a small strip on the 
flexor surface of the forearm, 
and a longer strip on the 
dorsal surface lateral from 
the axial line. 
1. Dilatation of 
pupil (C4-7). 
2. Scapular reflex 
(C.-Th,). 
3. Triceps reflex 
(C6-7)._ 
4. Periosteal- 
radial reflex. 
C* 
1. Long extensors 
and long flexors of 
the fingers. 
2. M. pronator quad- 
ratus. 
3. Hypothenar mus- 
cles. 
Extension and flex- 
ion of the fingers. 
Most of the hand and 
fingers (except the thumb 
on the volar surface, and 
the ulnar side of the little 
finger on the dorsal sur- 
face); small strips on front 
and back of wrist and fore- 
arm. 
1. Scapular reflex 
Cc-Th,). 
2. Palmar reflex 
C/Th,). 
3. C i 1 io - spinal 
reflex (efferent 
fibers) (Cg-ThJ. 
*For plurisegmental innervation of muscles, see preceding table; here only the dominant segment is given. 
♦♦The names of the zones in quotation marks are those used by Head. T h e r a p y 
51 
TABLE OF CORD SEGMENTAL REPRESENTATION OF MOTILlTY, SENSIBILITY AND REFLEXES 
(From L. F. Barker) 
SEGMENT OF SPINAL 
CORD: SPINAL 
NERVE ROOTS 
Muscles* 
Movements 
Cutaneous 
Sensibility** 
Reflexes 
Thj 
1. Hypothenar mus- 
cles. 
2. Mm. interossei. 
3. Mm. lumbricales. 
(CgandTh,). Move- 
ments of the thumb 
and lingers. 
Medial surface of upper 
arm and ulnar edge of fore- 
arm and hand; part of little 
finger, the ring finger, and 
ulnar margin of middle 
finger. 
“Dorso-ulnar zone.” 
1. Scapula reflex 
(Cg-Thj). 
2. Palmar reflex 
(Cj-ThJ. . 
3. Cilio-spinal 
reflex (efferent 
fibers) (Cs-Thj). 
Th2-Thl2 
1. Muscles of the 
back. 
2. Intercostal mus- 
cles (Th3-Th„). 
3. Muscles of 
abdominal wall 
(Thj-Lj). 
1. Movements of 
spine extension and 
rotation. 
2. Respiration. 
3. Prelum abdom- 
inis; rising from 
recumbent position. 
Th2. Skin over thorax 
below the cervico-thoracic 
limiting line (between 
second and third rib) lat- 
eralward to include the upper 
medial part of the arm; behind, 
to seventh cervical spine. 
“Dorsobrachial zone.” 
Th3. In front between third 
and fourth rib; behind, 
below the spina scapulae. 
To a slight extent in the axilla 
and upper medial arm(?). 
“Scapulobrachial zone.” 
Th4. In front, region of 
nipples above the inter- 
mammillary line; behind, 
as low as fifth thoracic spine. 
“Dorso-axillary zone.” 
' 
‘For plurisegmental innervation ot muscles see preceding table; here only the dominant segment is given. 
**The names of the zones in quotation marks are those used by Head. 52 
Ultra-Violet 
TABLE OF CORD SEGMENTAL REPRESENTATION OF MOTILITY, SENSIBILITY AND REFLEXES 
{From, L. F. Barker) 
Segment of 
Spinal Cord: 
Spinal Nerve 
Roots 
Muscles* 
Movements 
Cutaneous 
Sensibility** 
Reflexes 
• 
Th5. Area just below the 
nipples. 
“Scapulo-axillary zone.” 
Th6. In front, crosses 
xiphoid; behind, a little 
above eighth thoracic spine. 
‘‘Subsea pulo-infra- 
mammary zone.” 
ThT. In front, tip of 
xiphoid. 
“Sucscapulo-ensiform 
zone.” 
Thg. In front about mid- 
way between nipple and 
navel. 
“Mid-epigastric zone.” 
Th9. In front above the 
navel; behind, just above 
first lumbar spine. 
“Supra-umbilical zone.” 
Upper abdominal 
reflex (ThB-9). 
♦For plurisegmental innervation of muscles, see preceding table; here only the dominant segment is given. 
♦♦The names of the zones in quotation marks are those used by Head. Therapy 
53 
TABLE OF CORD SEGMENTAL REPRESENTATION OF MOTILITY, SENSIBILITY AND REFLEXES 
(From L. F. Barker) 
Segment of 
Spinal Cord: 
Spinal Nerve 
Roots 
Muscles* 
Movements 
Cutaneous 
Sensibility** 
Reflexes 
Thl0. In front, level of 
navel; behind, between 
first and second lumbar 
spines. 
“Subumbilical zone.” 
Thj,. In front, below the 
navel. 
“Sacro-iliac zone.” 
Th12. In front, lowermost 
adomen, above the direc- 
tion-line separating the 
trunk from the lower 
extremity. 
“Sacro-inguinal zone.” 
Lower abdominal 
reflex (Thl0-12). 
L, 
1. Lower abdominal 
muscles. 
2. M. quadratum 
lumborum. 
3. Mm. psoas major 
and minor. 
1. Prelum abdom- 
inis. 
2. Lateral flexion of 
spine. 
3. Flexion of thigh. 
Skin of the groin. 
“Sacrofemoral zone.” 
Cremaster reflex 
(L.-J. 
l2 
1. M. ileopsoas; M. 
sartorius. 
2. M. cremaster. 
1. Flexion of thigh. 
2. Retraction of 
testicle. 
Most of anterior surface of 
thigh; sensation in testicle 
and spermatic cord. 
“Gluteocrural zone.” 
1. Cremaster 
reflex (L,-2). 
2. Knee-jerk 
(L2-J. 
*For plurisegmental innervation of muscles, see preceding table; here only the dominant segment is given. 
**The names of the zones in quotation marks are those used by Head. 54 
Ultra-Violet 
TABLE OF CORD SEGMENTAL REPRESENTATION OF MOTILITY, SENSIBILITY AND REFLEXES 
(From L. F. Barker) 
Segment of 
Spinal Cord 
Spinal Nerve 
Roots 
Muscles* 
Movements 
Cutaneous 
Sensibility** 
Reflexes 
l3 
1. M. ileopsoas. 
2. Adductors of the 
thigh (L2-4). 
3. M. quadriceps 
(L2-J. 
1. Flexion of the 
thigh. 
2. Adduction of the 
thigh. 
3. Extension of leg 
on thigh. 
Region of the knee. 
Knee-jerk (L2-4). 
l4 
1. M. q uadriceps (L2-4) 
2. Lateral rotators 
of thigh. 
3. M. tibialis anti- 
cus. 
1. Extension of leg 
on thigh. 
2. Lateral rotation 
of thigh. 
3. Dorsal flexion of 
foot; elevation of 
medial margin. 
Medial surface of leg. 
1. Knee-j erk 
(L2-4). 
2. Gluteal reflex 
(L4-J. 
L. 
1. Mm. gluteus med. 
and min. (L4-S4). 
2. M. semimembra- 
nosus; M. semitendi- 
nosus; M. biceps 
femoris. 
1. Adduction and 
medial rotation of 
thigh. 
2. Flexion of leg. 
1. Narrow triangular area 
in front of ankle, extending 
to dorsum of foot. 
2. Narrow triangular area 
over tendo-Achilles and 
heel, extending to planta 
pedis. 
“Fibulodorsal zone.” 
1. Gluteal reflex 
(L4-B). .. 
2. Achilles-jerk 
(L8-S2). 
s* 
1. Mm.gluteusmaxi- 
mus (L4-S)2. 
1. Fixation of pelvis 
on thigh; extension 
of thigh. 
1. Narrow zone extending 
from the dorsum pedis up 
behind the fibula, on the 
lateral surface of the foot 
and leg. 
1. Achilles-jerk 
(Ls-S2). 
*For plurise'mental innervation of muscles, see preceding table; here only the dominant segment is given. • 
**The names of the zones in quotation marks are those used by Head. T h e r a p y 
55 
TABLE OF CORD SEGMENTAL REPRESENTATION OF MOTILITY, SENSIBILITY AND REFLEXES 
(From L. F. Barker) 
Segment of 
Spinal Cord: 
Spinal Nerve 
Roots 
Muscles* 
Movements 
Cutaneous 
Sensibility** 
Reflexes 
2. M. pyriformis; 
M. obturator inter- 
nus; Mm. gemelli; 
M. quadratus femo- 
ris. 
2. Lateral rotation 
of thigh. 
3. Dorsal flexion of 
the foot and toes. 
2. Narrow zone extending 
upward from behind the 
lateral malleolus; it extends 
in a spiral direction over 
the calf to reach the medial 
condyle of the femur. 
“Soleal zone.” 
2. Plantar reflex 
(S,-2). 
3. M. tibialis anti- 
cus. Mm. peronei; 
Mm. extensor 
digitor longus and 
brevis. 
s2 
1. M. gastrocnemius; 
M. soleus. 
1. Plantar flexion of 
foot. 
Lateral part of buttock, 
and most of posterior sur- 
face of thigh and upper 
lateral calf (anesthesia has 
riding breeches shape). 
Lateral surface of leg; 
lateral margin of foot; sen- 
sibility of bladder and rec- 
tum. 
“Sciatic zone.” 
1. Achilles-jerk 
(L5-S2). 
2. M. flexor digit, 
comm.: M. flexor 
hallucis. 
3. M. tibialis posti- 
cus. 
2. Flexion of the 
toes. 
3. Adduction of 
foot, with elevation 
of its medial margin. 
* 
2. Plantar reflex 
(S,-2). 
3. Ejaculation 
center (S2-3). 
*For plurisegmental innervation of muscles, see preceding table; here only the dominant segment is given. 
**The names of the zones in quotation marks are those used by Head. 56 
Ultra-Violet 
TABLE OF CORD SEGMENTAL REPRESENTATION OF MOTILITY, SENSIBILITY AND REFLEXES 
(From L. F. Barker) 
Segment of 
Spinal Cord; 
Spinal Nerve 
Roots 
Muscles* 
Movements 
Cutaneous 
Sensibility** 
Reflexes 
4. Small muscles of 
foot. 
4. Flexion, adduc- 
tion and abduction 
of toes. 
S3* . 
1. Perineal muscles. 
Voluntary starting 
and stopping of uri- 
nation and defeca- 
tion; erect ion; second 
phase of ejaculation. 
1. Most of gluteal region. 
1. Ejaculation 
center (S2-3). 
2. Voluntary muscle 
of genito-urinary 
organs and rectum. 
2. Perineum, scrotum, 
penis. 
3. Uppermost part of 
medial surface of thigh. 
2. Erection cen- 
ter (S3). 
3. Bladder center 
(S3-4). 
4. Rectal center 
(s3-4). 
s4-s 
+ coccyg. 
1. M. levator ani 
(S3-4). 
2. M. sphincter ani 
externus (S3-4). 
3. M . coccy ge u s 
(S3-coccyg.). 
Voluntary starting 
and stopping of uri- 
nation and defeca- 
tion. * 
1. Anal and perineal 
regions. 
2. Medial sacral and 
coccygeal regions. 
1. Bladder cen- 
ters (S3-J. 
2. Rectal centers 
(S3-4). 
3. Anal reflex 
(Sr, + coccyg). 
*For plurisegmental innervation of muscles, see preceding table; here only the dominant segment is given. 
**The names of the zones in quotation marks are those used by Head. Therapy 
57 
Just as the irritation produced in the viscus as the 
result of visceral pathology causes a pain to be referred 
to certain areas, so does stimulation of these areas also 
refer back reflex changes that affect the viscera. This 
is the basis of regional actinotherapy; and though used 
in painful diseases of the viscera, it is to be noted espe- 
cially that regional actinotherapy may be used for the 
correction, at least in part, of visceral disease that fails 
to produce pain. 
DISORDERS OF THE STOMACH 
The more common lesions of the stomach causing pain, 
and for which regional actinotherapy is useful, are: 
1. Gastralgia (?) 
2. Hyperchlorhydria 
3. Cardiac or pyloric spasm 
4. Acute dilatation 
5. Acute gastritis 
6. Chronic gastritis 
7. Gastric ulcers 
8. New growths 
9. Perigastric adhesions 
Pains induced by these lesions involve: 
(a) The epigastrium 
(b) The back between the posterior borders 
of both scapulae 
(c) The hyperalgesic areas include the sixth 
(when the esophagus is involved), the 
seventh, eighth and sometimes ninth 
dorsal (study table and see cut). 58 
Ultra-Violet 
Stomach 
(Left Half) 
Gall Bladder 
Kidney 
Cecum and 
Appendix 
Ovary and Tube 
Ureter 
Fig. 1—The general location and outline of the zones of cuta- 
neous hyperalgesia for some of the abdominal viscera. Anterior view. 
The maxima are deeply shaded. Only the left half of the gastric zone 
is given. The ureteral zone consists of a series of maxima (dia- 
grammatic). 
Gastralgia 
A sensory neurosis of the stomach that induces, 
reflexly, a pressure-pain sense in the epigastrium. 
Regional A ctinotherapy: The individual rests on a 
table. Draw a bed-sheet, or equivalent covering, over 
the face and upper part of the chest so as to cover all 
above a line that connects both nipples. Draw a second 
sheet over the legs and pelvic region to a level with the Therapy 
59 
-10th Dorsal Spine 
-1st Sacral 
Fig. 2—The general location and outline of the posterior parts of 
the zones (diagrammatic). 
umbilicus. This leaves an area in front exposing the 
hyperalgesic regions. 
Adjust the lamp over the patient so that the uviarc 
is directly over the median line of the individual, and 
in the same direction as the median line. Open the 
casing sufficiently wide entirely to cover the exposed 
area. The lamp must show an operating voltage (voltage 
across the tube) of 70. Apply a regenerative erythema, 
as follows: 
From the American Journal of The Medical Sciences, Vol. CXXXVI, 
No. 5, November, 1908. 60 
Ultra-Violet 
Light Type 
Dark Type 
Female adult 
90 seconds 
120 seconds 
Male adult 
120 seconds 
150 seconds 
With the sheeting in the same position, have the 
patient turn so as to expose an equivalent area on the 
back. Repeat the radiation on the back. The erythema 
should develop in 6 to 10 hours, and in its acute form, 
last one or two days. When it begins to disappear, if 
the pain is not entirely relieved, a second application in 
identical manner is used, but increasing the exposure 
time because of the established tolerance. 
Second Exposure 
Light Type 
Dark Type 
Female adult 
180 seconds 
240 seconds 
Male adult 
240 seconds 
300 seconds 
Comment: If the pain is due to gastralgia, excellent 
recovery follows the first treatment. A second exposure 
is seldom required. If the pain persists, restudy the 
case bearing in mind the possibility of gastric ulcer. 
Practically immediate amenability to actinotherapy is 
a distinguishing diagnostic symptom of gastralgia. 
HYPERCHLORHYDRIA 
A secretory neurosis of the stomach that produces 
pain (as distinguished from all other secretory neuroses). 
Regional Actinotherapy: Since, in hyperchlorhydria, 
the pain is diffuse, and extends over the entire abdomen, 
the region treated is the whole back and front above 
the waistline, two exposures to a treatment (back and 
front). Frequently repeated doses of stimulative ery- 
thema are better, it appears, than fewer doses of regen- 
erative erythema. Initial exposure: Therapy 
61 
Light Type 
Dark Type 
Female adult 
50 seconds 
60 seconds 
Male adult 
60 seconds 
90 seconds 
Each subsequent exposure is increased by the same 
amount as the original, viz.: 
Female 
Male 
Light 
Dark 
Light 
Dark 
1st 
exposure 
50 sec. 
1 
min. 
1 
min. 
1% min. 
2d 
it 
1% 
min. 
2 
U 
2 
a 
3 
3d 
U 
2% 
U 
3 
u 
3 
u 
4% “ 
4th 
U 
3 % 
u 
4 
u 
4 
u 
6 
5th 
u 
4 % 
u 
5 
u 
5 
u 
7% “ 
6th 
a 
5 
u 
6 
a 
6 
u 
9 
7th 
u 
5H 
u 
7 
u 
7 
a 
10% “ 
8th 
u 
6% 
u 
8 
u 
8 
u 
12 “ 
9th 
u 
7A 
“ 
9 
u 
9 
u 
13% “ 
10th 
u 
8H 
u 
10 
u 
10 
u 
15 
11th 
u 
9 H 
u 
11 
u 
11 
u 
16% “ 
12th 
u 
10 
u 
12 
u 
12 
u 
18 “ 
13th 
u 
10% 
u 
13 
a 
13 
u 
19% “ 
14th 
“ 
11% 
u 
14 
u 
14 
a 
21 
15th 
u 
12% 
u 
15 
u 
15 
“ 
22% “ 
Comment: Since hyperchlorhydria is generally asso- 
ciated with (1) mental fatigue and overwork, (2) gas- 
trointestinal atony with chronic constipation, or (3) 
indiscretions in food, coffee or tobacco, these must be 
attended to promptly. One must be cautioned not to 
overlook the possibility of gastric or duodenal ulcer, or 
reflex causes of hyperacidity such as cholelithiasis, chronic 
appendicitis or ileal stasis. Hyperchlorhydria, of what- 
ever origin, yields under a course (six to fifteen treatments, 
every second day) of ultra-violet therapy; but when due 
to other than secretory neurosis, the surgical possibilities 
should not be neglected. 
Cardiac or Pyloric Spasm 
Like other hollow abdominal viscera, the stomach is 
subject to colic; but the parts of the stomach chiefly 62 
Ultra- V'i o l e t 
affected are the pylorus and cardia. The pain and hyper- 
algesia is epigastric. 
• Regional Actinotherapy: The mechanism here is to 
excite, by stimulation, the nerve filaments that are in the 
epigastric skin region. This, by reflex, relieves the spastic 
reaction of the pyloric or cardiac sphincters. Minimum 
exposures to the epigastrium are sufficient. Overexposure 
is contraindicated because of the hyperemic temperature 
created; and, as Schmidt has shown, cold is borne better 
than heat. 
Direct the rays to the epigastrium. The back need not 
be exposed. Use a broken stimulative dose, about as 
follows: 
Female Adult 
Male 
Adult 
Light 
Dark 
Light 
Dark 
Initial dose 
10 sec. 
12 sec. 
12 sec. 
18 sec. 
15 minutes later 
10 “ 
12 “ 
12 “ 
18 “ 
30 minutes later 
10 “ 
12 “ 
12 “ 
18 “ 
45 minutes later 
10 “ 
12 “ 
12 “ 
18 “ 
1 hour later 
10 “ 
12 “ 
12 “ 
18 “ 
Total 
50 “ 
60 “ 
60 “ 
90 “ 
Comment: A stimulative dose, broken in five fractions, 
gives a splendid nervous reaction that usually diverts 
the sphincteral spasm. Each fraction follows the preced- 
ing exposure after a 15-minute interval. The sum of the 
fractions, at the end of one hour, equals the stimulative 
dose time. Excellent results in pure spasms of the 
stomach. 
Acute Dilatation 
Usually a post-operative sequelum when there has been 
much handling of the viscera. A relaxation of muscle 
tone. The discomfort-pain is epigastric, which should be 
rayed heavily, during or after immediate gastric lavage. 
Actinotherapy does not relieve the stomach of its con- 
tents. It increases, by reflex, the muscular tone. T h e r a p y 
63 
Regional Actinotherapy: Regenerative erythema over 
the epigastrium. 
Female 
Adult 
Male Adult 
Light 
Dark 
Light | Dark 
Regenerative erythema 
90 sec. 
120 sec. 
120 sec. | 150 sec. 
Comment: When not the result of operative han- 
dling, it is generally a less severe situation. If exposed 
viscera are irradiated during operation, many think that 
acute dilatation is completely aborted. This is an inter- 
esting speculation worthy of investigation. In post- 
operative dilatation, depend upon immediate and 
complete lavage for relief; and upon actinotherapy, to 
maintain the gastric tone for precluding possible repe- 
tition. 
Acute Gastritis 
A painful reaction of the stomach occasioned by inflam- 
matory pathology. When the inflammation involves the 
walls of the stomach, the immediately adjacent lym- 
phatics become affected. The distribution of pain and 
hyperalgesia is the same as for gastralgia; but the pain 
seems to run right through to the back, so that pain 
between the shoulders is also felt. Morphine must 
sometimes be used. 
Regional Actinotherapy: Regenerative erythema from 
the nipple line to the umbilicus level, over front and back. 
Prepare with sheets as for gastralgia. Exposure, over 
each region (back and front): 
Female Adult 
Male 
Adult 
Light 
Dark 
Light 
Dark 
Initial 
2d 
exposure 
U 
\x/i min. 
3 “ 
2 min. 
4 “ 
2 min. 
4 “ 
min. 
5 
3d 
a 
4K “ 
5 
6 “ 
6 “ 
m “ 
10 
4th 
u 
8 “ 
8 “ 
5th 
6th 
u 
“ 
8 “ 
10 “ 
10 “ 
12H “ 
15 “ 
u 
12 “ 
12 “ 64 
Ultra-Violet 
Comment: The radiation should relieve the tension of 
the recti muscles, which, particularly on the right side, 
are generally contracted. In proportion as this tension 
is reduced, the pain of the gastritis yields. 
Chronic Gastritis 
Usually not painful. Only a feeling of discomfort. 
Regional A ctinotherapy: Stimulative erythema in a 
course of exposures. Useful particularly in the atrophic 
forms where pains resembling the gastric crises of tabes 
are occasionally present. Actinotherapy is a most useful 
auxiliary measure. Exposure course: 
Exposure 
Female 
Male 
Light 
Dark 
Light 
Dark 
Initial 
50 sec. 
1 
min. 
1 
min. 
1% 
min. 
2d 
1% 
min. 
2 
U 
2 
U 
3 
U 
3d 
2% 
U 
3 
i< 
3 
if 
4% 
a 
4th. 
3 % 
if 
4 
u 
4 
u 
6 
a 
5th 
4 % 
u 
5 
a 
5 
a 
7% 
u 
6th 
5 
u 
6 
u 
6 
a 
9 
a 
7th 
5% 
a 
7 
u 
7 
it 
10% 
u 
8th 
6 % 
u 
8 
u 
8 
a 
12 
u 
9th 
7% 
u 
9 
u 
9 
u 
13% 
u 
10th 
8% 
u 
10 
u 
10 
a 
15 
a 
11th 
9% 
a 
11 
u 
11 
u 
16% 
u 
12th 
10 
u 
12 
u 
12 
u 
18 
u 
13th 
10% 
iC 
13 
u 
13 
a 
19% 
u 
14th 
11% 
u 
14 
a 
14 
u 
21 
u 
15th 
12% 
u 
15 
u 
15 
a 
22% 
u 
16th 
13% 
u 
16 
u 
16 
a 
24 
if 
17th 
14% 
u 
17 
u 
17 
a 
25% 
if 
18th 
15 
u 
18 
u 
18 
a 
27 
i( 
19th 
15% 
u ' 
19 
u 
19 
a 
28% 
a 
20th 
16% 
u 
20 
u 
20 
a 
30 
a 
Comment: Primary forms of chronic gastritis, resulting 
from dietetic errors, hasty eating, faulty mastication, T h e r a p y 
65 
lack of exercise, are benefited much; more especially is 
the mental depression, usually a prominent feature of the 
condition, dispelled. 
Secondary forms, where the chronic gastritis accom- 
panies various organic diseases, such as cancer, severe 
anemia, tuberculosis, renal disease, arterial sclerosis, car- 
diac insufficiency or portal obstruction, yield less readily 
unless, obviously, the major pathology is at the same time 
attacked. 
Gastric Ulcers 
It appears that the mechanism of pain production in 
gastric ulcer is much similar to that obtaining in gastritis; 
excepting that the circumscription of the ulcer more defin- 
itely focalizes the pain area on the skin. Increased acidity 
of the gastric juice is usually present, though its absence 
by no means rules out gastric ulcer. There is some ques- 
tion as to whether the increased acidity induces the pain 
attack. 
Regional Actinotherapy: Irradiate the epigastrium, 
using a regenerative erythema, as follows: 
Female 
Male 
Light 
Dark 
Light 
Dark 
Initial 
134 min. 
2 min. 
2 min. 
234 min. 
2d 
3 
4 “ 
4 “ 
5 
3d 
434 “ 
6 “ 
6 “ 
m “ 
4th 
6 
8 “ 
8 “ 
10 
5th 
734 “ 
10 “ 
10 “ 
1234 “ 
6th 
9 
12 “ 
12 “ 
15 
7th 
10 34 “ 
14 “ 
14 “ 
17 H “ 
8th 
12 
16 “ 
16 “ 
20 
9th 
13 34 “ 
18 “ 
18 “ 
22 H “ 
10th 
15 
20 “ 
20 “ 
25 66 
Ultra-Violet 
The interval between each treatment should be about 
two days. After the tenth treatment, stop the ultra- 
violet therapy. Wait an interval of two weeks without 
treatment. Then begin again the course above outlined. 
Comment: The treatment is long, but commendable. 
Hematemesis is soon checked, as can be determined by 
the silk thread test. Complications are aborted. Pain 
is dispelled. Under X-ray, the gastric spasm usually 
elicited is found to disappear. Hyperchlorhydria is dim- 
inished, the acidity of the gastric juice reaching a normal 
value. 
Clinically, at least in so-called “medicinal” ulcers of 
the stomach (so small as to contraindicate surgical inter- 
vention) most encouraging control follows actinotherapy. 
Be certain to distinguish from (1) carcinoma (especially 
ulcus carcinomatosum), (2) from duodenal ulcer (right- 
sided hunger pain, especially at 2-4 a.m.; vomiting less 
common; periodicity of symptoms more marked; X-rays); 
(3) from gallstones and cholecystitis (absence of occult 
blood and of hypomotility; occasionally, urobiligenuria; 
character of pain; sometimes icterus; X-rays); (4) from 
appendicitis in a high appendix; (5) from nervous epigas- 
tralgias (absence of occult blood, and of a definite relation 
of pain to the ingestion of food; introduction of 100 c.c. 
N /10 HC1 through a tube may cause no pain); (6) from 
gastric crises of tabes (pupils; knee jerks); and (7) from 
epigastric hernia (relation of pain to exercise rather than 
to food; palpation). It is wise to rule out, in addition, (8) 
renal stone, (9) .intestinal parasites, and, in women, (10) 
pelvic disease. Chapter V 
REGIONAL ACTINOTHERAPY 
viewP°int of gynecology, referred 
51 pains are important in connection with the 
treatment of certain disorders of the female 
genitalia, particularly the uterus, the tubes and 
the ovaries. The area of distribution of cord segments 
involved in uterine, ovarian and tubal diseases includes: 
1. For the uterus; tenth, eleventh and twelfth dorsal 
2. For the cervix; third and fourth lumbar, sometimes 
also the first and second sacral segments 
3. For the ovaries; the tenth dorsal 
4. For the tubes; eleventh and twelfth dorsal, and first 
lumbar segments 
So that the region involved in pelvic visceral disorders 
is from the level of the free borders of the ribs to halfway 
between the hip and the knee in front, and the corres- 
ponding area in back. It must be recalled that involve- 
ments of the female genitalia are capable of producing 
local, referred, reflected, transferred and sympathetic 
pains; and that this multiple effect taxes the diagnostic 
acumen of the surgeon. 
Dysmenorrhea 
Painful menstruation presents certain clinical varieties, 
such as: 
1. Neuralgic 
2. Congestive 
3. Mechanic 
4. Membranous 
5. Ovarian 
67 68 
Ultra-Violet 
For the neuralgic type, in which the pain is usually 
most severe just before the onset or during the early hours 
of the flow, regional actinotherapy is useful, particularly 
when combined with the supportive treatment demanded 
by the case (colchicum or salicylates in the gouty; iron, 
arsenic and strychnine intramuscularly administered in 
the anemic). 
The actinic erythema required over the region of hyper- 
algesia depends upon the severity of the pain when 
Mild or 
Moderate 
Stimulative erythema 
Intense 
Regenerative erythema 
Exposure factors are: 
Stimulative 
Regenerative 
Light 
Dark 
Light 
Dark 
Initial 
50 sec. 
60 sec. 
90 sec. 
120 sec. 
2d 
1% min. 
2 min. 
3 min. 
4 min. 
3d 
2K “ 
3 “ 
. 4H “ 
6 “ 
4th * 
3K “ 
4 “ 
6 
8 “ 
5th 
4/4; “ 
5 “ 
7'A “ 
10 “ 
6th 
5 
6 “ 
9 
12 “ 
7th 
5 H “ 
7 “ 
ioA “ 
14 “ 
8th 
6% “ 
8 “ 
12 
16 “ 
This generally relieves the pain during the acuity of the 
attack. In the course of the intramenstrual period, a 
complete survey of the pelvic organs should be made and 
the underlying pathogenesis of the dysmenorrhea cor- 
rected. 
Congestive dysmenorrhea is treated with a regenerative 
erythemic reaction over the pelvic area as outlined 
previously. Therapy 
69 
Light 
Type 
Dark Type 
1H 
3 
min. 
2 
min. 
2d 
u 
4 
u 
3d 
4H 
6 
u 
6 
u 
4th 
u 
8 
u 
7V2 
9 
a 
10 
u 
6th 
u 
12 
a 
7th 
10 Yt 
12 
u 
14 
u 
8th 
u 
16 
u 
9th 
13M 
15 
a 
18 
u 
10th 
u 
20 
u 
Scheme 
By stimulating the capillary requirement of blood, 
which the erythema accomplishes, the related internal 
viscera are correspondingly “decongested.” If there is 
some leucorrhea between periods, suspect a tumor or 
uterine displacement. Saline cathartics should always 
preceed decongestive actinotherapy. 
Ovarian dysmenorrhea is similarly treated, using regen- 
erative erythemic applications as for congestive dysmen- 
orrhea. Avoid alcoholic stimulants and morphine. 
Menorrhagia and Metrorrhagia 
One, menorrhagia, is an increased menstrual discharge; 
the other, metrorrhagia, is a discharge occurring at times 
other than the normal period. 
These conditions may arise as primary affections of 
the uterus, such as: 
(a) Endometritis (especially granular form) 
(b) Interstitial or submucous fibroid tumors 
(c) Para, or peri, metritis 
(d) Secundines, retained 
(■e) Subinvolution 
(/) Malignant disease 
(g) Chronic inversion 70 
Ultra-Violet 
or they may arise from conditions which secondarily 
affect the uterus, such as: 
(a) Diseases of the tubes and ovaries 
(b) Renal, hepatic, or cardiac diseases; 
tuberculosis, continued fevers, etc. 
(c) Fecal impaction 
(d) Hemophilia 
(e) Ectopic gestation 
Pain is relieved by actinotherapy, when pain is a 
distinguishing symptom. Beyond this, the pristine cause 
must be sought and corrected. For the pain, a stimulative 
erythema is ample, repeating frequently, say daily or at 
most every second day. This same exposure refiexly 
influences the tone of the uterine musculature, and is 
therefore a splendid measure. 
Pain due to disease of the Fallopian tubes may result 
from: 
1. Distension of the tubes 
2. Inflammation 
3. Adhesions 
These are collectively realized as forms of salpingitis, 
which may be acute or chronic. Pozzi gives an anatomical 
and clinical classification wTich is quite serviceable, as 
follows: 
Fallopian Tubes 
1. Noncystic 
salpingitis 
(a) Acute catarrhal 
(b) Acute purulent 
(c) Chronic parenchymatoses 
(d) Pachysalpingitis 
(a) Hydrosalpinx 
(b) Pyosalpinx 
(ic) Hematosalpinx 
2. Cystic 
salpingitis Therapy 
71 
Salpingitis is usually secondary to a gonorrheal or 
puerperal septic endometritis. Taking cold during the 
menstrual period, excessive excercise, tuberculosis, syphi- 
lis or eruptive fevers are also causal. 
Throbbing pains are usually due to hyperemia; when 
there should be given a regenerative erythema over the 
pelvic region. Dull aching pains are due to chronic 
inflammation, generally, and yield best to stimulative 
erythema over the pelvic region of hyperalgesia. 
When the indications are not such as to indicate 
operation, there being only slight pain and moderate 
menorrhagia, regional actinotherapy furnishes an excel- 
lent palliative treatment. Rest in bed and saline purga- 
tives should be prescribed. 
Exposures 
Stimulative 
Regenerative 
Light 
Dark 
Light 
Dark 
Initial 
50 sec. 
60 sec. 
90 sec. 
120 sec. 
2d 
1% min. 
2 min. 
3 min. 
4 min. 
3d 
2K “ 
3 •“ 
' “ 
6 “ 
4th 
3K “ 
4 “ 
6 
8 “ 
5th 
4 % “ 
5 “ 
“ 
10 “ 
6th 
5 
6 “ 
9 
12 “ 
7th 
5M “ 
7 “ 
ioA “ 
14 “ 
8th 
6K “ 
8 “ 
12 “ 
16 “ 
Pelvic Inflammation 
Pelvic inflammation is a clinical concept that includes 
pelvic peritonitis and pelvic cellulitis. It would appear, 
at first hand, that the two conditions might readily be 
separated; but the difficulties of differential diagnosis 
are sometimes so great as to preclude any absolute dis- 
tinction until after an exploratory operation. 72 
Ultra-Violet 
Pelvic Peritonitis 
Definition: An inflammation of the pelvic peritoneum. 
Etiology: Most usually pelvic peritonitis arises as a 
result of an extension to the peritoneum of inflammations 
involving the uterus, ovaries or tubes; and in the great 
majority of the cases, inflammation of the tubes. First, 
there may be an endometritis; then a salpingitis; and 
then a peritonitis. When the course of infection takes 
the avenues described, the pristine disorder may be 
traced to infection of the genital tract, such as that 
incident to: 
(a) Gonorrhea 
(b) Introduction into the genital tract 
anywhere of septic materials, as from 
instrumentation. Or the infection may extend by way 
of veins and vessels from the uterus into the broad 
ligament, omitting the intervening tubes. 
Pathology: At first the peritoneum becomes hypermic, 
its luster is lost and exudation forms and accumulates. 
According to the quantity and character of exudate, 
pelvic peritonitis may be: 
1. Adhesive: In which there is scarcely any serum 
exuded; the inflamed area being coated with fibrin 
and adhesions form which bind together the pelvic 
organs and intestines. 
2. Serous: In which the exudate consists mainly of 
serum and lies either free in the peritoneal cavity 
or is encapsulated by adhesions. 
3. Purulent: In which there is a severe exudate, and 
when especially septic, the exudate is almost wholly 
purulent. T h e r a p y 
73 
Pelvic Cellulitis 
Definition: An accumulation of serous exudate with 
or without fibrin and white cells, involving principally 
the cellular structures of the peritoneum. 
Etiology: Pelvic cellulitis arises as the result of two 
causes, summed up by Cragin in the words traumatism 
and sepsis. Traumatism may come from labor, abortion 
or cervical operations; or.from impaired physiological 
integrity of the individual cells of the pelvic structure 
(physiologic trauma). 
At one time, pelvic cellulitis was considered common; 
but the experience gained through exploratory laparot- 
omies teaches that masses and thickenings are most 
frequently found to be salpingitis and peritonitis. So that 
although pelvic cellulitis exists, its occurrence is fairly 
infrequent. 
Pathology: Serum, fibrin, and white cells accumulate. 
This exudate may resolve; it may form new connective 
tissue; or it may suppurate, and often does. When it 
suppurates the pus may point above the tubes, or it may 
rupture into any of the adjacent structures, as the vagina, 
bladder, rectum or uterus. 
Secondary Pathogenesis 
In cellulitis, as in peritonitis, two distinguishing patho- 
logic phenomena are resident. The first is the presence 
of a pathogenic organism; the second is a lowered thresh- 
old of physiologic integrity on the part of the individual 
cells in the region invaded by the organisms. Too little 
attention is paid to the topic of cellular contribution in 
the process of infection. It is generally summarily dis- 
missed by referring to it as “immunity” or “resistance.” 
The accumulation of exudate is a significant index point- 
ing to an impaired metabolism, and therefore alters the 74 
Ultra-Violet 
exchange existing between blood supply and cellular 
activity. It seems that we could include pelvic cellulitis 
and peritonitis under the general term of pelvic inflamma- 
tion; both being clinically related and being different 
manifestations of the same pathologic process. They 
differ only in the virulence of the attacking organism and 
in the anatomical orientation that the infection assumes. 
So that we may refer to the infectious character of these 
effects as the pristine pathogenesis of pelvic inflammation, 
and to the inhibited cellular physiology that leads to 
exudate formation as the secondary pathogenesis. 
The secondary pathogenesis of pelvic inflammation 
is' a factor that can be corrected through the proper 
administration of ultra-violet exposure. Stimulative 
erythemas are applied over the back and front of the nude 
individual (it is sufficient generally to expose from the 
waist up). The stimulation produced increases cellular 
metabolism in the surface structures. The radiations 
induce a change in the assimilative constant of the blood, 
making it more readily available for cells that are below 
par. This is another way of saying that systemic expo- 
sures to ultra-violet ray raise the resistance or immunity 
of the individual. 
Treatment of Pelvic Inflammation: Primary pathologic 
factors, such as endometritis, fibroids, chronic salpingitis 
and similar infections must be removed by operative 
interference if the potential cause for pelvic inflam- 
mation is to be eradicated. In the acute stages of 
infection the amount of exudate reaction is an index of 
operative treatment; if the reaction is purulent and the 
exudate accumulates rapidly, drainage is indicated; if 
the reaction is fibrinous and goes on to chronic course, 
it is better to resort to measures that increase immunity 
and that will make for resorption of plastic exudation. Therapy 
75 
Regional Actinotherapy 
In all cases stimulative ultra-violet radiations are 
indicated, whether or not operative interference is 
premeditated. When the attack is of non-operative 
virulence, this treatment may alone suffice to restore 
normalcy to the pelvic tissues. 
Dose scheme: 
Stimulative 
Regenerative 
Light 
Dark 
Light 
Dark 
Initial 
50 sec. 
60 sec. 
90 sec. 
120 sec. 
2d 
1% min. 
2 min. 
3 min. 
4 min. 
3d 
2K “ 
3 “ 
4K “ 
6 “ 
4th 
3K “ 
4 “ 
6 
8 “ 
5th 
4M “ 
5 “ 
7 Yi “ 
10 “ 
6th 
5 “ 
6 “ 
9 
12 “ 
7th 
5% “ 
7 “ 
ioy2 “ 
14 “ 
8th 
6% “ 
8 “ 
12 
16 “ 
The treatment must be begun and maintained, allowing 
only minimum intervals to intervene between applica- 
tions, usually 36 hours apart. When the primary patho- 
logic focus is of intra-vaginal origin, usually bactericidal, 
the conjoint use of the bactericidal lamp is 
at the same time indicated. 
General Comment: There has been a tendency to over- 
treat, with actinotherapy, in gynecologic conditions. Use 
stimulative and regenerative erythemas, regionally ap- 
plied, with intelligent discrimination; the stimulative 
being much more useful, as a rule, than the regenerative. 
When combined with glandular extracts, corpus luteum, 
ovarian, and other organotherapeutic agents, actinother- 
apy furnishes a splendid gynecologic aid. Infection of 76 
Ultra-Violet 
the urogenital passages is a bactericidal entity that will 
be discussed when the water-cooled lamp is considered. 
Be careful of the diagnosis; use the radiant agent as 
a palliative measure, and complete the treatment, when 
necessary, by removing the prime cause. Ultra-violet may 
in many instances be of itself sufficient; but its capacity 
for doing clinical good must be judiciously assayed in 
terms of how the good is accomplished. 
Avoid empiricism. Chapter VI 
FRACTIONAL ACTINOTHERAPY 
■Y FRACTIONAL actinotherapy is meant the 
irradiation of the body in fractional portions 
for the purpose of establishing a strong toler- 
ance to the rays in order that a more or less 
prolonged attack upon a general systemic condition can 
be made.. 
Those of us who are familiar with heliotherapy realize 
full well the entire significance of Dr. Rollier’s teaching 
and practice; the gradual exposure of the nude body to 
the sun’s rays as distinguished from an immediate thrust 
of the entire body into a highly active chemical environ- 
ment such as actinic rays represent. In our own country, 
Lo Grasso, at Perrysburg, subscribes completely to the 
necessity for fractional irradiation (he uses heliotherapy) 
in the treatment of tuberculosis; and insists that a very 
great measure of the successful handling of surgical 
tuberculosis by actinic energy is resident in the use of 
the fractional method. 
It is known that the limit of ultra-violet wave lengths 
reaching us from the sun is about 2900 Angstrom units. 
Spectographic measures show, also, that the usual glass 
of window panes does not transmit shorter wave lengths 
than 3022 Angstrom units; and that heliotherapy, to be 
successful, cannot be employed behind windows, but rpust 
be in open light. In other words, glass filters off the ultra- 
violet wave lengths of sunlight that are essential in the 
treatment of tuberculopathies (and rickets). 
Reproducing the wave lengths of the important bands 
of the biologic mercury vapor spectrum, we find: 
77 78 
Ultra-Violet 
Angstfom Units 
4000 
3907 
3821 
3752 
3663 
3650 
3544 
3391 
Average limit of visible violet 
Limit of Canada balsam transmission.. 
3342 
3126 
3022 
Limit of usual glass transparency 
Limit of cobalt glass transparency 
2967 
2925 
2894 
Extreme limit of sunlight ultra violet. . 
So that, obviously, the bands responsible for the actinic 
influence of ultra-violet in the treatment of constitutional 
states (tuberculosis, rickets and kindred aberrancies that 
will be discussed) are included between the limits of 
glass transparency and the sun’s shortest ultra-violet 
wave lengths, or: 
3022 
2967 
2925 
2894 
Observe particularly that the sun s ultra-violet spectrum 
ends at the region ithere skin absorption of ultra-violet ends! 
The problem of the treatment of surgical and medical 
tuberculosis through the use of ultra-violet therefore 
resolves itself into: 
1. Duplication of sun’s spectrum 
2. Fractional treatment 
3. Proper adjuvant measures Therapy 
79 
Tests point out that the spectral region indicated is 
at its clinical best when the air-cooled lamp operates at 
70 volts; but that at this voltage there aie present also 
certain wave lengths shorter than 2894 Angstrom units 
that may reverse the biophotophysical effect of the longer 
rays. These, however, are practically nullified by increas- 
ing the distance which separates the tube from the skin 
to 40 inches. Hence, the most efficient results are to be 
expected with: 
1. Air-cooled lamp 
2. 70 volts 
3. 40-inch tube-skin distance 
4. Tangential (right angle) irradiation 
5. Fractional irradiation 
On this basis, the chart on following page is con- 
structed, which serves as the method for treating every 
form of surgical or medical tuberculosis. 
First day: The patient, with eyes protected from the 
rays (colored glasses or towel) is rested upon a table or 
couch. The feet are exposed anteriorly for one minute 
under the air-cooled lamp; then for one minute poster- 
iorly. 
Second day: The patient is covered over the head, 
chest, abdomen and knees, and exposed to the lamp for 
one minute from the knees to the feet; the sheet is then 
drawn down to the ankles and the exposure continued 
another minute over the feet. The same technic is 
pursued with the patient turned over so as to expose 
posteriorly over corresponding fractions. 
Third day: The covering comes only to the level of 
the acetabula. Expose from here to the feet, anteriorly, 
one minute. Draw sheet to knees and expose one minute 80 
Ultra-Violet 
VICTOR RIR COOLED QURRTZ. LRMP. TRHCfEHTJRL ILLUMINRTlON; 
TUBE-5K.IH DISTRNCE, RBOUT 40 INCHES; INTENSITY,LOW (RBOUT 70V0LT5) 
&BCK RNO FRONT TRERTEP RT ERCR SESSION USING IDENTICRL PROGRESSION 
RFTER THE F1FTHEENTH PRY COMPLETE \RRRDlRTlON 
OVER THE FRONT RHP BRCK FROM HECK TO FOOT 
£ HOUR RT ERCH TRERTMENT EVER/ THlRP PRY 
VST I2.ND |3RP |<VTh|5Th|6TH TTH I 8Th I9TH IOTH lllTH h2TH| f5Tn|l4TH| ISTH 
PflV PRY PHY OPV PfiV OBV PRY PAY PRY PRY PRY PHY PRY PftY DRY 
\ E345&7&9 10II 
l 234 S&7&SI0U \Z 
\ 2 3 4 5 6 7 6 S »0 l\ 12. 13 
» 2 3 4 5 fe 7 8 9 10 \\ 12 13 14 
l 2 3 4 5 6 7 6 9 10 tl IE 13 14 15 Th erapy 
81 
longer. Draw sheet to ankles and expose one minute 
more. Turn the patient over and repeat the exposures 
posteriorly in the same manner. 
Fourth day: Cover only to a level opposite free borders 
of the ribs, anteriorly. Expose one minute. Draw sheet 
to acetabula and expose one minute more. Draw sheet 
to knees, expose one minute longer. Draw sheet to 
ankles, expose another minute. Repeat over correspond- 
ing posterior regions. 
Fifth day: Cover only the head. Expose the entire 
anterior body that remains uncovered, one minute. Draw 
sheet to free borders of ribs and expose another minute. 
Draw sheet to acetabula, expose one minute more. Draw 
sheet to knees and continue exposure for another minute. 
Draw sheet to ankles and ray another minute. Repeat 
posteriorly. 
These instructions are sufficient to explain the intent 
of the chart presented. It is advisable to prepare a chart 
such as the illustration shows, omitting the numerals 
in the squares. Leave a space to enter the name 
of the patient, and as each treatment is given fill in the 
date and the exposure time over each fraction treated. 
This gives an excellent permanent record of the therapy 
and serves as a reminder of the part and exposure time 
due at each treatment. 
While this method is somewhat complicated, it fur- 
nishes desirable clinical results, especially in those 
patients who are not at all robust. Although there seems 
to be no accountable reason, the favorable progress of 
the cure appears proportional to the intensity of pigmen- 
tation produced; many patients showing no discernible 
improvement until the tanning begins. 82 
Ultra-Violet 
Under this form of treatment, and providing further 
that the patient is instructed as to diet, hygiene, rest 
and the usual surgical measures that form an inherent 
part of established practice whether ultra-violet energy 
is or is not used, the various tuberculopathies respond 
well. 
Objectively and subjectively there is elicited: 
1. Practically an immediate reconstruction of mental 
assurance, manifesting in the patient by an appear- 
ance of good cheer and relivened vitality. 
2. Rapid alleviation of pain which, as a rule, com- 
pletely disappears. 
3. Reduction of temperatures above normal. 
4. The anorexia is dispelled; the appetite gradually 
returns. 
5. Weight and strength increase. 
6. The hemoglobin, red cell count and color index all 
increase to an approximate normal. The white 
cells rearrange their Arneth distribution and soon 
show a tendency toward preponderance of the 
lymphocytes. 
7. In cases of joint tuberculosis not too greatly 
advanced, the motion is gradually restored, par- 
tially or completely (compare this to the ankylosis 
usually expected in treating alone with casts or 
operative measures; whereas in surgery the aim is 
to ankylose, in actinotherapy the ideal is restor- 
ation of physiologic joint function). 
8. Radiolucent bone structures, as revealed by the 
X-ray, become normally radiopaque through the 
deposit of calcium and phosphorus. Sequestra tend 
to become spontaneously expelled. T h e r a p y 
83 
9. Lymph nodes in the region of the pathology grad- 
ually shrink; or, if they are broken down, quite 
often resorb or calcify. 
10. Effusions, in peritonitis and pleurisy, are partially 
or completely absorbed. 
11. Abscesses are absorbed; or they may even calcify. 
Occasionally they must be aspirated repeatedly. 
12. Sinuses react at first by an increasingly profuse 
discharge and sloughing. This is followed by the 
appearance of healthy granulations and the desic- 
cation (drying up) and ultimate healing of the tract. 
In actinotherapy, as in heliotherapy, a prerequisite is 
proper orthopedic fixation of the part undergoing treat- 
ment. What Lo Grasso says in connection with helio- 
therapy in tuberculosis applies with equal pertinency 
in actinotherapy, and is, therefore, reproduced here from 
the original: “The discarding of all casts in heliotherapy 
has led many to believe that immobilization is dispensed 
with in sun-cure. As I have brought out in previous 
articles, immobilization is one of the requisites in solar 
radiation. I cannot emphasize it too strongly that the 
Rollier method of heliotherapy is not mere insolation, 
but a combination of the sun treatment along with a 
specially devised method of fixation by rest in bed, by 
traction and by positions arranged with hard pillows— 
a combination which increases the resisting power of 
the patient, preserves or restores the natural function 
of the joint and prevents or corrects deformity. 
“A bed with a surgical spring is employed in Pott’s 
disease and in bone and joint tuberculosis of the lower 
extremities. 
“In children, immobilization is accomplished by means 
of straps made of webbing placed around the chest and 84 
Ultra-Violet 
legs and fastened to the side of the spring. Adults as a 
rule do not need any artificial immobilization. Traction 
is effected by leather cuffs that grip the thigh above the 
knee and the leg above the ankle. These are connected 
by straps that buckle at the side so that the pull will 
be at both the knee and the ankle and may be increased 
or decreased at will at either joint by shortening or 
lengthening the side straps. In case of tuberculosis of 
the knee the leather brace above the knee is discarded. 
“In Pott’s disease immobilization is accomplished in 
children as stated above while with adults we use absolute 
rest in bed. A hard pillow is placed under the kyphos 
and, when the patient is turned on his stomach, a tri- 
angular pillow with the base up is inserted under his 
chest, thus producing a compensating lordosis in both 
positions. In this way the deformity, unless very severe 
and ankylosed, is gradually reduced without interfering 
with complete insolation of the body. 
“In tuberculosis of the hip, if there is a flexion deformity, 
the flexion is gradually reduced by traction, pulling in 
the direction of the deformity. The limb is supported 
on an incline of wood or hard pillows the angle of which 
is gradually reduced until the limb is in line with the 
body. When the patient is turned on his stomach the 
traction is removed and the incline is then placed in the 
opposite direction. Abduction, adduction and rotation 
are corrected by means of a side working extension that 
grips the leather cuff above the knee and fastens on a 
roller that runs along the side of the bed. After the 
flexion deformity, if present, has been reduced, the hips 
are placed in hyperextension by placing a small, hard 
pillow under the hips. 
“In tuberculosis of the knee, immobilization is effected 
as in the case of spine and hip. Deformity is corrected T h e r a p y 
85 
by traction as in this disease. Whereas in hip the traction 
pulls from above both the knee and ankle, in the case 
of the knee the pull is only from above the ankle. Sub- 
laxation of the tibia is prevented by placing a pad 
underneath the head of the tibia and corrected by placing 
the leg on a splint suspended with rubber bands. After 
the knee is straightened the whole limb is placed on an 
incline made of board or pillows to avoid equinus. 
“In tuberculosis of the foot and ankle the limb must 
be placed, as in the case of knee tuberculosis, in an 
inclined plane to obviate equinus, which is sure to take 
place unless special precaution is taken. A splint may 
be used with a joint at-ankle so that the foot may be 
kept, or brought, to its normal angle. 
“In tuberculosis of the shoulder joint, no special immo- 
bilization or traction is used unless there is considerable 
displacement, in which case weights are hung from a 
leather cuff fastened just above the elbow. The weight 
of the arm itself, which acts as a natural tractor, is 
usually sufficient in these cases. 
“In tuberculosis of the elbow, the joint is immobilized 
in half flexion by means of a wire or celluloid splint open 
in front. It is jointed at elbow and includes hand at 
slight radial flexion. 
“In tuberculosis of the wrist and joints of the hand 
we use a similar splint, except that the arm is not 
included. 
“In tuberculosis of all joints except the spine, after the 
flexion deformity has been reduced, we repeatedly flex 
and extend the joint by degrees so slight as not to pro- 
duce spasm or pain. 
“In peritonitis we keep the patient in bed until all 
sinuses have been healed and there is no more evidence 
of fluid present. 86 
Ultra-Violet 
“In tuberculosis of the genito-urinary tract, if there is 
a marked cystitis we insist upon absolute rest in bed. 
“In tuberculosis of the lymph nodes no bed treatment 
is required outside of the three or four hours of the sun 
treatment, unless it is indicated by poor physical condi- 
tion. 
“The same may be said in cases of tuberculosis of the 
eye, rib, face and upper extremities. 
“Sinuses and ulcers are covered with a screen during 
insolation to protect from flies and to allow the sun 
access to the part. They are cleaned with alcohol and 
dressed with a gauze moistened with same. 
“The only surgical interference that we have used is 
aspiration. Occasionally when the pus has been very 
thick, I have resorted to the use of a very narrow-bladed 
knife. A healthy part of the skin is always chosen for 
the aspiration or incision to avoid the possibility of a 
sinus. After the aspiration or evacuation of the pus, a 
slight pressure with a piece of gauze is applied to prevent 
bleeding into the abscess cavity. 
“Dr. Rollier, outside of aspiration, condemns any and 
all surgical interference. We believe that there are times 
when surgery is advisable, but even then it should be 
judiciously combined with heliotherapy. The operation 
should be delayed until the sun has had a chance to do 
its work not only on the affected part but on the general 
condition of the patient, thus assuring a more favorable 
result. We have seen many instances in which a few 
months of sun-cure have changed the whole aspect of 
cases which at first had appeared hopeless.” 
Gassul has summarized his experience in the treatment 
of tuberculopathy by the use of various radiations (sun’s 
rays, X-rays, ultra-violet rays, radium rays) in a mono- T h e r a p y 
87 
graph entitled “Die Bedeutung der verschiedenartigen 
Strahlen fur die Diagnose und Behandlung der Tuber- 
kulose.” Among the important messages conveyed by 
this thesis is the finding, conjointly arrived at by Levy 
and Gassul, that the irradiation of the entire body of 
animals under quartz light (mercury vapor lamp) leads 
to a visceral congestion of the dominant internal organs— 
the lungs, spleen, kidneys, liver; and, as Janet Clark 
says, it may well be that the empiric finding of Rollier, 
that fractional treatment must be used, finds a basis in 
the laboratory experiments of Levy and Gassul. This 
coincides, also, with the experience that in pulmonary 
tuberculosis, general body radiation is followed often- 
times by severe hemorrhage; the patients not doing at 
all well as compared to the results that accompany the 
more approved method of fractional actinotherapy. 
Gassul, in a graphic table, shows that actinic energy 
is fraught with best results in the treatment of glandular 
tuberculosis. The order in which tuberculopathies 
respond are given as: 
1. Glands 
2. Joint 
3. Pulmonary 
4. Laryngeal 
5. Skin and mucous membranes 
6. Peritoneal 
7. Urogenital 
In this country, the general experience in the benefit 
that accrues from the use of actinotherapy in close 
accord with LoGrasso’s findings with heliotherapy, ab6ut 
as follows: 
“Historically, the J. N. Adams Memorial Hospital 
has shown a significant and increasing practice in helio- 
therapy since the inauguration of that work in 1913. 88 
Ultra-Violet 
From the brilliancy of the results obtained the writer 
suggests that the medical profession generally devote 
closer study to the therapeutic possibilities of helio- 
therapeutic measures. 
“Rigorous attention to established details of technic 
are imperative for best results. Various indications, 
contraindications and supporting adjuvant measures are 
recorded. It appears that the prognosis is favorable in 
proportion as the patient becomes pigmented. Pain is 
promptly dispelled. Temperature becomes normal. 
Appetite returns. Weight and strength improve, as 
does also the condition of the blood.” 
Here is presented a statistical table showing the 
results obtained in the treatment of surgical tuberculosis 
from 1913 to 1922 in many cases. Abridged, the findings 
are: 
T. Be. 
Site of Infection 
Cases 
Observed 
Recoveries 
Reported 
Eye 
15 
93.7% 
Glands 
244 
83.0% 
Peritoneum 
63 
81.8% 
Wrist and hand 
15 
78.0% 
Ankle and foot 
13 
72.2% 
Epididymitis 
6 
66.6% 
Hip 
35 
60.4% 
Elbow 
4 
57.1% 
Osteomyelitis 
8 
50.0% 
Knee 
13 
46.0% 
Spine 
16 
32.0% 
Kidney 
4 
16.4% 
The original table is more complete and includes also 
an expression of the percentages of arrested and improved 
cases, besides the failures. LoGrasso says also that helio- 
therapy is equally as useful in conditions other than Th e r ap y 
89 
surgical tuberculosis; puerperal sepsis, anemia, rickets, 
osteomyelitis, non-healing wounds and convalescence 
from all wasting and infectious diseases; and, says the 
author, “the established prophylactic qualities of the rays 
are more marked even than the remarkable therapeutic 
properties. ” Chapter VII 
GENERAL OR SYSTEMIC ACTINOTHERAPY 
BHEN a nude body is thrust quickly and 
entirely into the powerfully chemical radi- 
ation of the biologic air-cooled lamp, certain 
_____ immediate physiological readjustments are 
effected in response to the unusual qualities of the 
strange environmental energy. This physiological response 
is an expression of the bodily forces to become adapted 
to the stimulus of the light. It is, therefore, photoadapta- 
tion. Practicallyeveryphysiologicmechanism is attacked, 
depending upon the state of the mechanism at the time 
of environmental change. And it is singular and impor- 
tant that the induced physiological changes are wrought 
as the result of an absorption of the ultra-violet by 
the skin. 
If we refer to the absorption characteristics of each 
band in the mercury arc spectrum, we arrive at the 
generalization that, beginning with the limit of visible 
violet (about 4000 Angstrom units), the depth to which 
each band of smaller wave length enters human tissue 
becomes less and less as the wave length decreases. No 
exact figures are possible owing to the extremely great 
variety of tissues and conditions that modify the absorp- 
tion; but we are definitely informed that in the ultra- 
violet spectral region of 2900 Angstrom units, the ability 
of the rays to penetrate is lost; so that from 2900 to 
1850 units, the latter being the limit of quartz trans- 
mission, ultra-violet wave lengths are stopped at the 
90 Therapy 
91 
immediate surface of the tissue which they strike.* 
Hence the basic distinction between air-cooled and water- 
cooled lamps already presented, as follows: 
Ultra-violet Radiation 
(Mercury Arc in Quartz) 
Air Cooled Water Cooled 
1. Near ultra-violet intensity Far ultra-violet intensity 
2. Biologic (dominantly) Abiotic** (dominantly) 
3. Chemically oxidizing Chemically reducing 
4. Relatively penetrating Relatively superficial 
5. Metabolic synergist Metabolic depressor 
The better completely to understand the newer concept 
of ultra-violet therapy which is herein submitted, and 
since this newer concept is evolved on the basis of cellular 
physiology and ultra-violet absorption, there is repro- 
duced in full an article on microscopy with ultra-violet 
light, from Nature (London), Nov. 18, 1920: 
MICROSCOPY WITH ULTRA-VIOLET LIGHTf 
Increased Resolution Obtained by Using the 
Short Wave Light Beyond the Visible Spectrum 
By J. E. Barnard 
The microscope is now so widely used in all branches of science 
and in industry that it is not surprising to find an increasing demand 
for greater optical efficiency. It must be admitted that in compar- 
*The detailed studies of ultra-violet absorption are recorded in the 
Journal of Radiology, for September, 1922, and subsequent issues. 
**Bactericidal. 
tAn expression of appreciation is extended to Prof. Wm. Bayliss, 
London, who so courteously directed the writer’s attention to the 
brilliant researches of Barnard in this field of endeavor. 92 
Ultra-Violet 
atively few cases is the instrument used under such conditions as to 
secure the best possible result; but this is due to lack of appreciation 
of the principles involved, and it will be remedied only by a wide 
educational effort. Even when the greatest optical efficiency is 
secured the limitations are soon felt. The chief need is for increased 
resolution, that factor on which the delineation of minute structure 
depends. Advances of great value have been made in methods of 
rendering visible minute objects, but it must be clearly realized that, 
while this greater visibility can be secured, no information as to the 
form or structure of objects which are below the resolution limits is 
to be obtained by this means. Increased magnification is by some 
workers still regarded as desirable, but unless this is accompanied by 
proportionally increased resolution, the results are worse than use- 
less, and can lead only to serious errors of interpretation. Two 
factors mainly govern resolution—namely, the numerical aperture 
of the objective, and the mean wave length of the illuminant. No 
increase of numerical aperture has been obtained since the classic 
researches of Abbe, resulting in the production of apochromatic ob- 
jectives; and in the present state of knowledge there appears little 
likelihood of any substantial advance in this direction. By using 
light of short wave length, a promising field of research is at once 
opened up. An increase of resolution is obtained even with visible 
light if the violet or blue end of the spectrum is utilized, but the in- 
crease is much more definite if ultra-violet light is used, although the 
image is no longer a visual one. 
The computation of microscopic objectives for use with ultra- 
violet light presents considerable difficulties, as only two substances 
sufficiently transparent to these radiations are available—quartz and 
fluorite. So long ago as 1860, Spencer, in America, used fluorite for 
this purpose, and at a much later date Boys in this country suggested 
the possibility of using fused quartz. In 1904, Kohler, of Jena, suc- 
ceeded in computing objectives entirely of fused quartz, some earlier 
ones which were fluorite-quartz combinations being thereby super- 
seded. Ultra-violet light, therefore, became available for microscopic 
work, but the practical difficulties in the use of the apparatus are so 
considerable, calling for almost more knowledge of physical than of 
microscopical methods, that it has been used by few. 
The results obtained, particularly in biological work, are in many 
cases of great interest, as, in addition to the advantages already 
indicated, there is the further important point that organisms are Therapy 
93 
dealt with and photographs obtained of them in the living state. 
The classic researches of Hartley showed that organic substances 
which are perfectly transparent to ordinary light have very definite 
absorption regions or bands in the ultra-violet, and that their absorp- 
tion is, in many instances, so characteristic that it constitutes an 
accurate method of identification. To a considerable extent, this 
fact is of value when using ultra-violet in microscopy. Objects 
that show little or no structure by transmitted light are seen to be 
highly organized when examined by ultra-violet radiations, and the 
structure seen is in part dependent on the wave length of the light 
used. Objects for examination by this method must be dealt with 
in the living state, or at least in such a manner that no change takes 
place in their constitution. It follows that none of the ordinary 
methods of mounting such things as micro-organisms, in which stain- 
ing, hardening, fixing, drying, or heating is resorted to, can be em- 
ployed. The method is, in fact, its own staining process, differen- 
tiation of structure depending on the difference of absorption in 
ultra-violet, and not on complex staining processes, which are in some 
cases causing appearances not associated with the organism itself. 
Further, apart from the alteration that may take place in the tissues 
themselves as the result of such processes, their employment in the 
method under consideration would render them opaque to the radia- 
tions used, and, therefore, useless for the purpose. The organisms 
or tissues are simply mounted in any suitable fluid, such as water, 
normal saline, Ringer’s solution, etc., which is transparent to ultra- 
violet light and the photograph is taken at once. The result is an 
image that, whether it shows more or less than a stained preparation, 
is a representation of the object in the living state, and with greater 
resolution than can be obtained in the microscope by any other 
process. 
Such a method is obviously one to be tried to its utmost, whatever 
practical difficulties may be involved, and there is little doubt that 
in time it will be recognized as what it really is—the only great ad- 
vance in microscopic technic for a generation. The apparatus as 
used by the present writer is in its essentials the same as that devised 
by Dr. Kohler (Fig. 1), although in many points of detail improve- 
ments have been devised. 94 
Ultra-Violet 
FIG. 1. APPARATUS FOR TAKING PHOTOMICROGRAPHS 
WITH ULTRA-VIOLET LIGHT 
A, spark gap; B, quartz condensing lens; C, quartz prisms; D, box containing 
reflecting quartz prism; E, fluorescent ocular. The position of the other parts described 
will be evident to any microscopist. 
The quartz objectives are three in number, their equivalent 
focal lengths being 6 mm., 2.5 mm., and 1.7 mm., their effective 
numerical aperture being respectively 2.50, 1.7, and 0.7. It will at 
once be appreciated that in cases where the full aperture can be 
utilized the two higher powers are of much greater N. A. when used 
with light of 275 uu wave length than any objective available for use 
with ordinary light. These two are glycerine immersion combina- 
tions, the refractive index of the immersion fluid being 1.447. As 
these systems are not homogeneous, the cover glasses are optically 
worked fused quartz of uniform thickness. T h e r a p y 
95 
FIGS. 2 AND 3. SACCHAROMYCES PASTORIANUS (YEAST) 
X1200 
Left dark ground illumination; right ultra-violet light 
FIGS. 4 AND 5. BACILLUS ANTHRACIS 
Xiooo 
Left, dark ground illumination; right, ultra-violet light 
The slides are also of fused quartz, fitted into a carrier of a special 
type, which ensures that the surface of the slide is a constant dis- 
tance from the objective, a point that in practice is of considerable 
importance. The quartz oculars are five in number and range from 
an initial magnification of 5 to 20, giving camera magnifications of 
from 200 to 3600 diameters. The latter is a good deal too high for 
satisfactory results with most objects—in fact, it is doubtful, on 
theoretical grounds, whether such a magnification is justified. The 
quartz substage condenser is made with a duplex top, so that a com- 96 
Ultra-Violet 
bination is available for each objective to ensure that a suitable cone 
of illumination is used in each case. This is used as a glycerine im- 
mersion system with the two high-power objectives, and as a dry 
system with the lowest one. 
The source of light is prothiced by a high-tension discharge ih 
air between metal electrodes, usually cadmium or magnesium, 
although other metals may be used if they produce a suitable line 
spectrum. There are obvious limitations in this respect, as the char- 
acter of the spectrum emitted must be such that the principal lines 
in the ultra-violet region are sufficiently separated and of consider- 
able intrinsic brilliancy. The spectrum of iron, for instance, is ex- 
cluded, as, although it is rich in bright lines, these are so numerous 
and therefore so close together that the isolation of one line is impos- 
sible under the conditions realized in this method. 
The spark is produced by means of an induction coil of special 
design giving a heavy discharge of relatively low potential, the 
equivalent spark gap being about 5 cm. This is further reduced by 
placing a condenser immersed in oil in parallel with the spark gap. 
The interrupter may be either an electrolytic one or a mercury- 
break, the latter appearing to be more satisfactory. Special arrange- 
ments are made for accurately adjusting both the length of the spark 
and its position in relation to the optic axis of the microscope. The 
image of the spark is projected by means of a quartz lens, so that, 
after passing through a pair of quartz prisms of opposite rotation, 
an image of the spark in one wave length is obtained approximately 
at the position of the iris diaphragm below the substage condenser. 
To facilitate adjustment, a disk of uranium glass is placed at the 
latter position so that an image of the spark can be observed and 
focused as required, after which the uranium glass in its carrier is 
swung aside. The direction of the illuminating beam is at right 
angles to the optic axis of the microscope; it has, therefore, to be 
reflected by a right-angled quartz prism along the axis in the same 
way that the mirror operates in an ordinary microscope. 
The preparation being placed on the stage, the light adjusted, 
and the condenser accurately focused on the object, the actual 
focusing of the image has to be carried out. This is effected by means 
of a fluorescent searcher eye-piece which is mounted above the quartz 
ocular and by the use of which an image is seen on a fluorescent 
screen and focused by means of an auxiliary magnifier. This oper- 
ation is one of considerable difficulty, and only after long practice Therapy 
97 
can success be assured. Its difficulty varies, too, according to the 
wave length used; in some cases the fluorescent image is bright, but 
in others it is much more difficult to see. Some objects themselves 
fluoresce, with a result that a sharp visual image cannot be obtained. 
The method now largely adopted by the writer is to observe the object 
by monochromatic light as emitted by a quartz mercury vapor lamp. 
This illuminant has bright lines in the violet, blue, green, and orange 
regions, and by means of screens any one of these can be transmitted. 
- The image having been focused visually in one of these lines, 
the fine adjustment of the microscope is moved by a predetermined 
amount so that the image is in focus for any desired wave length in 
the ultra-violet. This method is quite practicable provided that the 
fine adjustment of the microscope is of sufficient accuracy (the search- 
er eye-piece is not used in this case except to confirm the accuracy 
of the process). The focusing having been performed, the searcher 
eye-piece is removed, the camera placed in position, and the exposure 
made. The image is projected for a certain distance, so that it is in 
focus at the plane of the plate with a known length of camera. The 
exposures required are as short as two seconds under favorable con- 
ditions, even at high magnifications. 
There was considerable difficulty in obtaining a suitable photo- 
graphic plate, as one was required of fine grain and with the smallest 
possible quantity of gelatine on its surface. Gelatine is itself opaque 
to ultra-violet light, so that the photographic action is confined to 
the surface of the gelatine, little or no penetration in depth taking 
place as with ordinary light. The result is that plates must be pre- 
pared with the smallest possible quantity of gelatine, but with the 
maximum quantity of sensitive silver salts that the gelatine can hold 
together. Such a plate has been prepared by the Kodak Co., and 
has proved satisfactory. Plates as prepared by Schumann for work 
in the far ultra-violet have also been experimented with, but for vari- 
ous reasons have not proved so satisfactory. The resulting negatives 
are at first glance somewhat disappointing if judged by ordinary 
photographic standards. They are always thin and lacking in violent 
contrasts, owing to the superficial action of the light, but the detail 
and fineness of lines due to the shorter wave lengths used are evident 
to anyone having any knowledge of photomicrography. Whether 
the utmost resolution that theory demands can be achieved is at 
present unproved because of the difficulty of finding an object that 
can be regarded as a satisfactory test. 98 
Ultra-Violet 
The accompanying illustrations give some idea of the compara- 
tive results obtained with living organisms. Figs. 2 and 4 are illum- 
inated by a concentric dark-ground illuminator, the most satisfactory 
method available for observing living organisms by ordinary light, 
and Figs. 3 and 5 by a solid cone of ultra-violet light. 
What we learn from this and similar studies by the 
same student (Barnard) is summarized by Bayliss 
(“Principles of General Physiology”) about as follows: 
The wave lengths able to reach deeply into the cell 
(near ultra-violet) attack preferably the nucleus or 
chromaffin structure. This is instantly revealed by 
ultra-violet microscopy; for under this type of special 
examination, it is seen that the nucleus so promptly 
absorbs the wave lengths as to appear dark (as if stained). 
In other words, long or near ultra-violet wave lengths 
are selectively sought by nuclear or chromaffin structures; 
so that the physiologic activities of the nucleus of rayed 
surfaces may be 
1. Stimulated 
2. Increased 
3. Exaggerated 
depending upon whether we use biologic ultra-violet 
wave lengths (air-cooled lamp) in 
Stimulative erythema 
Regenerative erythema 
Desquamative erythema 
doses. 
Functionally, the nucleus is the essential element of 
the cell. A nucleus isolated from its cytoplasm (cell 
body) may build or develop a new cytoplasm; but a 
cytoplasm deprived of its nucleus soon disintegrates and 
expires. Obviously the nucleus has to do with regener- 
ation of the cell. Therapy 
99 
Osterbaut (Science, 1917; 46; 367) suggested, as have 
others, that the nucleus controls processes of oxidation. 
Speaking generally, then, the systemic irradiation of 
the entire body, back and front, or as much of the entire 
body as propriety and conditions will permit, is indicated 
most in cases where 
1. The action is desired to precipitate 
immediate results. 
Calcium and Phosphorus Metabolism 
Among the proved effects of general irradiation under 
ultra-violet is the increase in the blood of calcium and 
phosphorus. 
In a general way, the calcium and phosphorus metab- 
olism becomes stable at about twenty-six years of age; 
when all the epiphyses have united and there is no longer 
any bodily requirement for excess calcium and phos- 
phorus in the blood (see especially the studies of Tisdall). 
It happens, also, that the initiation of whatever pathology 
that attacks the mineral metabolism of bone, induces 
an immediate rise in the blood of calcium and phosphorus. 
Cases of fracture, for example, are attended by a rise in 
the calcium and phosphorus of the blood throughout the 
healing stages of the reunion. 
Diseases or conditions showing a deficiency of calcium 
or phosphorus are, therefore, amenable or much aided 
by ultra-violet therapy. This includes: 
1. Anaphylactic reactions 
2. Tetany 
3. Cancer 
4. Rickets 
5. Diseases of bone 
6. Fractures 100 
Ultra-Violet 
Anaphylactic Reactions 
Calcium salts reduce anaphylactic reactions (see Kastle, 
Healy and Buckner, Jour. Infec. Dis., 1913; 12; 127), 
and it is clinically noticeable that systemic irradiations 
with ultra-violet produce sufficient calcium fixation as 
to be accompanied by a marked recovery from the 
allergy. 
Hay fever and its various modifications; asthma; 
eczema (and other diseases of the skin); angio-neurotic 
edema and certain gastrointestinal disturbances show 
themselves to be, in a considerable number of cases, 
hypersusceptible to proteins of various origins. These 
may be quite accurately ascertained through the use of 
skin tests. 
TECHNIC OF CUTANEOUS TESTS* 
If the antigenic proteins are already in solution, as is the case 
with blood serum, no especial treatment is required other than suit- 
able dilution under strictly aseptic precautions. If the protein is in 
solid form, as in the case of vegetable proteins and other cellular 
forms, extracts are required. The studies of Walker and of Wode- 
house on the preparation of materials for the tests have been of the 
utmost importance. These are independent of the preparation of the 
various tuberculins, which will be discussed subsequently. They 
found that an excellent dried preparation of serum could be obtained 
by precipitating with several volumes of acetone, washing the pre- 
cipitate centrifugally twice with alcohol and with ether, and drying 
to a powder. The powder may be applied to an incision in the skin 
and dissolved with N/10 NaOH solution. Bacteria are cultivated 
on solid media, washed centrifugally in salt solution, then twice in 
absolute alcohol with 0.5 per cent phenol added, twice in ether and 
then dried to a powder, which may be used as is the serum powder. 
Cereals, nuts and other seeds, roots and tubers, fruits, leaves and 
stems are extracted in water, precipitated with 95 per cent alcohol, 
washed with 95 per cent alcohol, absolute alcohol, ether, and desic- 
*Verbatim from Karsner and Ecker, “Principles of Immunology.” T h e r a p y 
101 
cated over hydrochloric acid. Hair and dandruff of animals may be 
employed as a dissolved extract in 14 per cent alcohol, but for more 
accurate studies, dried preparations of acid metaprotein, alkali meta- 
protein and peptone extracted from the material are employed. 
The methods of inoculation include introduction of the protein 
into abraded surfaces and intracutaneous injection through a fine 
needle. In special instances, as, for example, in the use of tuberculin, 
the material may be incorporated in an ointment and carefully rubbed 
into the skin; this is the so-called percutaneous test. Somewhat 
similar to the cutaneous tests is the ophthalmo reaction, more par- 
ticularly applied in tuberculin tests, where the material is installed 
into the conjunctival sac. Subcutaneous injection of material is also 
resorted to, again with tuberculin rather than with other substances, 
but the determination of results is by means of the general rather 
than the local reaction. As with other reactions, controls are a nec- 
essary part of these tests. The cutaneous test, by which is meant 
introduction of material into an abrasion, is performed as in smallpox 
vaccination. Any part of the body may be selected, but we have 
found the arm most convenient. Walker advises making small 
incisions in the skin, deep enough to permit absorption, but not deep 
enough to cause bleeding. A small dental burr may be used, as in 
the Schick test. The material is placed on the abrasion or incision and 
allowed to remain one-half hour. If a powder, a solvent should be 
added after the powder is placed on the skin. If not completely 
soluble in water, a weak solution of sodium hydroxide, either 0.1 per 
cent, or N/10 may be employed, as it does not affect the reaction. 
Walker’s studies show that for detecting hypersensitiveness in cases 
of asthma, hay fever, etc., the cutaneous test is more delicate and 
yields fewer false positive reactions than the intracutaneous test. 
Whenever a diagnosis of anaphylactic reaction is made, 
a systemic ultra-violet irradiation is useful in striking 
the allergy from within by increasing the fixation of 
calcium. Method: Give calcium lactate by mouth in 
20-grain doses: Expose the whole back and front of the 
nude individual under the biologic air-cooled lamp, 70 
volts, 40-inch tube-skin distance, and give a stimulative 
erythema daily; or, in severe cases, twice daily, morning 
and evening. Exposure: 102 
Ultra-Violet 
Female 
Male 
Light 
Dark 
Light 
Dark 
Initial 
50 sec. 
1 min. 
1 min. 
1% min. 
2d 
1% min. 
2 “ 
2 “ 
3 “ 
3d 
2% “ 
3 “ 
3 “ 
4% “ 
4th 
3 % “ 
4 “ 
4 “ 
6 
5th 
4% “ 
5 “ 
5 “ 
7% “ 
6th 
5 “ 
6 “ 
6 “ 
9 “ 
7th 
5% “ 
7 “ 
7 “ 
10% « • 
8th 
6% “ 
8 “ 
8 “ 
12 
9th 
7 % “ 
9 “ 
9 “ 
13% “ 
10th 
8% “ 
10 “ 
10 “ 
15 “ 
11th 
9% “ 
11 “ 
11 “ 
16% “ 
12th 
10 
12 “ 
12 “ 
18 “ 
13th 
10% “ 
13 “ 
13 “ 
19% “ 
14th 
11% “ 
14 “ 
14 “ 
21 
15th 
12% “ 
15 “ 
15 “ 
22% “ 
16th 
13% “ 
16 “ 
16 “ 
24 
17th 
14% “ 
17 “ 
17 “ 
25% “ 
18th 
15 “ 
18 “ 
18 “ 
27 
19th 
15% “ 
19 “ 
19 “ 
28% “ 
20th 
16% “ 
20 “ 
20 “ 
30 
The purpose of the calcium lactate is to furnish a sup- 
ply of the element in order that it may be more quickly 
assimilated by the blood. 
Comment: A thorough knowledge of the pathology of 
serum disease will point out the many useful applications 
of this therapeutic measure. One should review especially 
the chapters on hypersusceptibility, and anaphylaxis in: 
Wells, “Chemical Pathology;” Karsnerand Ecker, “Prin- 
ciples of Immunology;” Hiss Zinnser and Russell, “Text 
Book of Bacteriology.” T h e r a p y 
103 
Tetany (Parathyroid) 
Nervous irritability is increased by the administration 
of calcium (as lactate or other therapeutic form); and if 
the use of calcium is accompanied by systemic ultra- 
violet treatments, the fixation of the element is more cer- 
tain and the clinical response more definite and prompt. 
One uses a stimulative erythemic dose over the front and 
back daily, about as follows: 
Tetany Chart 
(For Children) 
Light 
Dark 
Initial 
20 secs. 
30 secs. 
2d 
U 
40 “ 
1 min. 
3d 
u 
1 min. 
IK “ 
2 “ 
u 
IK “ 
IK “ 
2 “ 
u 
2K “ 
3 “ 
u 
7th 
. 
2K “ 
2K “ 
3 “ 
3K “ 
4 “ 
8th 
u 
9th 
u 
4K “ 
5 
10th 
a 
3 K “ 
Cancer 
Cancerous growth is sometimes checked wThen there is 
an increase in the calcium salts (see Goldzieher; Verhaudl. 
Deut. Path. Gesellsch., 1912 (15) 283). Cramer showed 
that isolated cancer cells exposed to calcium salts lose 
their growth capacity when inoculated. The blood, in 
cancer, contains less calcium than normal, which tends to 
result in an osteoporosis of the long bones, discernible 
with the X-ray. 
In addition to the systemic uplift that influences the 
hemoglobin, red cells and color index, the increased cal- 
cium metabolism is an excellent accessory therapeutic 104 
Ultra'- Violet 
adjuvant in the treatment of cancer. Whether operation 
or deep roentgenization is contemplated, the patient 
should be prepared by systemic biologic lamp treatments, 
giving calcium lactate by mouth at th6 same time; and, 
in cases of deep roentgenization, the interim between 
X-ray exposures should be occupied with a course of 
ultra-violet treatments. Stimulative doses, applied daily, 
are indicated. The dose would be about: 
Female 
Male 
Light 
Dark 
Light 
Dark 
Initial 
50 secs. 
1 min. 
1 min. 
1% min. 
2d 
1% min. 
2 “ 
2 “ 
3 
3d 
2% “ 
3 “ 
3 “ 
4% “ 
4th 
3 % “ 
4 “ 
4 “ 
6 
5th 
4% “ 
5 “ 
5 “ 
7% “ 
6th 
5 “ 
6 “ 
6 “ 
9 
7th 
5% “ 
7 “ 
7 “ 
10% “ 
8th 
6% “ 
8 “ 
8 “ 
12 “ 
9th 
7% “ 
9 “ 
9 “ 
13% “ 
10th 
8% “ 
10 « 
10 “ 
15 “ 
11th 
o % “ 
11 “ 
11 “ 
16% “ 
12th 
10 
12 “ 
12 “ 
18 
13th 
io% “ 
13 “ 
13 “ 
19% “ 
14th 
n% “ 
14 “ 
14 “ 
21 
15th 
12% “ 
15 “ 
15 “ 
22% “ 
16th 
13% “ 
16 “ 
16 “ 
24 
17th 
14% “ 
17 “ 
17 “ 
25% “ 
18th 
15 “ 
18 “ 
18 “ 
27 
19th 
15% “ 
19 “ 
19 “ 
28% “ 
20th 
16% “ 
20 “ 
20 “ 
30 
Rickets 
Clinical and laboratory studies on the influence of actin- 
otherapy in the treatment of rickets are already familiar 
to the therapist from the brilliant work at Columbia T h e r a p y 
105 
(Hess), New Haven (Powers), Johns Hopkins (Shipley, 
et al), and Toronto (Tisdall). # These original studies 
should be consulted, from which the following method of 
ultra-violet usage becomes obviously efficient: Knowing 
the actinic region of the sun’s spectrum involved in the 
prevention and cure of rickets, this significant fact must 
be first realized: that the wave lengths of ultra-violet 
radiation concerned are those impervious to glass. The 
ultra-violet spectrum of the sun ends at 2900 Angstrom 
units, or thereabouts. Usual glass panes are transparent 
to 3022 Angstrom units. So that the sun’s benefit in 
rickets lies in the ultra-violet wave lengths included be- 
tween 3022 and 2900 Angstrom units,* or that part of 
the ultra-violet spectrum that has been designated 
“biologic-’ in activity (see Journal of Radiology, Septem- 
ber, 1922 issue, and subsequent issues). Obviously, the 
air-cooled, ultra-violet equipment, as distinguished from 
the water-cooled apparatus, is the instrument of scien- 
tific choice in the solution of the problem. 
In applying the air-cooled, ultra-violet radiation, it is 
desirable so to arrange the necessary factors of radiation 
intensity and spectral formula as to insure a maximum 
energy distribution in the region of the spectrum that 
operates best in rickets. This is accomplished by regulat- 
ing the wattage so that the voltmeter reads 70. At this 
voltage, the region indicated is at its best. The clinical 
elimination of shorter ultra-violet wave lengths is gained 
by adopting a long distance between the tube and the 
skin, which should be 40 inches. 
With this intensity, and at that distance, the time of 
irradiation is next governed by the skin reaction mani- 
*This subject was originally investigated and will appear in medical 
literature at an early time. 106 
Ultra-Violet 
fested by the patient. For obvious reasons, this should 
not be too severe, and should be carried to a point usually 
designated “stimulative erythema.” The factors involved 
include the endocrine type of the patient, the age and 
the sex. Speaking generally, with the air-cooled lamp 
operating at 70 volts, and at 40-inch distance, a stimu- 
lative erythema is obtained in the following intervals of 
time: 
Light Types 
Dark Types 
Infants 
15 seconds 
25 seconds 
Children 
35 
50 
Females 
1 minute 
\}/2 minutes 
Males 
minutes 
2 minutes 
Each subsequent exposure is increased by the same 
amount of time assumed in the original. For instance, 
if the child undergoing the treatment is a dark type 
(brunette), the time for the initial exposure is 50 seconds, 
the second exposure is 100 seconds, the third is 150 sec- 
onds, fourth 200 seconds, etc. A good rule to follow in 
determining the frequency of exposure intervals is that 
generally recommended in all systemic ultra-violet ther- 
apy, as follows: 
Initiate the degree of erythemicreaction sought, in this 
instance stimulative. Observe the erythema develop and 
note especially the beginning of recrudescense. When the 
erythema begins to disappear, it is an expression that the 
biologic phosphorescence induced is becoming exhausted, 
and a second application should be applied. This 
clinical determinant for the frequency of irradiations is 
useful in that it makes the reactivity of the patient the 
guide for the amount of treatment necessary. Usually 
the frequency is daily, or every second day. Ocassion- 
ally, highly susceptible reactions are met that extend the 
intervals to three or more days apart. T h e r a p y 
107 
In hospital practice, the air-cooled quartz lamp may 
be placed over the crib or cot of the youngster. The 
eyes are bandaged to preclude actinic conjunctivitis. The 
infant or child is bared and allowed to remain in the radia- 
tion. If the tube is directly over the center of the crib, 
and the radiation is at right angles to the plane of the 
bed, the time given in the preceding table is used. If 
the circumstances are such as to make it necessary to use 
oblique illumination, an approximate estimate of the 
angle made by the “central ray” and the bed plane is 
determined; and according to this angle, the exposure 
time must be increased.* 
Angle of Central 
Ray with Plane 
of Bed 
Additional Time 
of Radiation 
Required 
90° 
0 
75° 
1/10 
60° 
1/5 
50° 
1/4 
45° 
2/5 
30° 
1/2 
Example: A brunette (dark type)" child is to receive 
bed treatment. The initial radiation should be: 
Air-cooled lamp volts 70 
Tube-skin distance 40 inches 
Time 50 seconds 
At the bed, the angle made by the central ray with 
the plane of the bed is 45 degrees; therefore, the additional 
time required because of this angle is % more than 50, 
70 seconds (50 plus % of 50). 
*This is governed by the Cosine Law, elsewhere explained. 108 
Ultra-Violet 
At the second treatment, the same angle should be used 
beside the same settings for the lamp (70 volts, 40 inch 
tube-skin distance), and the second exposure time is then 
160 seconds (80 plus 80). The third treatment is for 240 
seconds (160 plus 80). When the total time of radiation 
has reached fifteen minutes per treatment, it is no longer 
necessary to increase the time, but simply to increase the 
frequency of treatment. 
Barker conveniently subdivides his consideration of 
diseases of bone into the following headings: 
I The congenital osteopathies 
II The degenerative, the toxic, and 
the endocrinopathic osteopathies 
III The osteopathies of circulatory 
origin 
IV The inflammatory osteopathies 
V The neuropathic osteopathies 
VI The parasitic osteopathies 
VII The neoplastic osteopathies 
In this group, those conditions listed as degenerative, 
toxic or endocrinopathic osteopathies show a deficiency 
in the metabolism of calcium, or phosphorous, or both; 
and in these conditions, the biologic energy derived from 
the air-cooled, mercury-vapor lamp is essentially helpful. 
Diseases of Bone 
Method 
Studies leading to the consideration of the quality of 
the ultra-violet spectrum necessary to effect calcium and 
phosphorous increase in the blood have elsewhere been 
submitted and should soon appear in print. Pambrun 
aptly speaks of spectral quality as “spectral form- 
ula;” and we are now convinced that each type of path- 7 h e r a p y 
109 
ology amenable to ultra-violet therapy requires its spe- 
cific spectral formula to insure maximum efficiency in 
clinical result. 
Calcium and phosphorous is influenced most by* the 
ultra-violet spectral region included between 3022 and 
2600 Angstrom units; a region which is most intense in 
the air-cooled lamp operated under the following char- 
acteristics: 
Voltage across burner 70 
Tube-skin distance 40 inches 
At this voltage, the region discussed is at its best; and 
the tube-skin distance is purposely 40 inches to insure 
that shorter wave lengths, which are antagonistic to 
calcium and phosphorous deposition, are obliterated by 
passing through much air. 
With the above characteristics of lamp operation, the 
nude body, or as much of the body as propriety and 
other conditions will permit to denude, is exposed, at the 
first treatment for: 
Light Types Dark Types 
Infants % minute 134 minutes 
Children 1 minute 134 minutes 
Female adults 134 minutes 2 minutes 
Male adults 2 minutes 3 minutes 
Each day the radiation is increased as follows: 
Infants, children 34 minute 
Female adults 1 minute 
Male adults 1 minute 
Eyes should, of course, be screened against the rays to 
prevent conjunctivitis. The radiations are continued 
daily until the X-ray study of the bone, or the clinical 
observation of the case, indicates maximum recovery. 110 
Ultra-Violet 
Promptness of recovery and degree of benefit derived are 
contingent upon the character and severity of the pristine 
pathology. 
Conditions Treated 
Osteoporosis: When, for any reason, a part is immobi- 
lized, the disuse leads to an atrophy of the bone that 
likewise suffers immobilization. This osteoporosis of 
disuse, as the condition is called, is frequent in fractures 
and in all forms of arthritis. It is quickly revealed under 
X-ray examination and is a factor that militates against 
the prompt calcification and ossification of a fractured 
part. 
So that the better to assist reunion and reossification 
of a fractured bone, and as a preventive against fragility 
that disused bone parts acquire incident to immobiliza- 
tion, the ultra-violet energy serves an excellent purpose. 
In general, such conditions as show, under X-ray exami- 
nation, bone atrophy or osteoporosis, are those in which 
ultra-violet energy, used as described, is helpful. 
Rickets: The characteristic skeletal changes in rickets 
are too well known to require comment; as is, also, the 
brilliant work of Hess, Powers, Shipley, et al who have 
afforded a great contribution in the progress of therapy 
by their unchallengeable studies on the preventive and 
curative effects of the ultra-violet energy in rickets. 
For rickets, as for all conditions in which bone changes 
are present, the method of treatment is systemic, that is, 
general irradiation as discussed under method. 
Achondroplasia: Formerly known as fetal rickets, 
achondroplasis is a disturbance of the skeleton occurring 
during fetal life. Its etiology is unknown. It is char- 
acterized by micromelia (undersized limbs), which comes 
from a premature closure of the long bone epiphyses. Th er apy 
111 
Infants showing achondroplasia, which must be differ- 
entiated from rickets (in which the ossification is delayed 
instead of premature); from thyroaplasia and athyreosis 
(myxedema symptoms); and osteogenesis imperfecta (X- 
ray plates; frequent and multiple fractures); if exposed 
to ultra-violet energy, assume a renewed calcium and 
phosphorous activity that has led, in some cases observed 
clinically, to a general re-establishment of bodily pro- 
portion tending completely to eliminate the micromelic 
deformity. There is an instance somewhere recorded of 
an intra-uterine diagnosis of achondroplastic fetus of 
eight months arrived at through anthropometric X-ray 
examination of the mother. Ultra-violet irradiations of 
the mother two weeks before delivery resulted in an in- 
fant of practically normal limb measure. It is interesting 
to think of the possibility of precluding a “rickety dia- 
thesis” in the child by ultra-violet irradiation of the 
mother. 
Osteogenesis Imperfecta: This, Lobsteins’ disease, is a 
condition in which the bones are found to be exceedingly 
brittle. Fractures follow even trifling injuries. It is a 
dominantly minus calcium-balance entity. It is espe- 
cially amenable to ultra-violet radiation. 
Schabad, says Barker, studied a 7-year old child with 
osteogenesis imperfecta and found a deficient calcium 
retention. In addition, he obtained improvement under 
cod-liver oil therapy. Obviously, in the light of the recent 
studies of Hess, it is clear to understand now why ultra- 
violet is almost a specific therapy in the treatment of 
this obscure bone disease. 
Osteomalacia: Much dispute exists as to whether or 
not osteomalacia is, after all, an aggravated form of rick- 
ets. Clinically, it is well to realize that the condition 112 
Ultra-Violet 
affects women in the reproductive age, usually after they 
have borne children (puerperal osteomalacia); and that 
ultra-violet energy corrects the disorder. It should be 
applied during term, when the calcium needs of the fetus 
challenge the calcium metabolism of the mother, thereby 
insuring a stabilization of the calcium metabolism and 
averting osteomalacia in the mother, rickets and osteo- 
genesis imperfecta in the child. 
X-Ray and Ultra-Violet 
We see at once that the X-ray study of bone leading 
to the inference of deficient calcium function, is a 
definitely certain clinical index for the use of ultra-violet 
energy. Possibly, the various calcium and phosphorus 
dystrophies affecting bones all arise from an aberrancy 
similar or identical to that including rickets; and in the 
ultra-violet energy, from its proved action of increasing 
calcium and phosphorus metabolism and its equalizing 
regulation of normal ossification and calcification, is a 
virtual therapeutic specific for the remedy of pathology 
derived from such causes. 
Fractures 
Recently, Tisdall and Harris point out that in adults 
there is an increase in the phosphorus of the serum fol- 
lowing a bone fracture; and that the union of the frag- 
ments, like the fusion of an epiphysis, invokes a physi- 
ologic demand for phosphorus. This observation they 
supplemented and confirmed by animal experiments 
(with dogs). 
From which basic considerations we may conclude, a 
posteriori, that there is a fundamental law in the physi- 
ology of the economy, as follows: That a physiologic (as T h e r a p y 
113 
in the case oj epiphyses) or pathologic (as in the case of 
fractures) want in the continuity of a hone establishes a 
systemic demand for increased calcium and phosphorus 
necessary to effect complete fusion * Applied immediately 
to the question of the treatment of fractures, it is obvious 
that any factor threatening the ability of the system to 
furnish the necessary increase of calcium and phosphorus, 
makes for that clinical entity called “delayed union;” for 
instance, in the case of luetic infection. 
It is an established surgical practice to administer cer- 
tain drugs in cases showing delayed union of fracture, 
with the view, it was thought, of increasing the general 
well-being of the patient. Probably the most useful 
tonic usually selected for this measure is cod-liver oil; 
and it is significant to know that cod-liver oil raises the 
phosphorus content of the serum—a property which has 
made it beneficial in the therapy of rickets. What it is 
desired to consider at this time has to do with an ingenious 
application by the surgeon of biologic ultra-violet radia- 
tion to insure a maximum serum saturation with phos- 
phorus and calcium, and therewith foster the speediest 
clinical reunion of fracture fragments. 
The use of biologict ultra-violet radiation in such cases 
depends upon the observation that this energy increases 
the calcium and phosphorus content of the blood; and, 
in addition, the radiation is bactericidal, a quality that 
augments its clinical value in the treatment of those open 
fractures where union is hindered through septic inter- 
ference. 
*More complete biophysical research data confirming the definite- 
ness of this physiological law will be furnished in another paper. 
tAir-cooled quartz lamp. 114 
Ultra-Violet 
Since the war, the tendency has grown more and more 
to replace absolute fixation with methods in which the 
fundamental principle is extension of the member in the 
position of zero muscle pull. By zero muscle pull is meant 
the physiologic direction and position of the bone axis 
in a fashion that the muscle tension is so equally dis- 
tributed as to preclude angular deviation of the frag- 
ments. The method is summarized in the formula, “sus- 
pension of the member combined with traction.” The 
limb is suspended in a position of flexion, abduction or 
rotation coinciding as nearly as possible with the position 
of physiological rest for the opposing muscles; that is, 
for the muscles tending to cause deformity. When the 
position of physiological rest is attained, little force is 
required to keep the fragments in place, and it permits 
of better circulation and almost the complete elimination 
of all pain. Next to asepsis, mechanical efficiency of 
traction-fixation is of great importance in the proper 
treatment of fractures. 
Assuming that the surgeon has furnished every me- 
chanical aid to permit the fragments to reunite in their 
correct alignment (for which see blake, “Gun Shot 
Fractures of the Extremity;” and speed, “Fractures 
and Dislocations”), the therapeutic measures that form 
an important part of the treatment are expressed by any 
method that will insure a maximum supply of calcium 
and phosphorus in the blood. 
Distance: In clinical practice, the above desideratum 
is obtained by maintaining a tube-skin distance of 40 
inches. It has been found that this furnishes an ade- 
equately satisfactory air filter which serves completely to 
eliminate the clinical antagonistic effects of shorter ultra- 
violet wave lengths. Therapy 
115 
Time: In ultra-violet therapy, as in X-ray therapy, the 
application time of the radiation is restricted generally 
to the amount of erythemic reaction that ensues. When 
a skin surface is exposed to ultra-violet for a brief time, a 
biologic phosphorescence appears after a latent period. 
The latent period is dependent upon the original intensity 
of the ultra-violet energy; so that when the energy is 
intense the reaction appears promptly, as distinguished 
from the delayed appearance of a reaction induced by 
low intensity. 
After the exposure time is increased, the biologic phos- 
phorescence produced presents various degrees of ery- 
thema; at first and under short periods of irradiation, 
the reddening is pale. More prolonged radiation pro- 
duces an intense reddening approaching almost a scarlet 
coloration; and if the radiation is continued even a longer 
time, the intense scarlet reddening is accompanied by 
small vesicles or blisters. 
Histologically, the various degrees of erythema just 
described correspond with certain important cellular 
activities, from which it is generally accepted that the 
erythemas and cellular histologic changes bear to each 
other the accompanying relations: 
Degree of 
Erythema Designation Histophysiology 
1. Mild Stimulative erythema Stimulation 
2. Moderate Regenerative erythema Regeneration 
3. Intense Desquamative erythema Desquamation 
Since, in the treament of fractures, the effects sought 
with ultra-violet radiation are not focal epidermal ones, 
but rather a systemic uplift that is induced through the 
combined action of the energy acting upon the cellular 
nuclei, the capillary blood and the capillary lymph, the 116 
Ultra-Violet 
total exposure time for each treatment is gauged by that 
amount of time that will produce minimum skin effect 
and maximum biologic uplift. 
Skin reactivity is a complicated phenomenon depend- 
ent upon many factors, but particularly upon the endo- 
crine status of the individual; the region of the radiated 
area; the thickness of the skin and the capillary distribu- 
tion of blood in the area. So that it is impossible to fur- 
nish a simple statement of the exact time required for the 
production of similar degrees of erythemic reaction in 
different individuals of varying sex, age and color. But, 
generally speaking, the time indicated in the accompany- 
ing table represents a good working average for the pro- 
duction of stimulative erythemas when the voltage is 70, 
the distance 40 inches, and the angle of illumination is 
tangential. 
Light Types 
Dark Types 
Infants 
15 seconds 
25 seconds 
Children 
35 seconds 
50 seconds 
Females 
1 minutes 
minutes 
Males 
1% minutes 
2 minutes 
Angle of Central Ray: It will be observed that the 
erythema is produced under the conditions above 
described when the illumination strikes tangentially. By 
tangential is meant that the “central ray” meets the 
plane of the surface irradiated at a right angle. 
In radiation therapy the clinician must be perfectly 
conversant with the concept of the “central ray” or 
“Haupstrahle.” In ultra-violet therapy the central ray 
represents the shortest distance between the burner and 
the plane of the surface irradiated. In arranging the air- 
cooled lamp for irradiation over a large body surface, the 
casing of the instrument should be so placed as to permit Ther apy 
117 
the central ray to strike at right angles to the plane of the 
surface rayed. This is generally obtained when the casing 
is directly over the patient so that the axis of the uviarc 
is parallel to the median axis of the body, and exactly 
superimposed. 
When, for whatever reason, mechanical difficulties arise 
that preclude the position described, and it becomes 
necessary to tilt the casing in a fashion to permit the 
radiation to strike the body so that the central ray is 
other than at right angles, although the distance between 
the tube and the skin is still preserved at 40 inches, an 
increase in the radiation time is required to compensate 
for the loss of intensity incident to the angle made by 
the rays striking at less than 90 degrees. The law govern- 
ing this loss of intensity was first formulated by Lambert 
and bears the name of the Cosine Law. The accompany- 
ing table gives the various angles that may usually be 
used in clinical practice, and the increased time necessary 
for the production of similar degrees of erythema: 
Incident Angle 
Time 
Compensatory 
Increment 
Total 
Time 
90° 
60 sec. 
0 
0 
60 sec. 
75° 
60 “ 
1/10 
6 
66 “ 
60° v 
60 “ 
1/5 
12 
72 “ 
50° 
60 “ 
1/4 
15 
75 “ 
45° 
60 “ 
2/5 
24 
84 “ 
30° 
60 “ 
1/2 
30 
90 “ 
Frequency of Application: There is a cogent rule 
in modern ultra-violet practice that determines the fre- 
quency of application intervals in accordance with the 
expression that "ultra-violet therapy is successful in pro- 
portion as the desired physiologic action through the use 
of the radiation is initiated and maintained." Since 
various individuals present varying degrees of reactivity, 118 
Ultra-Violet 
this reactivity is utilized clinically as an index for deter- 
mining the frequency of applications. In the treatment of 
fractures, systemic ultra-violet radiation is applied over 
the chest and back to the point of stimulative erythema. 
When the skin exhibits the pink reaction sought, maxi- 
mum physiologic activity is in progress. As soon as the 
stimulative erythema is observed to disappear, the bio- 
physical effects of the biologic phosphorescence are spent; 
and it is then time for the application of the second radia- 
tion. In this fashion each patient becomes an individual 
index whereby the clinician may determine the frequency 
of ultra-violet application. In general, it will be found 
that the intermission varies from twenty-four hours to 
three or four days, depending upon the tolerance of the 
case undergoing treatment. 
Laboratory Control: There are a number of factors 
that influence the amount of good that can be obtained 
through ultra-violet radiation; and it is not an infrequent 
experience to find that certain instances arise in which 
the utra-violet therapy, like any other form of therapy, 
produces no obvious good. In the treatment of fractures 
there are few subjective changes in the average case, and 
the clinician must depend upon frequent chemical exami- 
nations of the blood serum for the calcium and phosphorus 
content. In organized clinics and hospital practice, the 
calcium and phosphorus curve of the blood is plotted 
every second day; and ultra-violet therapy is continued 
until the curve assumed by these figures shows there is 
a maximum maintenance of calcium and phosphorus in 
the blood. 
X-ray Control: A method which finds even wider 
acceptance is the frequent radiographing of the fractures. 
With modern methods, using double intensifying screens 
and duplitized films, the exposure time is so brief as to T h e r a p y 
119 
preclude the possibility of retarding the growth or union 
of the fragments through any influence of the X-radiation. 
Roentgenography is preferable to blood chemistry; for it 
shows not only the increasing opacity of the fracture space 
due to mineralization of the callus, but it shows also 
whether immobilization and alignment are being main- 
tained. 
Fracture Complications 
and Transplants 
When a fracture is complicated by septic infection, its 
treatment becomes increasingly difficult. In addition to 
correct immobilization by traction in the position of 
physiological rest and the increase in the phosphorus and 
calcium metabolism by the use of biologic ultra-violet 
radiation, the pathology of the infection must receive 
critical consideration. For this, there is much to approve 
the modern method of irrigating the infected area with 
a solution of photosensitive dye dissolved in physiological 
salt. An appropriate formula is about as follows: 
Gentian violet 1 
Salt 9 
Sterile distilled water 1000 
Following the irrigation, the area is focally rayed with 
the highly bactericidal water-cooled, ultra-violet energy. 
Although the number of cases in which this technic has 
recently been employed is still not very great, every 
report points to the unusual promise of the procedure. 
In the case of transplants, the irradiation of the recip- 
ient bone under biologic energy previous to inserting the 
transplant has in some cases made for such marked 
refreshment of the fragments as to enable the transplant 
to become physiologically accepted in its new location. 120 
Ultra-Violet 
We have just dealt with the principle that actinic 
radiation mobilizes the calcic and phosphoric element of 
the blood; and that when these minerals are wanting, or 
their increase would materially aid to overcome pathol- 
ogy, the administration of the mineral (as calcium lactate, 
or better, calcium phosphate) followed by ultra-violet 
raying of the entire nude body, was accompanied by good 
clinical success. 
Similarly, the fixation of iron may be achieved; which 
makes for usefulness in the treatment of primary and 
secondary anemia. 
Anemia, though originally conveying the meaning of 
lack of blood, has come to be used particularly with refer- 
ence to those conditions in which the number of red cells, 
or the amount of hemoglobin to the unit of blood volume, 
is diminished. Skin palor and anemia are by no means 
interdependent, as the combination of hard work, 
poor food and ill-lighted dwelling produces skin palor, but 
not necessarily anemia. Following the classification that 
Hewlet adopts (Functional Pathology of Internal Dis- 
eases), anemias are conveniently classed as: 
1. Those incident to increased loss of red cells 
(a) As from hemorrhage 
(b) From blood destruction (toxic) 
2. Those incident to diminished formation of 
cells or hemoglobin 
3. Anemias due to increased blood plasma 
Anemia of Hemorrhage 
Unless the emergency is great, the loss in fluid volume 
incident to hemorrhage may be replaced by the injection 
of normal saline in the lower bowel and rectum. Having 
replenished the fluid volume by this means, the increase Therapy 
121 
in the red cells and hemoglobin is determined by the 
assimilation of iron, which is greatly accelerated under 
actinic radiation. The iron is given hyperdomatically, 
preferably with arsenic or strychnine, and the body daily 
exposed front and back to stimulative actinic erythema 
doses. 
Simple Toxic Anemia 
Various poisons hemolyze the red blood cells, and when 
this cellular destruction is slight and prolonged, there 
ensues an anemia unaccompanied by any additional strik- 
ing manifestations, and often overlooked. This may be 
found in lead poisoning; infections; malignant tumors; 
bothriocephalus. The hemolytic destruction can be 
checked, in part, by systemic actinotherapy; but the 
cause should, of course, be sought and removed. 
Chlorosis 
In this peculiar form of anemia, ultra-violet finds an 
especial utility. This condition is a most brilliant exam- 
ple of actinic efficacy and emphasizes the concept of 
mineral fixation. Iron is present in the feces of chlorotic 
girls much before they are placed under any form of 
treatment; so that chlorosis is not a condition of iron 
deficiency, but insufficient iron assimilation. The treat- 
ment of chlorosis resides in whatever measure will insure 
the fixation, or better, the assimilation of iron. It consists 
in furnishing a preponderance of iron, in the form 
of Blaud’s pills, in which each pill contains 2 grains of 
iron sulfate (so called Niemeyer’s formula). During the 
first week of treatment, one pill three times a day is 
sufficient; and each day, a stimulative actinic erythema 
is produced over the back and front of the entire body. 
The actinic erythemas are continued, following the usual 122 
Ultra-Violet 
rule for increasing the dosage; and each week, the pill 
dose is increased so that for the second week, two pills 
are taken three times a day; for the third week, three 
pills, three times a day, etc. A saline purge is given 
every second morning. In severe cases rest in bed is 
imperative. 
Leucocytic Pathology 
It is said (Wagner, “Die Kunstliche Hohensonne”) that 
the leukemias and pseudoleukemias do well with combined 
therapy; roentgenization of the spleen, and ultra-violet 
radiation systemically. There is much to commend the 
combination upon purely theoretic principles; but a 
lack of definite information precludes further mention 
here. Chapter VIII 
INTENSIVE ACTINOTHERAPY 
S DISTINGUISHED from regional, fractional 
or systemic actinotherapy, intensive actin- 
otherapy is characterized by: 
===_====== 1. High voltage 
2. Short tube-skin distance 
3. Short exposure time 
The fundamental object being simply to induce a maxi- 
mum focal reaction in the skin layers with minimum 
systemic changes in the blood and lymph. Intensive 
actinotherapy is, therefore, especially valuable in the focal 
handling of skin diseases. 
The treatment of skin diseases demands a wide medical 
knowledge and attention to many points. General meas- 
ures are of much importance. The state of the circulatory 
system demands attention, especially the integrity of the 
surface circulation. An example is acne. It is futile to 
treat systemically in order to enrich the blood in immu- 
nologic qualities if the surface circulation is so scanty and 
insufficient to saturate the site of the lesions. So that 
one should take precaution to strengthen the surface cir- 
culation, which, in acne cases, is usually anything but 
best. For this, photo-therapy is quite practical and 
efficient; since the heat and visible light issuing from the 
large 1500 watt bulb induces a flushing of the surface 
capillaries that is highly desirable. 
In ultra-violet therapy, a great point is to know when 
to soothe and when to irritate; or, more properly, the 
123 124 
U lira- Violet 
correct selection of the required reaction of actinic ery- 
thema; whether: 
Stimulative 
Regenerative 
Destructive 
Speaking broadly, a heavy reaction in the chronic and 
a light reaction in the acute conditions is the rule. Mild 
and long continued treatment often succeeds in the long 
run, where heroic measures either fail or render matters 
worse. 
Certain general diseases affect the skin, as for instance, 
myxedema, where the skin is thickened and harsh. Rheu- 
matism is associated with rashes, more particularly in 
children. The most common are urticaria, multiform 
exudative erythema and erythema nodosum. Diabetes 
is connected with various erythematous and papular 
eruptions, and often with marked pruritis. It seems 
hardly necessary to point out that actinotherapy w ill fail 
if these quite obvious, though occasionally overlooked 
facts, are not definitely investigated and excluded. 
Ultra-violet energy is valuable in the following con- 
ditions: 
Lupus vulgaris 
Lupus erythematosus 
Naevus flammeus 
Acne vulgaris 
Alopecia areata 
Chronic indolent ulcers 
X-ray and radium burns 
Pruritus cutaneous 
Dermatitis seborrheica 
Pityriasis rosea 
Furunculosis 
Neuralgia following Zoster T h e r a p y 
125 
Lupus Vulgaris 
Atrophic and ulcerative forms yield best. Hypertro- 
phic forms are more successfully handled with X-rays or 
radium. Rather marked erythemic reactions should be 
produced. The exposed part being usually the face, it 
is important that the eyes be protected from the rays. 
They may be kept shut tight, or goggles may be worn. 
The affected part is sponged with hydrogen peroxide, one 
part in ten of water, and exposed to the air-cooled lamp, 
90 volts across the burner, ten-inch tube-skin distance, for: 
Initial treatment 
30 sec. 
2d 
60 “ 
3d 
\y% min. 
4th 
2 
5th 
2K “ 
6th 
3 
7th 
3 M “ 
8th 
4 
9th 
“ 
10th 
5 
11th 
5H “ 
12th 
6 
13th 
“ 
14th 
7 
15th 
' lYi “ 
The local treatments are given every third day; and 
in addition, a systemic treatment should be practiced 
such as was outlined in one of the preceding chapters, 
the better to insure a constitutional uplift. Iron, qui- 
nine, fresh air, good food, hygiene, systemic ultra-violet 
treatments and focal high intensity actinic treatments are 
all required. Allyl sulfide is helpful if applied in glycerine 126 
Ultra-Viol et 
just prior to the focal actinic treatments in place of 
hydrogen peroxide. 
Other tuberculous affections of the skin, including: 
Tuberculosis verrucosus cutis 
Scrofuloderma 
Tuberculosis orificialis 
are similarly treated and offer encouraging results. It 
must be recalled that the various forms of tuberculosis 
cutis, unless they can be treated at an early stage, are 
exceedingly chronic and rebellious skin conditions that 
offer good prognosis as to life, but unfavorable prognosis 
as to cosmetic elegance unless ultra-violet is used. When 
ultra-violet energy is used the results are sometimes 
tedious to attain. 
Dr. George C. Andrews, associated with Dr. George 
Miller MacKee,* tendered a communication in which he 
says “we have frequently treated clinically identical 
lesions separately with X-rays and ultra-violet light to 
determine the most advantageous method of treatment, 
and while we favor X-rays, sometimes ultra-violet energy 
gives superior results.” 
Lupus Erythematosus 
Ultra-violet energy, in few treatments, furnishes quite 
gratifying results if measured in terms of immediate 
betterment. There is, of course, a tendency for the dis- 
ease to recur, which tendency persists regardless of the 
character of the treatment used. 
Actinic rays induce an absorption of the diseased proc- 
ess without scarring; a decided advantage over whatever 
other form of treatment employed. When the affection 
*170 West 59th Street" New York City Th er a p y 
127 
is chronic, ultra-violet generally excels X-ray or radium 
treatment. 
A heavy raying should be sought. Cover the unaffected 
parts with chamois skins, or towels, and expose the 
lesions to the air-cooled lamp, 90 volts, ten-inch tube-skin 
distance for five minutes. A swelling and blistering 
results. This subsides and in a few weeks leaves only a 
slight erythema and very little swelling. The actinic 
treatment is then repeated and continued at intervals of 
about two weeks until the lesions have entirely disap- 
peared, or until no further improvement is obtained. 
During the interval between treatments, any lotion, col- 
ored a skin pink with carmine, makes a useful application 
in that it tends to overcome the unsightliness of the 
lesions and the initial results of the treatment. 
Telangiectases 
Definition: Telangiectases represent dilatations or 
new formations of capillaries as the result of stagnant 
blood in the terminal venous vessels. 
Classification: 
I Congenital 
Primary 
(a) or 
Essential 
1. Punctate 
2. Sinuous 
3. Spider naevi 
4. Macular 
5. Papular 
II Acquired 
Secondary 
(b) or 
Symptomatic 
1. Cutaneous symptoms 
2. Circulatory symptoms 
3. Visceral symptoms 
4. Occupational symptoms 
Congenital Telangiectases: These are best considered 
under the heading of naevi. Port-wine marks and 128 
Ultra-Violet 
similar vascular structural changes are at this time 
being extensively investigated by Fred Wise, especially 
with regard to their treatment through the agent of the 
ultra-violet ray. The subject of naevi is too great to 
include in a discussion of telangiectases. 
Acquired Telangiectases: Convenient description per- 
mits acquired telangiectases to be divided into the 
following groups: 
1. Primary or Essential Telangiectases 
2. Secondary Telangiectases, symp- 
tomatic of some cutaneous disease, or 
internal disorder 
Primary or Essential Telangiectases: These are arbi- 
trarily divided into five classes, depending upon the 
anatomical appearance that the pathology assumes. Thus 
the lesion may be punctate; or it may present sinuous 
and branching lines; or it may be a very delicate cluster 
of radiating vascular branches with a centrally raised 
point, the entire structure closely resembling a spider and 
commonly known as “spider naevus.” Or the lesion may 
involve a spot and be represented as a striated discolor- 
ation without elevation or displacement (macule); or, 
finally, the vessels may produce a flat or rounded papule, 
varying in size from a few to six or eight millimeters in 
diameter. Examination of these papules with a hand 
magnifying lense shows them to consist of a dense net- 
work of fine capillaries. Papular telangiectases are most 
commonly seen in elderly persons, the so-called senile 
angiomata of dubreuith. 
Pathogenesis of Primary Telangiectasis: As for the 
symptomatic, so with the Primary Telangiectasis, the 
causative pathology is twofold: it resides first in a change T h e r a p y 
129 
of the normal physiologic chemical composition of the 
blood, and second, in the impairment of the normal 
activity of the individual cells in the area where the tel- 
angiectasis occurs. The change in the composition of the 
blood makes it unsuitable for cellular assimilation. The 
change in the cellular activity of the immediately con- 
tiguous tissues predisposes to the lack of blood absorp- 
tion. And, thus, these two changes, one complementary 
to the other, react to produce undue accumulation of 
blood at the site involved. The accumulating blood may 
distend the capillary vessels which already enclose it; or 
it may stimulate endothelial proliferation to the forma- 
tion of additional capillaries for the store of the stagnant 
volume. 
Pathogenesis of Symptomatic Telangiectases': These may 
be associated with certain skin affections, of which they 
may form the most important feature; or may be one of 
several and equally prominent symptoms; or they may be 
relatively unimportant and barely perceptible. In each 
case their formation has the same pathogenic initiation 
as in the instance of Primary Telangiectasis; impaired 
blood stagnation leading to engorgement of new vessels. 
In young individuals, badly compensated valvular 
diseases of the heart are often found to enfeeble the 
peripheral circulation and the resistance of the tissues, 
so as to produce areas of telangiectases; and in older 
individuals, arterio-sclerosis may in alike manner lead to 
these vascular phenomena. They accompany diseases of 
the liver, especially where gallstones are present, with 
such frequency as to be a valuable clinical diagnostic sign 
in these conditions. Under exposure to inclement weath- 
er, to severe cold, sleet and rain, and to excessive heat, 
as in the case of bakers, stokers, etc., telangiectases fre- 
quently occur on the face. 130 
Ultra-Violet 
Secondary or symptomatic telangiectases, in addition 
to the local pathogenesis described as for primary lesions, 
accompany always, obviously deranged general bodily 
metabolism. In fact, impaired bodily metabolism may 
be observed to exist in all forms of acquired telangi- 
ectases, whether primary or secondary; but this remains 
less obvious in certain cases, hence it receives the name of 
Essential Telangiectases, and becomes apparent in other 
cases when it is known as symptomatic telangiectases. 
Naevus is a type of angioma in which ultra-violet fur- 
nishes better results than X-ray or radium. In children 
and in adolescents the response is better than in adults. 
Successive regenerative focal erythemas give good results, 
apparently, from the obliterative vasitis that follows. In 
small naevi, suitable tubular applicators are fitted to the 
air-cooled lamp casing, and the lesion covered with the 
applicator. Larger lesions are exposed, everything else 
covered with protective chamois skins or toweling, to the 
rays from the open casing at ten-inch tube-skin distance. 
90 volts are used. The first exposure is seven minutes; the 
second, about ten days or two weeks later, ten minutes. 
Indurated types are‘unsuited for ultra-violet therapy; 
but papular and pustular forms yield well in many 
instances. 
Acne that recurs after X-ray treatment is suited to 
ultra-violet therapy; and the converse is likewise so. 
Systemic ultra-violet measures should first be given 
(as for anemia, which see). After the second or third 
general or systemic treatment, the focal attack is begun 
with the photo-therapy lamp and the high intensity 
actinic dosage. The affected region is brought to a marked 
hyperemia by exposure to the photo-therapy lamp. 
Acne Vulgaris Therapy 
131 
Adjust the photo-therapy lamp at the distance where 
the patient can just tolerate the heat. As tolerance is 
established, decrease the distance. This photo-therapy 
treatment should last not less than twenty minutes. 
When the hyperemia is induced, apply the rays from 
the air-cooled lamp at 90 volts, ten-inch tube-skin 
distance, as follows: 
Initial treatment • 30 seconds 
2d 1 minute 
3d minutes 
4th 2 “ 
5th 2 y2 
6th 3 
7th 3V2 
8th 4 “ 
9th “ 
10th 5 “ 
Space the focal intensive treatments two days apart. 
Before each focal treatment, use the photo-therapy 
lamp to produce hyperemia. Maintain an ultra-violet 
systemic treatment at the same time. 
Alopecia Areata 
There is a consensus of opinion that expresses occasion- 
ally favorable clinical results in the treatment of alopecia 
areata with ultra-violet rays. The technic suggested is 
the application once a week of regenerative intensive 
doses. The hair is first wet so as to part easily in order 
to make the scalp accessible. At 90 volts, and ten-inch 
tube distance, each parted stripe is treated for one min- 
ute. An effort should be made to ray the scalp area 
showing the alopecia, keeping out of the way such inter- 
fering hairs as may occlude the energy. 132 
Ultra-Violet 
Pruritus Cutaneous 
Pruritus is a sympton of great importance and frequent 
occurrence, sometimes arising without any visible cutane- 
ous lesion and meriting independent consideration. Sev- 
eral different sensations are grouped under the heading 
of pruritus, including pricking, tingling, formation, and 
itching. Convenient description would discuss the sub- 
ject of pruritus under two groupings; first, symptomatic 
pruritus; in which the itching is a symptom of an obvi- 
ously manifest cutaneous affection; and then, essential 
pruritus, which is not accompanied by any obvious skin 
condition. Whether essential or symptomatic, the funda- 
mental pathology of pruritus is similar and resides in a 
functional derangement of the nerves of common sensi- 
bility. Pruritus seems to arise from the stimulation of 
the nerve endings of the interepithelial plexus ramifica- 
tions that reach the spaces between the epithelial cells 
comprising the prickle-cell layers. It is predisposed by 
an existing idiosyncrasy or by age; the age of the patient 
furnishing often a good indication of the probable cause. 
For instance, it is commonly due to papular urticaria in 
infants and young children; to scabies in young adults; 
to diabetes in the middle aged; and to senile skin in the old 
aged, and also among the poorer classes, to pediculi vesti- 
mentorum. It may be excited by certain internal causes, 
including some blood diseases, disorders of the alimentary 
tract, disorders of the liver, disorders of the nervous 
system—diseases of the genital system, and drugs. A 
large number of external causes may precipitate pruritus, 
such as temperature extremes, irritating garments and 
local irritants. 
Pruritus may often be overcome entirely by the appli- 
cation of successive regenerative doses of ultra-violet ray. Th e r ap y 
133 
In producing regenerative erythema, the cells of the stra- 
tum Malpighii proliferate; the intercellular spaces be- 
come engorged with lymph and products of cell metab- 
olism, and the bare nerve endings gain additional pro- 
tection from this regenerative activity. 
Successful correction of the various individual skin 
lesions commonly met in the clinic depends upon careful 
recognition and identification of the causative agent and 
the existing pathology. 
Dose: (90 volts and ten-inch tube-skin distance, best 
every three days). 
Initial % minute 
2d \x/i minutes 
3d 2 M 
4th 4 “ 
5th “ 
6th 5)dj “ 
Dermatitis Seborrheica 
When the condition is limited to the scalp, and is 
accompanied with defluvium, occasional stimulative ery- 
themas, about four to five days apart, appear of value. 
The first treatment, intensive, should be about one-half 
minute; the second, one minute. 
Pityriasis Rosea 
This condition yields quite promptly, almost every 
case showing a rapid disappearance of the lesion after two 
or three intensive rayings. The accompanying itching is 
almost at once checked. A satisfactory technic is: 
Initial treatment 1 minute 
2d* 2 minutes 
3d 3 
4th 4 “ 
5th 5 “ 134 
Ultra-Violet 
Furunculosis 
Intensive radiation often aborts early lesions. If the 
furunculosis is confined to the nuchal region, a cure is 
nearly always effected after a regenerative erythema 
applied every five days. Factors: 
Initial 1 minute 
2d 2 minutes 
3d 3 
4th 4 “ 
5th 5 “ 
Neuralgia (following zoster) 
If the course of the nerve tract is heavily irradiated, 
many cases (Michall says 50 per cent) are cured, and all 
cases are relieved. Irradiations are given every five or 
seven days. The course of the pain is charted with a 
wax pencil and the entire zone so rayed as to have each 
area receive, at ten inches from the tube and 90 volts 
across the burner, one and one-half minutes for the first 
raying, and three minutes for the second, five days later. 
X-Ray and Radium Burns 
It is difficult to say, definitely, that a skin area may be 
so prepared with ultra-violet tanning, as to permit a 
greater use of the X-ray (or radium) without causing a 
burn; but there is little doubt that after the X-ray or 
radium has induced its trauma to the skin and flesh, 
the erosions can be in part, and sometimes completely 
controlled, by judicious actinotherapy. 
First degree: In radiodermic trauma (whether resulting 
from X-ray or radium) it is essential to avoid any form 
of irritation; a bland ointment being quite useful and 
sufficient. Itching may be controlled with any form of T h e r a p y 
135 
anelgesic preparation, such as the addition of phenol or 
menthol to the ointment. Of course, the phenol is 
irritating and may then be best replaced by regenerative 
doses of ultra-violet, which control the itching more 
effectively than phenol or its equivalent. During the 
acute stage, omit water and soap, and use instead any 
cleansing mixture in which liquid petrolatum is the base. 
If the reaction is severe, and the burning intense, a wet 
dressing of aluminum acetate proves useful. 
Second degree, trauma means a break in the expidermis 
with more or less exudate. The exudative drainage should 
be encouraged, so that ointments are not used. If the 
surface is coated with an ointment, the serum infiltrates 
the space between the ointment layer and the skin, and 
induces eczema—a most dreaded complication. MacKee 
mentions Pusey’s liniment, so useful in inflammatory 
dermatoses generally, as having especial merit. As soon 
as the acuity of the symptoms subsides, regenerative 
actinic erythema doses are helpful to reconstruct the 
broken epidermal fissures. Pain is somewhat lessened 
under ultra-violet treatment, but seldom to the extent 
as to preclude the use of anesthesin. Case, applies Hull’s 
ordinary treatment for burns, which is: 
Resorcin 1.00% 
Oil of eucalyptus 2.00 
Olive oil 5.00 
Petrolatum 25.00 
Paraffin 67.00 
Melt the hard paraffin; stir in the petrolatum and olive 
oil; add the resorcin which is first dissolved in half its 
weight of absolute alchohol; and when the mixture has 
cooled to about 55 degrees, add the eucalyptus. 136 
Ultra-Violet 
Third degree, trauma offers pain as its most severe 
symptom requiring treatment; and for this, the photo- 
therapy light is indeed helpful. The burn should be ex- 
posed to the light and gentle heat from the lamp, the 
distance being determined entirely by the patient’s toler- 
ance. During the stage of sloughing, no remedies seem 
to offer any aid whatever. After the slough, the control of 
pain through the use of the lamp becomes more certain; 
to which must be added actinic stimulative erythema to 
foster granulations. Carefully guard the granulations, 
being especially solicitous about preserving their integ- 
rity. Use only very short ultra-violet exposures, often 
repeated; say twice daily, 90 volts, ten inches, air-cooled 
lamp, 15 seconds per area. 
Should the granulations become exuberant, it seems 
better practice to curette them than to desiccate with 
long exposures to ultra-violet. The short abiotic wave 
lengths of the water-cooled lamp are less useful than the 
long biologic wave lengths of the air-cooled lamp. It 
seems infinitely wdser to depend upon the gradual cellular 
reconstruction imparted by small and frequently repeated 
ultra-violet doses, than to superimpose violent actinic 
reactions upon already sensitive and radiotraumatized 
tissue. 
Ulcers 
Chronic indolent ulcers of various etiologies are bene- 
fited by stimulating exposures to ultra-violet. Marked 
improvement is manifested in the ulcers that arise as the 
result of trophic conditions; and when of bacterial origin, 
results are obtained that cannot be achieved by other 
measures. Ulcus cruris (varicose), ulcus perforans pedis, 
diabetic ulcers, chronic ulcerative radiodermatitis, 
trophic ulcerations of leprosy and syphilis, tuberculous T h e r a p y 
137 
ulcerations, mycotic amebic and chancroidal ulcerations 
—all are markedly benefited by ultra-violet therapy. 
It is advisable to irrigate the ulcer with calcium 
chloride solution, about one per cent in distilled water. 
This concentration gives the proper salinity for isotonic 
effect, and provides also a biosensitization that is mark- 
edly helpful. 
Good results are obtained in diabetic ulcerations by 
submerging the affected limb in a tub of hot water, and 
raying the water surface at the same time. Not only 
does the water evenly diffuse the energy so that it strikes 
the entire affected part, but the residual bactericidal 
qualities of the solution, imparted by the raying, lend 
much to the treatment. 
For ulcers, the average dose would be 90 volts; ten- 
inch tube-ulcer distance; initial time, 30 seconds. Each 
subsequent exposure, two days apart, is increased by 30 
seconds. 
Tabular Summary 
Biologic air-cooled, ultra-violet therapy may be: 
1. Regional 
2. Fractional 
3. General or systemic 
Lamp at 40 inches; 
volts across the 
burner, 70. 
Technic 
Lamp at 10 inches; 
volts across the 
burner, 90. 
4. Intensive Chapter IX 
BACTERICIDAL ACTINOTHERAPY 
HECALLING the biophysically established dis- 
tinction in the properties of the energy issuing 
from the water-cooled lamp, as contrasted 
from those furnished by the air-cooled lamp, 
the three dominant actions upon which the therapeutic 
quality of short ultra-violet wave lengths depends are 
classified as: 
1. Bactericidal 
2. Abiotic 
3. Metabolic depression 
These properties are, after all, simply expressions of 
various degrees of the same underlying change—proto- 
plasmic coagulation. It must be remembered, also, that 
the short wave lengths, less than 2900 Angstrom units, 
are entirely superficial in their effects; and that when the 
convection or direction of the rays is required in deep 
recesses, such as sinus tracts, an “optical contact” must 
be established through the use of quartz or light convey- 
ing or light sensitive solutions. 
Tonsils* 
In the child the lymphatic system is dominantly active, 
and since the tonsils may really be considered an integral 
part of the lymphatic system, we may expect hyper- 
activity in those organs in early age. Those of us who 
are in accord with the teachings of Colonel Bushnell with 
regard to the immunizing dose of tubercle infection sus- 
*Read at the annual meeting of the Radiological Society of North 
America, Chicago, December 7, 1921. 
138 T h e r a p y 
139 
tained in childhood by repeated ingestion and aspiration 
of tubercle bacilli can see in the tonsils a locus through 
which the circulating tissue of the infant derives its 
immunologic defense against usual pathogenic bacterial 
(lora. It is not improbable that the physical texture and 
the chemical constitution of the tonsillar glands are 
purposely adapted to bacterial culture; for, whether pur- 
poseful or not, in children it is a frequent finding to 
observe subacute infections commonly present. 
Assuming that the tonsil, by reason of its position, its 
histologic texture, and its chemical constituency marked 
by lymphatic preponderance, is charged with the duty 
of collecting ingested and aspirated organisms, and also 
breeds pathogenic organisms in a subactive fashion, it is 
possible to conjecture a threshold of maximum activity 
at which pathogenic organisms thrive to a point where 
focal or systemic infection is not clinically established, 
though the products of their elaboration are osmosed 
into the lymph and circulated and distributed throughout 
the body, raising generally, the immunologic titer of the 
tissues against various infections. Or, to speak in terms 
of an established science, it seems probable that the 
tonsils are likely to contribute, during childhood, to the 
establishment of an immunity. An immunity acquired 
at so early a date as to be inseparable from the defense 
usually recognized as natural immunity. 
Speaking only of hypertrophied tonsils in children, 
there will be observed in the clinic, in the light of the 
hypothesis presented, three types of tonsillar conditions: 
1. Those in which the tonsils are obviously hyper- 
trophied, but are not excessively reddened, suggest- 
ing by their appearance a minimum bacterial 
activity. 140 
Ultra-Violet 
2. Those in which an obvious reddening is present, 
suggesting a bacterial activity, but an activity below 
the point of clinically established infection. 
3. Markedly reddened and congested tonsils in which 
infection is clinically established as is evidenced by 
the accompanying systemic manifestations. 
In the first instance, careful observation will develop 
the singular fact that the child may be classed as a 
hypo-ontomorph of Bean and shows a form of clinically 
recognized signs indicating a trend in the direction of 
status lymphaticus. In these cases, according to the 
terms of the hypothesis presented at the beginning, it 
would seem fitting to argue that the defensive processes 
against invading organisms outweigh the power of attack 
in such fashion as to preclude the establishment of any 
obvious degree of immunizing infection. Tonsils of this 
type are, therefore, hypoactive and bear treatment along 
the lines that will establish some degree of activity. It 
would seem that their surgical removal is not at all 
warranted; for the physical removal would not assist in 
accelerating a hypoactive function, but would, rather, by 
total removal of the immunizing organ, preclude the 
possibility of any degree of immunizing activity. And 
in this type of case, if the premises of the immunizing 
hypothesis are correct, the therapeutic use of the X-ray 
should be followed by marked success. 
Here, the X-ray will reduce the size of the tonsil, 
through which reduction there will be a proportionately 
less volume of immunizing surface and material; and, if 
the reduction is carried to the degree where the usual 
pathogenic organisms-may establish their subactive func- 
tion, the immunologic defense of the child will be placed 
at normal adjustment. In support of this hypothesis Therapy 
141 
may be cited the unusually brilliant results that follow 
the reduction of hypertrophied tonsils in hypo-onto- 
morphs by the use of X-rays. In observations confined 
to school children of the lower grades the outstanding 
feature of the improvement seems to be the reflection 
in the intellectual background and study interest; both 
are awakened in the previously dulled and intellectually 
insipid pupil. 
The second type, pursuant to the theme submitted, 
comprises the large majority of school children, in which 
the tonsils present what we should like to refer to as a 
state of active immunization. The glands are enlarged, 
less spongy than the previous type, reddened, but not 
abnormally so, and give, on culture, more numerous 
and greater varieties of organisms than the hypertrophy 
of the first class. In these cases it is contrary to best 
judgment to intercede with an agent or means that will 
totally remove the tonsil should indications arise for their 
treatment. The tonsils appear to be playing a markedly 
active part in the physiology of the child; and should 
conditions arise that demand treatment, such* as physical 
obstruction to proper aeration, it is the better course, at 
least at first, to resort to the use of X-rays in preference 
to surgery. 
In this second type, however, the general systemic 
level of the child may, for whatever reason, fall markedly 
below par; and when it does the tonsillar infection 
acquires a new proportion requiring clinical intervention. 
Any form of intervention should be based upon two 
fundamental principles: First, the immediate correction 
of the excessive bacterial activity, and secondly, the 
moderate reduction of the immunizing capacity of the 
tonsils so that any future impairment of systemic nor- 
malcy will not be followed by outburst of focal tonsillar 142 
Ultra-Violet 
infection. And with these two indications there is a 
contraindication, the strict avoidance of the removal of 
the tonsils. The very fact that the tonsils are subacutely 
inflamed at all times is sufficient index to show the 
necessity for raising the general immunity of the indi- 
vidual. Surgical removal of the tonsils would preclude 
the possibility of maintaining this immunizing mechanism 
after the acute aberrancy has subsided. In this type of 
cases the X-rays were not as singularly successful as in 
type one; and the difference in success was attributed 
to the nonbactericidal action of the X-ray. In other 
words, the X-ray accomplished the second indication, 
but entirely failed in the first indication for treatment; 
that is, it eventually reduced the immunizing activity of 
the glands, but it failed immediately to correct the acute 
infectious exacerbation. So that the X-ray treatment in 
class two should be supplemented by a form of treatment 
aimed directly at the immediate cessation of the infectious 
activity. An agent remarkably suited for this indication 
is the ultra-violet ray. Through its bactericidal influence 
the acute infection is quickly dominated and the clinical 
symptoms are, therefore, speedily removed. 
Coming now to the discussion of the third clinical 
class of hypertrophied tonsils in children we observe the 
manifestly infected glands. There is a clear and distinct 
difference between the gland showing active immuno- 
logic processes, and the obviously infected tonsils. The 
characteristics of the former type have been discussed; 
the features of this third type are well known and may 
be summarized by saying that the differentiating symp- 
tom is the presence of purulent accumulations. Not 
simply leukocytes scattered over the surface, but definite 
gatherings of pus in the crypts and spaces on the surface 
and in the mass of glands. T h e r a p y 
143 
This type of tonsil is decidely pathologic. The use of 
the X-ray, owing to the lack of immediate bactericidal 
effect is wholly impractical; and even the powerfully 
germicidal ultra-violet ray alone is far from the most 
efficient treatment. The indication is not to relieve the 
pathogenic infection, for even if it were relieved, the 
major immunizing influence of the gland has been lost 
through the changes induced by the severe pathogenic 
inflammation, and will, therefore, contribute little to the 
immunologic well-being of the child. In these cases, 
again in the light of the hypothesis presented, the indica- 
tions are for the surgical removal of the gland. 
All of this may be summarized by saying that tonsils 
in children are divisible into three groups, based on 
their supposedly immunizing function: 
First, the hypoactive 
Second, the active 
Third, the infected 
In which we distinguish between immunologic activity 
and pathologic infection. The immunologic activity is 
characterized by the thriving of many organisms, sapro- 
phytic and pathogenic, below the threshold of clinical 
infection; whereas, infection is characterized by the 
presence of one dominant strain of organism that has 
established an activity that no longer contributes to the 
physiologic manifestations. 
In these cases our experience with school children has 
been that when treatment is indicated because of the 
temporary establishment of an acute infection, or because 
of the mechanical impediment to normal physiologic 
processes, better results are obtained in the discriminate 
use, either alone or conjointly, of the X-ray, the ultra- 
violet rays and surgery; the X-rays being reserved for 144 
Ultra-Violet 
the hypoactive tonsils, the conjoint use of X-ray and 
ultra-violet rays being especially beneficial in the cases 
of type two, and surgery being reserved for cases of type 
three. 
The use of the X-rays is already well familiar to every 
roentgenologist in the form of the Witherbee technic. 
When it is to be supplemented by the use of ultra-violet 
rays, the X-ray applications are given every two weeks, 
as is generally advocated by Witherbee and others; the 
ultra-violet irradiations are applied directly to the tonsil 
through a pharyngeal applicator in units of actinic 
saturation, alternating days in the usual case, and daily 
in the more severe infections. 
The choice of surgical operation is left for surgical 
specialists to decide. 
Since the active immunizing types are by far the most 
frequent that are to be observed clinically, it is obvious 
that the ultra-violet ray plays a significant role in the 
treatment of tonsillar pathology. The indications are 
plain, the application is simple and the results obtained 
through the conjoint use of the X-ray and ultra-violet 
ray in hypertrophied tonsils are eminently brilliant and 
deserve every consideration. 
Many claim that enlarged tonsils are reduced in size 
by actinotherapy; but the mechanism of the reduction 
is misinterpreted. As a general rule, the enlargement 
of a tonsil is reduced in proportion as the hypertrophy 
is due to edematous swelling. The greater the amount 
of edema, the more marked the reduction. This is to be 
observed, also, in the X-ray treatment of tonsils. True 
shrinkage of hyperplastic connective tissue has not been 
proved for actinotherapy, though Witherbee seems to 
have shown that it does occur as a consequence of X-ray 
radiation. Therapy 
145 
Infected tonsils are often overtreated with ultra-violet. 
Too long an exposure (more than one minute) coagulates 
the mucosal protein covering of the gland. The resulting 
incrustation temporarily occludes surface drainage and 
serves to retain the purulent activity under the incrusted 
shell. It is far better to depend upon very short exposures, 
say not more than thirty seconds, repeated two or even 
three times a day, than to irradiate heavily and produce 
a coagulation of the tonsil surface. 
Spraying the surface with a photosensitive dye is a 
great help. One may use eosin or methyl violet, about 
1 to 1000 in saline, to which a few drops of adrenalin 
chloride have been added. Hydrogen peroxide diluted 
1 in 10 makes an excellent preparatory spray; under the 
influence of the light the peroxide liberates nascent 
oxygen that readily enters the crypts and effects a more 
speedy sterilization. Diluted solutions of iodine, or the 
colorless tincture, are likewise beneficial expedients. 
The treatment is quickly summarized by saying that 
the water-cooled energy is focalized over the tonsil area 
with any form of instrument that will best accomplish 
the purpose. The exposures are brief—30 seconds with 
the lamp operating at 50-65 volts. The tonsil is first 
sprayed with a dye solution, or diluted hydrogen peroxide, 
iodine or similar toxicide. Avoid heavy exposure. Depend 
upon the bactericidal action of the rays, which is prompt, 
and not upon tissue destruction. 
Human Infection Carriers 
This extremely important problem deserves particular 
study; more expecially because the water-cooled bac- 
tericidal energy lends itself admirably to the preventive 
control of carriers, “Simon’s Human Infection Carriers,”* 
*Lea and Febiger. 146 
Ultra-Violet 
should be diligently studied. For the presentation here, 
frequent and verbatim quotations are made from the 
work of Simon. 
Diphtheria: Habitat of the Organisms.—“As in the case 
of various other pathogenic organisms there is steadily 
increasing evidence to show that the normal and exclu- 
sive habitat of the diphtheria bacillus is the diphtheria 
patient and the diphtheria carrier. In both, moreover, 
it is exclusively the mucous membrane of the nose, the 
throat and the mouth, with the communicating struc- 
tures, which enter into consideration. 
“In the great majority of cases the carriers harbor the 
bacilli in the tonsils. In a small number the organisms 
are found only in the nose and in the most persistent 
carriers of this type chronic inflammatory or atrophic 
processes are almost invariably demonstrable. 
“The middle ear is apparently infected in many cases 
of the disease and it is noteworthy that this frequently 
occurs at a time when the patient has, apparently, 
already entered upon the stage of convalescence. Wolff 
mentions that in nasal diphtheria the corresponding 
sinuses are always involved. In one case of this order he 
could demonstrate diphtheria bacilli in the nose on the 
one-hundred and twenty-first day following the beginning 
of the disease. Those relatively rare cases in which the 
disease attacks the skin, the genitalia and the stomach 
hardly enter into consideration from the standpoint of 
the carrier.” 
Meningitis: Habitat of the Organisms.—“As regards 
the manner in which an individual becomes a carrier, and 
more particularly of the predisposing causes, very little 
is known. The fact that the organism’s resistance outside 
of the body is so very slight suggests, of course, that in 
the human nasopharynx it must find special conditions Therapy 
147 
favoring its growth. Bearing in mind the common occur- 
rence of catarrhal conditions associated with lymphatic 
involvement in civilized races more particularly, one can- 
not help but think that the ready availability of certain 
serum constituents which are poured out upon the surface 
and which collect in the various nooks and corners of the 
mucous membrane of the nasopharynx may prove to be 
the point of attraction. Some writers lay stress upon an 
increased secretion of mucous as a factor favoring the 
development of the organisms in the throat, but it seems 
more likely that the underlying inflammatory process 
with the resultant exudation of serum is the more impor- 
tant. Unfortunately no systematic bacteriological exami- 
nations of the lymphatic structures of the throat have 
thus far been made in carriers, but we may logically 
assume that the organisms do not develop to any special 
extent upon the exposed surfaces of the mucous membrane, 
but more likely in its depth, and particularly in the clefts 
of the larger lymphatic structures, such as the pharyngeal 
and faucial tonsils. In actual cases of meningitis, both 
acute and chronic, in children as well as in adults, Westen- 
hoeffer invariably found .a very considerable hypertrophy, 
hyperemia and hypersecretion of the pharyngeal tonsil, 
and both he and v. Lingelsheim, as well as Meyer, could 
demonstrate the meningococcus directly in the secretion 
taken from the depths of the recesses. Meyer, moreover, 
found them in the peripheral portion of the pharyngeal 
tonsil, while in the deeper parts they were lost. The 
faucial tonsils in contradistinction to the pharyngeal 
gland Westenhoeffer found less frequently involved. 
“Similar conditions no doubt exist in the carriers, 
though in these the pharyngeal tonsil cannot play the 
prominent role which Westenhoeffer has assigned to this 
structure in cases of the actual disease. According to 148 
Ultra-Violet 
Trautmann the pharyngeal tonsil usually disappears after 
the eighteenth year. In view of the fact that in adults 
the carrier state is decidedly common, whereas the 
malady itself has a special predilection for children in 
whom the gland is present, and whereas all adults con- 
tracting the disease showed the same hypertrophy as 
children, this observation would suggest that this struc- 
ture may play an important role as portal of entry when 
it is developed, but that it is not essential as a nidus for 
the development of the organisms in carriers. In the 
latter the remaining lymphatic structures and mucous 
glands no doubt serve as points of anchorage for the 
organisms. 
“A careful study of the distribution of meningocci in 
the upper respiratory tract of carriers has been made by 
Herrold. This investigator examined 93 segregated men 
with the results presented in the following three tables: 
TABLE I—THE INCIDENCE OF POSITIVE CULTURES OF 
MENINGOCOCCI FROM DIFFERENT SOURCES 
OF THE UPPER RESPIRATORY TRACT OF 
NINETY-THREE CARRIERS 
Positive 
Source of Cultures 
Number 
Per Cent 
Nasopharynx 
. 66 
70.9 
Tonsils 
. 29 
31.2 
Anterior superior nares 
. 16 
17.2 
Sputum 
12 
12.9 
TABLE II—SUMMARY OF RELATIONS OF POSITIVE 
CULTURES FROM ELSEWHERE THAN THE 
NASOPHARYNX Number 
Positive tonsil, negative nasal and sputum cultures. . 25 
Positive nasal, negative tonsil and sputum cultures. . 11 
Positive sputum, negative nasal and tonsil cultures. . 8 
Positive tonsil and nasal, negative sputum cultures. . 2 
Positive tonsil and sputum, negative nasal cultures.. 1 
Positive nasal and sputum, negative tonsil cultures. . 2 
Positive tonsil, nasal and sputum cultures 1 Th e r a p y 
149 
TABLE III—A COMPARISON OF THE PERSISTENCE OF 
THE CARRIER STATE ACCORDING TO THE 
DISTRIBUTION OF MENINGOCOCCI 
Type of Carrier 
Number 
IN 
Each 
Group 
Incidence of 
Persistence After 
Six Weeks 
Number Per Cent 
Positive nasopharynx and else- 
where 
39 
28 
73.0 
Positive nasopharynx, negative 
elsewhere 
27 
17 
63.0 
Negative nasopharynx, positive 
elsewhere 
11 
6 
54.6 
Negative nasopharynx and else- 
where 
16 
3 
18.8 
“The results speak for themselves and warrant the con- 
clusion that cultures should be taken not only from the 
nasopharynx but from the tonsils and anterior superior 
nares as well. 
“Practically important, further, according to Westen- 
hoeffer, is the fact that in children median otitis fre- 
quently, in fact invariably, develops, and that in this 
situation the organisms may possibly persist for some 
time in some of the convalescent carriers.” 
Pneumonia: Habitat of the Organisms.—“Regarding 
the habitat of the pneumococci in healthy carriers our 
knowledge is practically nil. The results reached by the 
investigators mentioned in the foregoing pages have refer- 
ence either to cultures taken from the saliva or the 
sputum, but this does not of necessity imply that the 
organisms multiply on the free mucous surface. From 
corresponding observations made in connection with 
diphtheria and meningitis we have reason to assume that 
organisms found upon the free surfaces are there more 
or less accidentally, and that their actual habitat is in 150 
Ultra-Violet 
the crypts of the tonsils or the various nooks and corners 
connected with other lymphatic structures of the throat 
and the posterior nares. In cases of pneumonia, of course, 
we know that the pneumococci are present in abundance 
in the exudate, and it is easily conceivable that from here 
they may be distributed upward over the bronchial and 
tracheal mucosa, and that during the act of coughing 
and expectoration the larynx, pharynx and mouth of the 
individual also become contaminated. This, however, 
raises the question whether pneumonia is not a descend- 
ing infection, which is the view that is now generally 
held. But in that case we would have a right to assume 
that every pneumonic was for a while a passive carrier 
until a sufficient number of organisms became available 
to bring about such a complete overthrow of the natural 
defenses as to render an infection of the lung possible. 
And in that case the question, where does this initial 
development take place, still remains unanswered. But 
supposing even that the infection were an ascending one, 
it is more than likely that the primary focus is neverthe- 
less located in the upper respiratory tract. In the healthy 
carrier, of course, there is no reason for assuming that the 
organisms come from the deeper portion of the respiratory 
tract. In the absence of definite information on the sub- 
ject we can only surmise that in the pneumococcus 
carriers also the crevices of the lymphatic structures of 
the upper respiratory tract contain foci in which the 
organisms find suitable conditions for their development, 
and from which they find their way to the surface and 
into the saliva. The fact that they are so frequently 
present in the latter, in which the diptheria bacillus and 
the meningococcus are only exceptionally found, would 
further suggest that they might develop in diseased areas 
about the teeth. Streptococci are here so constantly Therapy 
151 
met with that it would not be at all surprising if pneu- 
mococci also here found conditions favorable for their 
growth. Dochez, Avery and Stillman when speaking of 
their findings in individuals who were not or had not 
been suffering from pneumonia quite constantly refer to 
‘normal mouths.’ But every one knows that relatively 
few mouths are normal, and from the standpoint of the 
epidemiology of lobar pneumonia it would seem most 
important to ascertain whether or not pneumococcus 
carriers actually do have ‘normal mouths,’ which would, 
of course, include the condition of the teeth. A system- 
atic investigation in this direction would suggest itself 
as a most promising field for future investigation.” 
Streptococcus Infections: Habitat of the Organism.— 
‘‘The habitat of the organisms in the upper respiratory 
tract is as yet unknown, but we may well imagine that 
like other pathogenic organisms which gain access to the 
human body through the air, they probably lodge in the 
crypts of the tonsils and other nooks and corners con- 
nected with the lymphatic structures of this region.” 
Influenza: Habitat of the Organism.—“As regards the 
habitat of the organism in healthy carriers, Scheller 
found that positive cultures are most apt to result if the 
secretion is obtained from the pharyngeal tonsil. This 
should be borne in mind, if a bacteriological diagnosis is 
desired, in clinically doubtful cases.” 
From Simon’s summary of the habitat of the organism 
in active and passive carriers of diphtheria, meningitis, 
pneumonia, streptococcic infection and influenza, the 
offending structures are, in the order of their importance: 
1. Tonsils 
2. Nasopharyngeal mucosa 152 
Ultra-Violet 
These passages are readily reached by sprays, and the 
spray should contain a photosensitive dye that will be 
carried, by infiltration, into the structures for some 
considerable depth. In order to increase the mucosal 
tolerance to the ray, there may be added some adrenal 
chloride for its dehematizing effect. 
With this photosensitive solution, the structures are 
sprayed and the energy applied for brief periods, using 
whatever form of quartz or tubular applicator that will 
insure reaching the parts. In the nose, the spatulate 
applicator is good. For the nasopharynx, one of the 
curved quartz rods introduced passed the soft palate and 
the curved end directed upward. For the tonsils, a metal 
tubular applicator with or without a quartz lens at its end. 
The exposures are not longer than thirty seconds. 
Even better results follow two exposures a day, morning 
and evening, each exposure twenty seconds. Donnelly, 
in the “Journal of the Michigan State Medical Society,”* 
reports that two or three exposures suffice to make 
laboratory cultures negative. These results can be 
certainly confirmed and point to unusually many impor- 
tant applications in preventive medical practice, particu- 
larly as it affects school and municipal authorities. 
Paranasal Sinusitis 
Certain cavities communicate with the nasal chambers; 
these are: 
1. The Antra of Highmore 
2. Anterior, middle and posterior ethmoid cells 
3. Sphenoid cells 
4. Frontal sinuses 
♦March, 1921. The rapy 
153 
The mucosal linings of these cavities are evaginations 
of the mucosa of the nose chambers, being lined with 
identical epithelium derived from the same blastic origin; 
and this in turn is of the same blastic origin as the epi- 
dermis of the skin. So that whenever a beginning infec- 
tion spreads from the nasal chamber to any of the 
adjacent paranasal cavities, there is a sympathetic reflex 
incited in the contiguous layers of epidermis that arise 
from the same germ layer. On this basis, the so-called 
“blau-licht” (blue light) therapy of the Germans appears 
to depend wherein they use a special blue glass filter over 
the water-cooled lamp and claim deeper penetration and 
longer irradiation with less chance of burning the skin. 
It can be speedily proved, by spectroscopic measure, 
that the glass filters used absorb everything shorter than 
about 2900 Angstrom units; leaving only a spectrum 
that simulates the air-cooled lamp, but much less intense. 
Obviously, any good effects derived from the use of the 
energy in paranasal infection must be due to the counter- 
irritant effect rather than to an impossible penetration 
of bactericidal wave lengths. As can be surmised, only 
in beginning infectious pathology, when the mucosal 
membranes are first inflamed, can this counter-irritant 
action be useful (and it is useful) in aborting progress. 
After the infection is established, and the accessory 
cavities accumulate purulent exudate, the superficial 
counter-irritant effect can no longer be of great service. 
The sinus must be surgically drained. 
Following the drainage, in the case of the maxillary 
antra, a quartz rod may be introduced and the cavity 
irradiated; a procedure that makes for splendid recovery 
in short time. Here again, the exposure should be brief— 
not over one minute. The cavity had better be first 154 
Ultra-Violet 
lavaged or irrigated with an antiseptic dye solution, 
such as: 
Eosin 1 part 
Glycerine 5 parts 
Phenol 5 parts 
Water 1000 parts 
Infections attacking the mucosa of the urogenital 
tract, particularly in the female, are amenable to ultra- 
violet treatment. In the male urethra, because of the 
difficulty inyolved in applying the energy, the results 
are less certain and may often be discouraging. 
This may be: 
(a) Simple catarrhal 
(b) Gonorrheal 
(c) Ulcerative 
(.d) Croupous 
In simple catarrhal vaginitis, an unusually excellent 
treatment consists in frequent vaginal douching with 
rayed water containing an ounce of borax to the pint. 
Just before using, a pint of water, to which the ounce 
of borax has been added, is placed in an open basin and 
exposed ten minutes to the rays of the air-cooled lamp 
at ten inches from the burner. It is then used as a douche. 
The raying imparts a peculiarly accelerated bactericidal 
quality that makes the solution quite effective. The 
douche should be taken in the dorsal, not sitting, position. 
No other local treatment is required. Cathartics, light 
diet and alkaline diluents are used. 
In chronic forms, focal raying is employed, using any 
convenient vaginal speculum and exposing the mucosal 
walls to the bactericidal energy for 30 seconds over 
each area. 
Vaginitis T b e r a p y 
155 
Gonorrheal Vaginitis 
Keep the patient quiet; move the bowels; attend to 
the diet, which should be light. During the acute stage, 
douche with freshly rayed water (as above) holding 
1-10000 bichloride of mercury, three times a day. After 
the acute stage has passed, thoroughly disinfect the 
vagina with bichloride of mercury, 1-1000 and loosely 
pack with sterile gauze in a manner to insure maximum 
drainage. Each 24 hours remove and replace the packing, 
first exposing the walls to a short ultra-violet exposure 
from the water-cooled lamp, using a quartz speculum to 
distend the cavity and unfold the mucosal rugae. Ultra- 
violet exposures must be brief—not over 30-45 seconds 
per area. If the draining tends to persist too long, douche 
with rayed eosin solution, 1-1000, and with the mucosa 
still wetted from the wash, ray the mucosa through a 
speculum, 30 to 45 seconds. 
Ulcerative Vaginitis 
Touch the spots of desquamated epithelium using any 
of the straight quartz rod applicators attached to the 
water-cooled lamp. Treat the attendant leucorrhea, 
which is most always present, by frequent douching with 
rayed eosin solution. Sometimes pruritus is present 
which requires ultra-violet care (see pruritus). Chapter X 
ABIOTIC ACTINOTHERAPY 
■ LTRA-violet absorption increases as the wave 
length of the energy decreases; from which 
it follows that chemical action also increases 
;=======JJ as the wave length decreases. Downes ajid 
Blunt pointed out that the destructive action of light 
upon protoplasm increases as the wave length decreases. 
Much evidence points to the fact that elements, exposed 
to ultra-violet, undergo change. Oxygen, for example, 
becomes converted to ozone, and Bovie mentions that 
the transformation is of interest to biologists, for ozone 
is more opaque to ultra-violet than oxygen, so that life 
on our planet is made possible only because the ozone 
formed in the upper layers of the atmosphere by the ultra- 
violet of sunlight serves as a filter and protects the 
organisms on the surface of the earth from these shorter 
and more destructive rays. 
In consequence of the many changes produced by light, 
it is often found, says Bovie, that many compounds 
containing the same element are photosensitive. For 
example, light affects many of the compounds containing 
silver. Protoplasm contains many photosensitive ele- 
ments, and it is found that a large number of the sub- 
stances elaborated by protoplasm, such as sugar, starch, 
cellulose, chitin, are decomposed when exposed to ultra- 
violet light. 
Dreyer and Hanssen showed that albumins and globu- 
lins were coagulated when exposed to ultra-violet light; 
156 T b e r a p y 
157 
and Bovie pointed out that ultra-violet coagulation 
involved two reactions: 
1. A chemical change in the albumin 
2. The precipitation of the albumin 
Henri has shown that a thin layer of egg white is 
opaque to ultra-violet wave between 3000-2000 Angstrom 
units (far ultra-violet of the water-cooled lamp); and 
that the opacity is greatest for the shorter wave lengths. 
If the absorption coefficient of egg white can be applied 
to living protoplasm, and the later studies of Glitscher, 
Hasselbach and Pacini indicate that they can, then 
obviously the far ultra-violet energy exerts its extreme 
destructive effect as the result of a strong superficial 
absorption. 
This abiotic or coagulative effect has been used in the 
treatment of naevi, a review of which study will make 
clear the method involved. 
Port-Wine Mark 
Classification: Naevus is a term used generally in 
connection with congenital new growths of blood or 
lymph vessels, though in Europe it is used in the wider 
sense to include all circumscribed and regional cutaneous 
deformities of embryonic origin. A most comprehensive 
classification of naevi is that given by McLeod, and 
reproduced here: 
I Vascular Naevi 
1. Derived from blood-vessels 
(a) Capillary naevi, or port-wine stains, macules 
or patches 
(b) Raised haemangiomata, cavernous naevi 
(c) Stellate or spider-naevi 
2. Derived from lymphatics 
(a) Lymphangiectases 
(b) Lymphangiomata 158 
Ultra-Violet 
II Non-Vascular Naevi 
1. Plane pigmented macules and patches 
2. Raised 
Non-Pigmented 
A. Soft neavi Pigmented 
(moles) Hairy 
Giant-neavi 
B. Hard naevi 
Verrucose 
Linear 
(a) Circumscribed Ichthyosis 
Hystrix 
Keratosis 
Palmaris 
(b) Regional et 
Plantaris 
C. Fibromatous neavi 
(a) Fibroma molluscom 
(v. Recklinghausen’s Disease) 
(b) N. Lipomatodes 
D. Adenomatous neavi 
(a) Adenoma sebaceum 
Cb) Syringo-cystadenoma 
In this discussion it is desired to consider only the 
clinical conception and the ultra-violet ray treatment of 
naevi derived from blood vessels, more especially the 
capillary variety commonly designated port-wine stains. 
Etiology: Other than ascribing the etiology of naevi 
to peculiar developmental anomalies, little is yet known 
regarding the cause of these exceedingly common mani- 
festations. Heredity appears to play a significant part 
in their appearance, certain types of naevi recurring in 
the offspring of several generations. One significant 
factor in their obscure etiology is their undoubted rela- T h e r a p y 
159 
tion with imperfect development; as may be gathered 
from the frequency with which these marks are associ- 
ated with other physical defects, such as harelip, cleft 
palate, webbed fingers, and syndactylism. Virchow’s 
conjecture, that naevi were of anatomical origin and 
situated at embryonic fissures, is not entirely applica- 
ble to all cases; many instances being observed of naevi 
situated in portions other than embryonic clefts. Unna’s 
hypothesis, that naevi result in consequence of uterine 
pressure, though applicable to some, is wholly unsatis-. 
factory in explaining the great majority of cases. 
Capillary Naevus; Port-Wine Stain: It is better to refer 
to this type of naevus as capillary rather than port-wine 
stain; for the latter terminology, though applicable to a 
goodly number of cases, is prone to be misleading owing 
to its suggestion of a dark port-wine discoloration of the 
skin; whereas, in clinical reality, all grades of color may 
be observed varying from the faintest pink to the most 
livid purple. Capillary naevi may occur anywhere on 
the body surface, but they seem to favor the face and the 
upper parts. Their most frequent situation is in the 
region of the posterior fontanel, fully one-fourth of infants 
showing naevi having them in this region. They are also 
present on the forehead, cheeks, and lips, and occasionally 
they involve an entire half of the face. 
Pathology: Capillary naevi result because of dilatation 
or new growth of venous capillaries. They may be super- 
ficial, in which the venous capillaries involve mainly the 
lower layers of the epidermis; or they may be deep, when 
the capillary engorgement is situated principally in the 
corium. For the treatment of naevus, the clinician is 
guided in a large measure by the depth to which the lesion 
is situated; and this must be tested with a glass slide 
such as is used in microscopic work. This slide is placed 160 
Ultra-Violet 
against the naevus. Under exertion of moderate pressure, 
superficial naevi show their capillary network, and their 
redness is in part or wholly obliterated; while the deep 
naevi show little or no change under similar conditions. 
Newer Concept of Wine-Mark Pathogenesis: Naevi con- 
sist of newly formed blood vessels. They are benign 
tumors and never form metastases. Early in the forma- 
tion and derivation of the blastodermic layers, at a period 
before definitely organized vascular structures exist, the 
•interchange of material necessary for the proper metabo- 
lism of the growing cells, is carried in the intercellular 
spaces and taken up by various processes of absorption 
and osmosis. As the cells differentiate and assume inde- 
pendent histologic identity, the rate of metabolic exchange 
likewisevaries in proportion to the character and structure 
of the tissue; so that some areas demand a moderately 
lessened stream of nutrient supply, and others a greatly 
increased source of metabolic materials. In the fetus, 
the cells of the skin surface require a comparatively great 
nutrient supply, owing to the fact that metabolic ex- 
change must be carried on with rapidity and proficiency 
in order that the skin may undergo the necessary meta- 
morphosis so as to withstand the forces of exposure (air, 
light, and gaseous exchange) in which the born body will 
eventually be immersed. 
It is, therefore, a natural proclivity for the skin of the 
embryon to show exaggerated metabolism; an activity 
that demands a maximum quantity of blood for the use 
of the embryonal skin cells. Any factor that interferes 
with the physiologic activity of the skin cells is conducive 
to passive venous congestion. It may be through trauma, 
as Unna described, or through anatomical situation call- 
ing for cellular stress, as in the fissural concept of Virchow, 
or from any similar cause, that cellular avidity for blood Therapy 
161 
nourishment is impaired in an area. There being estab- 
lished proclivity for exaggerated blood supply, and a focal 
reactivity against the consumption of blood, the physio- 
logic expression for the correction of the anomalous 
lesions is the formation of many and new blood capillaries 
into which the volume unused by the perverted cells 
may naturally accumulate—the process of an embryonic 
example of the establishment of compensatory capillary 
circulation. 
So that the newer concept of the pathogenesis of 
naevus is found to begin with any disturbance in the 
metabolic avidity of the skin cells. Their nourishment 
impaired through whatever cause, new vessels are formed 
in amount sufficient to accommodate the volume of blood 
that would otherwise go for the physiologic consumption 
of the cells. 
Treatment: Previous to the introduction of the concept 
for the pathogenesis of naevus as above propounded, con- 
temporaneous dermatologists make for the basis of treat- 
ment a method aiming at the destruction of the capillary 
network; and for this destruction, radium, refrigeration, 
electrolysis, X-ray, electrocoagulation and ultra-violet 
light, have at different times been suggested with indiffer- 
ent success. Of these, radium yields the best results. It 
appears to exert a selective action on blood vessels which 
causes them to shrivel and disappear, the capillary net- 
work being eventually replaced by a' new connective 
tissue manifesting as a delicate white scar. There are 
many points of favor in the use of radium; it is painless 
(an attractive treatment for children) and its results are 
reasonably certain. Against its use may be mentioned 
the long and tedious applications; the great quantity 
of radium necessary when large areas are being treated; 
the fear of producing an uneven and mottled scar, often 162 
Ultra-Violet 
more unsightly than the original stain, and the tremen- 
dous expense and care that must be exercised in its judi- 
cious use in order to avoid the production of telangiectasis. 
Treatment:.Since the shorter wave lengths are the ones 
desired for the coagulation of the capillary net that 
naevus represents, the use of the “blau-licht”* filter in 
connection with the water-cooled lamp is to be depre- 
cated. Heavy irradiation under reasonable pressure with 
unfiltered water-cooled energy is certainly more effective. 
When the lesion is small, a hole is cut in a chamois skin 
that corresponds with the area of the lesion. The patient 
is comfortably posed and shielded so that only the lesion 
presents through the opening in the chamois. A quartz 
lens is selected that fits the area; or, if the area is large, 
it is marked off with a wax pencil in squares, and each 
square separately treated, much like the multiple portals 
of entry in attacking a cross-fire X-ray treatment. Press- 
ing the quartz firmly against the lesion, the water-cooled 
lamp is held in this position for ten minutes over each 
portal of raying. 
A severe blistering follows, which, when it has subsided, 
leaves the lesion paler in color. At this time, about two 
weeks, a second intensive radiation is applied in a like 
manner. The treatments are continued at the intervals 
named until the lesion has disappeared. It may not 
disappear completely, leaving a slightly noticeable pink- 
ish discoloration; but the majority of cases, depending 
upon the initial character of the lesion and the age of the 
patient, improve to a remarkable extent. Children 
respond well to the treatment; adults less well. 
It is advisable to follow each irradiation by daily 
bathings, locally, of boric acid to prevent infection of 
the vesicles. 
*Blue light; blue glass filter. Therapy 
163 
Finsen Treatment of Lupus Vulgaris 
At the International Congress of Medicine in Paris, 
1900, Finsen presented a thesis entitled “The Treatment 
of Lupus Vulgaris by the use of Concentrated Chemical 
Rays.”* Because of its historical value as the contribu- 
tion that directed the attention of the medical world to 
the first modern re-establishment of scientific therapy, it 
will be reproduced (translated) and commented upon in 
the light of newer researches. 
“In the course of several years of study dealing with 
the physiological effect of light, I observed in the first 
place that its capacity to produce a more or less intense 
cutaneous inflammation was accompanied by a desirable 
influence in certain affections, as for example, in variola. 
In comparing this effect with the bactericidal property 
of light, definitely attested to by many researches in 
which the ability of the energy to penetrate tissue has 
been pointed out,f the concept struck me to try light in 
the treatment of various bacterial affections of the skin. 
In October, 1895,1 began my first practical investigations 
commencing with a case of lupus vulgaris. 
“In the first place, it must be reported that in the 
method which I shall indicate it is not a question of the 
thermic effect of light. My method is based exclusively 
on the employment of the chemical rays (blue, violet 
and ultra-violet) of light. 
“It is necessary, therefore, to use a source of light that 
is rich in these rays and to concentrate it as much as is 
possible. In the next place, since it is necessary to ex- 
clude the thermic rays, it is essential to “cool” the light, 
*Traitment Du Lupus Vulgaire Par Les Rayons Cliniques Concentres. 
Niels R. Finsen. 
tThis is, of course, fallacious for ultra-violet.—A. J. P. 164 
Ultra-Violet 
with maximum effectiveness. It is with the double view- 
point that our apparatus is constructed. For the source 
of light we are using at this time the light derived from 
an arc or even sunlight. The light is concentrated through 
a system of convex rock crystal lenses, and it is cooled by 
having it pass through a layer of distilled water. It is 
necessary to observe also that blood offers an obstacle 
to deep penetration of light in the tissue, and that the 
region undergoing treatment must be exsanguinated as 
completely as conditions will permit; a result obtained 
through the use of compression appliances, applied during 
the treatment directly upon the skin. These applicators 
may also be arranged so as to permit water circulation 
in them and so insuring a complete elimination from the 
possibility of the accompanying thermic rays. 
“The treatment is effected in seances lasting one and 
one-quarter hours. 
“Each individual is treated once or twice each day. 
“At each seance the patient maintains a definite position 
throughout the entire hour, during the action of the light. 
“The area of the lupus is brought in contact with the 
concentrating lens of the apparatus in such fashion that 
the radiation strikes the field at right angles over a space 
of two or three centimeters in diameter. 
“The treatment is entirely free from pain although this 
may occasionally exist for a short time during the seance. 
If ulceration is present, the continuous pressure incident 
to the treatment may occasionally induce a little pain. 
“The effect of such a treatment is characterized by local 
erythema, generally accompanied with the formation of 
a vesicle, but never with any loss of substance. This 
reaction subsides, and after six or eight days is accompan- 
ied by an epidermal exfoliation. Therapy 
165 
“In order to avoid an infection of the vesicles, a boric 
acid solution or an ointment of zinc oxide is applied 
(after the treatments). 
“When the lesion of the lupus is reasonably extensive 
the treatment is begun at the periphery. It is generally 
necessary to irradiate the same spot more than once, 
which may be done from eight to fifteen hours after the 
initial treatment. 
“The effect of the treatment is characterized by suc- 
cessive and gradual involution of the affection, ulcerations 
diminishing in size and in depth, and finally disappearing 
completely; hypertrophic nodules become level and 
smaller; confluent nodules are transformed into smaller 
nodes that become separated by healthy skin and finally 
disappearing entirely. The healing process may last a 
longer or shorter time depending upon the original 
intensity and extent of the lesions; but the treatment is 
at no time interrupted, being maintained until the 
patient exhibits no more traces of the disease. At this 
stage, however, the patient is not yet totally cured. At 
the end of this first course of treatments the patient is 
kept under observation. In the more favorable cases, 
the patient remains in perfect health, without additional 
treatment; but more often comes the unnoticeable lesions 
that persist in the depths of the skin, and reappearance 
is newly instituted at the surface. A second course of 
treatment, of shorter intensity and duration than the 
first, is then begun. 
“In the numerous cases in which we have applied these 
principles, we have never observed a relapse. But if the 
patient neglects the second course of treatments, the 
deeply situated small foci may take on a considerable 
extension of pathologic invasion. 166 
Ultra-Violet 
“In order to obtain a mean average I studied carefully 
the results in the first hundred cases that were cured. 
It seems established that the effects of the first course of 
treatments persist for four and one-half months. Twice 
it was necessary to apply a second course of treatment so 
that the effective treatment for each patient can be estab- 
lished as occupying six months. 
“The advantages of the method are the following: 
1. The effect is remarkably constant, being as suc- 
cessful in the more severe and extended cases where an 
absolute cure can hardly be expected, though a complete 
arrest of the process is certainly realized. Cases that are 
wholly refractory never amount to more than two or 
three per hundred. 
2. The results are satisfying because of the good 
plastic effect and the conservatism of the method. 
3. Contiguous lesions, beyond the periphery of the 
obvious pathologic area, also respond to the treatment 
without leaving scars. 
4. There are no secondary or retroactive sequelae. 
5. The method is free from pain. 
“The inconvenience of the method is its shortcoming. 
This is being eliminated by progressive studies in technic. 
We have used the method not alone in lupus vulgaris, 
but likewise in various other conditions, such as: 
Lupus Erythematosus 
38 cases 
12 cured 
13 still under treatment 
13 discontinued T h e r a p y 
167 
Alopecia Areata 
36 cases 
28 cured 
2 still under treatment 
6 discontinued 
Cutaneous Epithelioma 
22 cases 
10 cured 
4 still under treatment 
8 discontinued 
Note—-Only small superficial epitheliomas are conven- 
iently treated by this method. 
Acne Vulgaris and Rosacea 
20 cases 
7 cured 
5 improvements 
1 still under treatment 
7 discontinued 
Naevus Vulgaris Planus 
13 cases 
2 cured 
9 still under treatment 
2 discontinued 
“These cases are interesting as they do not represent a 
bacterial infection. One must believe, therefore, that the 
inflammatory effect of the light is involved in the cure.’’ 
Of Finsen’s work, this must be said: that a critical 
study of most of his reports reveals a reasonable con- 
servatism in the expression of the results obtained. This 
conservatism was overthrown by writers subsequent to 
the time of Finsen. One may profit much by the original 
studies issued from the Finsen Institute, if allowance is 168 
Ultra-Violet 
made for the increased knowledge of our own times and 
the mechanical perfection of the apparatus involved. 
With the water-cooled lamp, the same basic principles 
are carried out, using a compression treatment under any 
adequate size of lens. The skin may be wetted with 
diluted hydrogen peroxide. The treatments are given for 
five to ten minutes when there is much hypertrophy. 
When the vesicles form, they are bathed in boric acid 
solution. It is not necessary to wait longer than two days 
between treatments if the scales of dried serum are 
removed with peroxide previous to each exposure. Chapter XI 
ACT1NOTHERAPY IN METABOLISM 
HETABOLISM must be conceived in its broad 
sense—the changes that substances introduced 
into the body undergo while passing through 
ib or on becoming incorporated with it, and 
the transformations of energy that accompany these 
processes. 
When speaking of the action of light on metabolism, 
many have referred to the case of the plant and its 
chlorophyll, which has been compared to the animal and 
its hemoglobin. But this is not at all an analogy, for 
the plant, aided by and dependent entirely on sunlight, has 
to do with the synthesis or building up of the compounds 
that compose it; whereas the animal has to do with the 
analysis or breaking down of already formed compounds, 
which it does through the processes of cleavage and 
oxidation. Of course, both sets of processes occur in the 
plant and in the animal; but the dominant function of 
the plant is to synthesize, and that of the body to analyze. 
Substances taken into the human body as food and 
drink are disposed of as follows: 
1. Analyzed into simpler products 
2. Taken up by protoplasm for growth and main- 
tenance 
3. Leave the body, changed in the form of secretions 
and excretions; or leave the body in an unaltered 
condition 
This constant coming in and going out of substances is 
a process aptly described by the Germans as “Stoff 
wechsel.” 
169 170 
Ultra-Violet 
In addition to the changes undergone by protoplasm 
as the result of food ingestion, there must be considered 
also the changes in energy. The potential energy of the 
intake is far greater than the potential energy of the 
output; or, what amounts to the same thing, in passing 
through the body, food intake is accompanied by an 
actual conversion of energy, which appears as heat, 
mechanical work, and electricity. The study of metab- 
olism, therefore, demands a consideration of: 
1. The chemical, or material phase 
2. The dynamic, or energetic phase 
Chemically, metabolism has to do with the physio- 
logical studies of foods, grouped commonly as: 
Proteins 
Carbohydrates 
» Fats 
Minerals 
Water 
and so we speak of the metabolism of protein, of carbo- 
hydrate, etc. 
Proteins, as is known, are composed of entities called 
amino-acids; and the quantity and character of amino- 
acids are constant for every protein. From the viewpoint 
of actinotherapy, it is important to remember that 
certain amino-acids, or certain proteins rich in certain 
amino-acids, display photosensitivity when exposed to 
light. Soret, Kober and Harris and Hoyt have begun 
to throw light on this topic; so that their researches 
should be well studied. Harris and Hoyt presented a 
thesis* in the University of California Publications in 
Pathology, which is reproduced here in full: 
*The action of ultra-violet light on certain bacteria in relation to 
specific absorption by amino-acids. T h e r a p y 
171 
“Within recent years considerable interest has been 
shown in the study of the ultra-violet radiations in 
relation to their toxicity for living protoplasm. It was 
early found that these radiations exert a highly toxic 
influence on protoplasm exposed to them. Henri, in 
conjunction with various co-workers, has done pioneer 
work in this field, and was the first worker to point out 
the possibility of a practical application of this subject, 
namely, in the sterilization of various substances and 
solutions. Further work on the germicidal effect of ultra- 
violet light has been done by Houghton and Davis, who 
found that the rays produced by the Cooper-Hewitt 
mercury arc exert a strong bacterial action on various 
species of bacteria, including spore-forming organisms. 
“The action of these radiations was recognized as a 
photochemical process, and was supposed to be due to 
the absorption of the rays by the bacterial protoplasm. 
In a previous report we studied this phase of the problem 
and proceeded on the basis of the first law of photochem- 
ical action, that in a photochemical system, to be effec- 
tive, the rays must be absorbed, usually by specific 
constituents. We have further shown that the toxic 
action of ultra-violet light obeys this law and is due to 
the absorption of the rays by certain constituents of all 
living protoplasm, namely, the tyrosine and phenyla- 
lanin radicals of the protein molecules. These two acids 
are the specific absorbents in living protoplasm for the 
rays of the mercury arc. 
“The object of the present work was to confirm this 
work, using bacteria as a biological test, and further to 
study the relative speed of absorption of the ultra-violet 
rays by the protoplasm of the various types of bacteria.” 172 
Ultra-Violet 
M ETHODS 
“Three organisms were selected as typifying three 
general groups of bacteria, which are classed on the basis 
of the possession or lack of protective structures, spores 
and capsules. 
1. A non-sporulating, non-capsulated organism, sta- 
phylococcus aureus 
2. A sporulating, non-capsulated organism, bacillus 
subtilis 
3. Acapsulated, non-sporulating organism, B. mucosus 
capsulatus 
“For the exposure of these organisms various methods 
were tried. The organisms were grown on agar slants 
for twenty-four hours, and then washed off with sterile 
0.85 per cent NaCl. A preliminary exposure was made 
with a given amount of each saline suspension exposed 
directly to the rays. As no consistent results were obtained 
by this method, due undoubtedly to the absorption of 
the rays by the upper layers of the bacterial suspension, 
this method was abandoned. 
“A number of plating methods was then tried. 
Melted agar was poured at 42 degrees C and allowed to 
harden in ten centimeter petri dishes. To prevent 
condensation it was found best to cover with sterile tile 
covers. After hardening, three methods of inoculation 
were tried. 
“(a) Two separate streaks were made with a loopful 
of saline suspension, one on either side of the diameter 
of the plate. Half of the plate was then exposed, the other 
half being protected by a glass cover, covered with black 
paper. The plate was then incubated twenty-four hours, 
and the colonies were identified directly, or, in suspicious 
cases, smears were made. The objection to this method T b e r-apy 
173 
was that there was no certainty that the control streak 
and the exposed streak were similarly inoculated. 
“(b) To overcome this objection a single large streak 
in the shape of the letter ‘Z’ was made of one loopful 
of bacterial suspension, and half the plate exposed as 
before. 
“(c) Another plating method experimented with was 
to flood the entire plate with a definite amount of saline 
suspension and then expose one side, as in the above. 
“Plating methods were also abandoned finally because 
they did not yield uniform results, due undoubtedly to 
some organisms getting in under the agar and being 
protected by the protein material. 
“The method finally employed was a cover slip method 
suggested by Professor Ivan C. Hall. Upon one surface 
of a sterile cover slip one loopful of saline suspension of 
a twenty-four hour agar growth was placed and allowed 
to dry in a sterile petri dish. Assuming the saline suspen- 
sion to be uniform each cover slip, therefore, had approxi- 
mately the same number of organisms. When dry the 
cover slips were exposed directly to the rays by placing 
them in a petri dish 12 cm. below the arc of the Cooper- 
Hewitt machine. After the given exposure the cover slip 
was picked up with sterile forceps, dropped into a tube 
of broth (the broth was incubated for forty-eight hours) 
and the results observed. The growth of these three 
organisms in broth is quite characteristic, and no further 
examination was usually necessary. In doubtful cases 
agar plates were streaked from the broth and the organ- 
isms were identified by the usual methods. 
“The exposures varied from 5 seconds to 200 seconds. 
Somewhat over 100 exposures were made, and although 
there were slight discrepancies in the results, due to the 174 
Ultra-Violet 
objections mentioned to plating methods, consistent 
results were obtained by the cover slip method, so that 
we may definitely say that: 
Bacillus mucosus capsulatus was killed after 20 
seconds 
Staphylococcus was killed after 90 seconds 
B. subtilis was killed after 150 seconds 
These figures represent the relative resistance of these 
three organisms. 
“The protective action of the amino-acids was then 
studied. The cover slips were exposed as before, but 
between the cover slip and the arc a quartz beaker con- 
taining the given amino-acid was interposed, so that the 
rays before striking the organisms passed through the 
amino-acids. The results obtained confirm our previous 
work. With B. subtilis, whose normal extermination 
period is 150 seconds, we found exposure for forty minutes 
to ultra-violet light passed through one per cent tyrosin 
solution exerted no toxic effect upon the bacilli, a good 
growth being obtained in forty-eight hours. Similarly, 
staphylococcus aureus gave good growth after forty 
minutes; B. mucosus capsulatus, though not tested after 
longer exposure, gave satisfactory growth after ten 
minutes. 
“A good growth was also obtained with amino-benzoic 
acid after exposure of these organisms for 3200 seconds 
to ultra-violet light detoxicated by passing through this 
substance. Phenylalanin could not be secured, but there 
is little doubt that similar results could be obtained 
with it. 
“These results confirm those of our previous report 
and indicate that the aromatic amino-acid radicals are 
the absorbing substances in bacteria as well as in pro- 
tozoa. Kober’s work placed the absorption band for T hero, py 
175 
tyrosin at 248 to 297u, or 2480-2970 Angstrom units of 
wave length, and for phenylalanin 236-271u, or 2360- 
2710 Angstrom units. 
“Therefore, ultra-violet light, of wave lengths 2360- 
2970 Angstrom units, should contain practically all of 
the rays toxic for protoplasm. Two recent papers have 
appeared, however, which report different results. Brown- 
ing and Russ found the toxic action of ultra-violet light 
falling off sharply at 2960 A. U., which would apparently 
correspond with one edge of the tyrosine band. They 
report, however, an apparently constant toxicity from 
2960-2100 A. U., and did not investigate below 2100 A. U. 
Newcomer reported also a constant toxicity from 2100 
A. U. up to a little less than 2900 A. U., the toxicity 
falling off to practically zero at 2970 A. U. The region 
in which tyrosine and phenylalanin are both absorbed, 
i.e., 2480 to 2710 A. U., should be the most toxic for 
protoplasm, whereas the region containing wave lengths 
shorter than 2300 A. U. should be relatively non-toxic. 
“Our former experiments conclusively demonstrated 
that a solution of tyrosine will absorb practically all of 
the toxic rays, those getting through not being sufficiently 
toxic to kill paramecia after exposure for forty minutes, 
whereas if the rays absorbed by tyrosine were allowed to 
act the paramecia were killed in 100 seconds.” 
Conclusions 
“1. The aromatic amino-acid radicals are among the 
substances in bacteria affected by the action of ultra- 
violet light, as was shown for paramecium in a previous- 
report. 
“2. The ultra-violet radiations produced by the mer- 
cury arc of wave lengths not absorbed by tyrosine and 
phenylalanin are relatively non-toxic. Therefore, using 176 
Ultra-Violet 
Kober’s determinations for the wave lengths correspond- 
ing to these two absorption bands, the ultra-violet radia- 
tions which are toxic for protoplasm are of wave lengths 
from 2480-2710 A. U. 
“3. In the three types of bacteria studied capsulated 
organisms were found to be most susceptible and sporu- 
lating organisms most resistant to the action of ultra- 
violet light.. The work suggests strongly that the proto- 
plasm of Bacillus mucosus capsulatus contains greater 
amounts of the above mentioned substances than the 
non-capsulated staphylococcus and the sporulating hay 
bacillus.” 
A most important message, as conveyed by this study, 
is that the amino-acids tyrosine and phenylalanin impart 
photosensitivity to the protein of which they are a part; 
and it is reasonable to infer, further, that the photo- 
sensitivity is great in proportion as the amino-acids are 
high in the composition of the protein. This generaliza- 
tion leads at once to a critical survey of the protein 
composition of foods. Sherman gives the following table 
for the relative percentage of tyrosine and phenylalanin 
in various common proteins used as food: T h e r a p y 
177 
Albumins 
• 
Globulins 
Egg Al- 
bumin 
(hen’s 
eggs) 
Lactal- 
bumin 
(cow’s 
milk) 
Legume- 
lin 
(pease) 
Leucosin 
(wheat) 
Amandin 
(al- 
monds) 
Edestin 
(hemp 
seed) 
Excelsin 
(Brazil 
nuts) 
Glycinin 
(soy 
beans) 
Legumin 
(pease) 
Phaseo- 
lin 
(white 
beans) 
Vicilin 
(pease) 
Yignin 
(cow 
pea) 
Glycine .... 
0.00 
0.00 
0.50 
O.94 
O.51 
3-8o 
0.60 
O.97 
0.38 
0-55 
0.00 
0.00 
Alanine .... 
2.22 
2.50 
0.92 
4-45 
I.40 
3-6o 
2-33 
* 
2.08 
I.80 
0.50 
O.97 
Valine 
2.50 
0.90 
0.69 
0.18 
0.16 
6.20 
I-5I 
0.68 
* 
I.04 
0.15 
0-34 
Leucine .... 
IO.71 
19.40 
9-63 
H-34 
4-45 
14-5° 
8.70 
8-45 
8.00 
9-65 
9-38 
7.82 
Phenylalanine . . 
5-°7 
2.40 
4-79 
3-83 
2-53 
3-09 
3-55 
3-86 
3-75 
3-25 
3-82 
5-27 
Tyrosine i . . . 
1.77 
4.90 
1.56 
3-34 
X.12 
2.13 
3-03 
1.86 
i-55 
2.84 
2.38 
2.26 
Serine 
* 
* 
* 
* 
0-33 
0-53 
0.38 
Cystine .... 
* 
* 
* 
* 
1.00 
Aspartic acid . . 
2.20 
1.0 
4.11 
3-35 
5-42 
4-5° 
3-85 
3-89 
5-3° 
5-24 
5-30 
3-97 
Glutamic acid . . 
9.10 
IO.I 
12.96 
6-73 
23-14 
18.74 
12.94 
19.46 
16.97 
14-54 
21-34 
16.89 
Arginine .... 
4.91 
3-23 
5-45 
5-94 
11.85 
14.17 
16.1 
5-12 
11.71 
4.87 
8.91 
7.20 
Lysine . ' . . . . 
3-76 
9.16 
3-°3 
2-75 
0.70 
1.65 
1.64 
2.71 
4.98 
4-58 
5-40 
4.28 
Histidine .... 
1.71 
2.06 
2.27 
2.83 
1.58 
2.19 
2.50 
i-39 
1.69 
2.62 
2.47 
3.08 
Proline .... 
3-56 
4.0 
3-96 
3-i8 
2.44 
4.10 
3-65 
3-78 
3-22 
2.77 
4.06 
5-25 
Oxyproline . . . 
* 
* 
* 
* 
* 
* 
* 
Tryptophane . . 
jresent 
3- 
present 
present 
present 
present 
present 
present 
present 
present 
present 
present 
Ammonia .... 
i-34 
1.32 
1.26 
1.41 
3-70 
2.28 
1.80 
2.56 
2.05 
2.06 
2.03 
2.32 
Summation . . 
48.85 
63-97 
Si-i3 
50.27 
59.00 
82.28 
62.20 
54-73 
62.21 
56.19 
65-74 
59-65 
* Not determined. 
Percentages of Amino Acids from Hydrolysis of Various Proteins 178 
Ultra-Violet 
Glutelins 
Alcohol-Soluble Proteins 
Albu- 
minoid 
Phosphoproteins 
Flesh (not single proteins) 
Glutenin 
(wheat) 
. 
Maize 
Glutelin 
Gliadin 
(wheat) 
Horde in 
(barley) 
Prolamin 
of Rye 
Zein 
(maize) 
Gelatin 
Casein 
(cow’s 
milk) 
Ovovi- 
tellin 
(hen’s 
eggs) 
Beef 
Chicken 
Halibut 
Scallop 
Glycine . . 
0.89 
0.25 
0.00 
0.00 
0.13 
0.00 
16.5 
0.00 
0.00 
2.06 
0.68 
0.00 
0.00 
Alanine . . 
4-65 
? 
2.00 
0-43 
1-33 
13-39 
1.6 
I.50 
0.75 
3-72 
2,28 
— 
— 
Valine. . . 
0.24 
? 
3-34 
0.13 
— 
1.88 
1.0 
7.20 
1.87 
0.81 
— 
0.79 
— 
Leucine . . 
5-95 
6.22 
6.62 
5-67 
6.30 
19-55 
9.2 ? 
9-35 
9.87 
11.65 
II.19. 
io-33 
8.78 
Phenylalanine 
1.97 
i-74 
2-35 
5-°3 
2.70 
6-55 
1.0 
3.20 
2-54 
3-15 
3-53 
3-04 
4.90 
Tyrosine . . 
4-2S 
3-78 
1-5° 
1.67 
1.19 
3-55 
0.0 
4-5° 
3-37 
2.20 
2.16 
2-39 
i-95 
Serine . . 
0.74 
? 
0.13 
? 
0.06 
1.02 
0.4 
0.50 
? 
? 
? 
? 
? 
Cystine . . 
0.02 
* 
o-45 
1.00 
* 
* 
— 
0.06 
* 
? 
Aspartic acid 
0.91 
0.63 
0.58 
? 
0.25 
1.71 
1.2 
i-39 
2.13 
4-5i 
3-21 
2-73 
3-47 
Glutamic acid 
23.42 
12.72 
43.66 
43.20 
38.05 
26.17 
16.8 
15-55 
12.95 
iS-49 
16.48 
10.13 
14.88 
Arginine . . 
4.72 
7.06 
3-i6 
2.16 
2.22 
i-55 
9-3 
3-8i 
7.46 
7-47 
6.50 
6-34 
7-38 
Lysine . . 
1.92 
2-93 
0.92 
0.00? 
0.00 
6.0 
7.61 
4.81 
7-59 
7.24 
7-45 
5-77 
Histidine . . 
1.76 
300 
1.84 
1.28 
0-39 
0.82 
0.4 
2.50 
1.90 
1.76 
2-47 
2-55 
2.02 
Proline . . 
4-23 
4.99 
13-22 
13-73 
9.82 
9-°4 
10.4 
6.70 
4.18 
5.82 
4-74 
3-1.7 
2.28 
Oxyproline . 
3-o 
0.23 
Tryptophane 
present 
present 
I..O 
present 
present 
absent 
absent 
I-5° 
present 
present 
present 
present 
present 
Ammonia 
4.01 
2.21 
5.22 
4.84 
5-n 
3-64 
0.4 
1.61 
1-25 
1.07 
1.67 
i-33 
1.08 
Summation . 
59-68 
45-53 
85-99 
79-I4 
67-55 
88.87 
77.2 
67.211 
53-o8 
67.30 
62.15 
50.25 
52.51 
* Not determined in these cases and not, in the cases left blank. In other cases the figures given for cystine 
may be much too low because of decomposition of this amino acid in the process of hydrolyzing the protein. 
\ 1 Fischer and Abderhalden report also diamino-trioxy-dodecanic acid 0.75 %. 
Percentages of Amino Acids from Hydrolysis of Various Proteins Therapy 
179 
A study of Sherman’s tables and Harris’ and Hoyt’s 
premises, reveals important findings. For example, the 
glutelin from maize contains a very high percentage of 
tyrosine as compared to other proteins. Maize and pella- 
gra have been associated for some time.* The skin 
changes in pellagra occur first in the parts exposed to 
sunlight. LeRoy and Pacini, in 1911, showed that pella- 
gra lesions could be quickly induced by exposing a small 
section of a pellegrin’s skin to the highly actinic light of 
burning magnesium ribbon. Obviously, tyrosine photo- 
sensitization plays a significant role in this condition. 
It is curious to observe, also, that all of the proteins 
occurring in foods for which hypersensitization is a com- 
mon finding, such as wheat, egg albumin, lactalbumin, 
are those that in Sherman’s tables show a high content 
of phenylalanin, tyrosine, or both. The question of diet 
is therefore an important consideration in prolonged 
(fractional or systemic) actinotherapy. Where photosen- 
sitization is required, seek protein diets rich in tyrosine 
and phenylalanin; and where photosensitization is not 
desired, eliminate from the diet the proteins rich in these 
two amino-acids. 
In physiological value, proteins vary according to their 
elementary amino-acid composition. Superior proteins 
are classed as milk, meat, eggs, and fish; and inferior 
proteins as bread and Indian corn. 
An important part of protein metabolism is the study 
of nucleic acid and the purins. The nuclei of the cells 
have a very different chemical constitution than the 
protoplasm. 
The Italian adage “Poverta, Pollenta, Pellagra:” (Poverty, yel- 
low corn meal, pellagra). 180 
Ultra-Violet 
In states of under-nutrition, much may be accomplished 
by increasing the energy factor of metabolism through 
the external application of a chemical energy, such as 
ultra-violet represents. The form of therapy would be 
systemic, already described. The biologic air-cooled 
lamp is used; and the conditions treated would include: 
Marasmus 
Scurvy 
Beri-Beri 
Pellagra 
The cachexias of: 
(a) Cancer 
(b) Grave anemias 
(c) Hyperthyroidism 
(d) Band's disease 
The usual diet regulation essentially along the lines 
discussed, must be observed, in addition to the stimula- 
tive erythema of biologic energy according to instructions 
already furnished. 
Just as the biologic synergism displayed by the air- 
cooled lamp in the states of under-nutrition are benefited 
by the biologic energy, so it is proper to infer that the 
abiotic energy of the water-cooled lamp might serve useful 
in checking or arresting the condition of metabolism in 
states of over-nutrition. Here, the short wave lengths 
are efficient; so that the lamp must be used at distances 
of six inches from the body, or less. Longer distances 
diminish the intensity of the short wave lengths owing 
to the increased air filter that automatically enters into 
play. The lamp is held six inches away and kept over the 
area illuminated for the time necessary to produce a 
regenerative erythema, usually one minute. After this 
exposure, another area of the body is similarly treated; Therapy 
181 
and this treatment continued until the whole of the body 
has been attacked. The conditions thus treated would 
include various: 
1. Fatty diatheses, and 
2. Amino-acid dystrophies 
Speaking generally, the basal metabolic rate is an 
excellent index for the indication of the use of air-cooled, 
or water-cooled ultra-violet. High rates may be lowered, 
low rates may be raised, depending upon whether the 
metabolic synergistic or metabolic depressing energy is 
used. 
I 
Finally, it must be remembered that if a chemical 
process is initiated in the body through the use of internal 
medication, such as organo therapeutic agents, that 
process may be accelerated through the use of the air- 
cooled lamp. That is, pituitary extract fed by mouth, 
will produce its effects quicker and more characteris- 
tically if the body is then rayed by ultra-violet. From 
which the conjoint use of endocrine therapy and ultra- 
violet offers a most valuable clinical measure. Osborne* 
summarizes the uses for various glands; to which may be 
added that the additional use of ultra-violet makes for 
a more certain and more prompt expectation of the action. 
1. Thyroid absent = a cretin 
2. Pineal disturbance = precocious sexuality 
3. Thymus insufficiency = too early sexuality 
4. Thymus too long active = delayed puberty 
5. Pituitary hypersecretion = a giant 
6. Pituitary posterior hyposecretion. . 
Pituitary anterior hypersecretion. 
_ overgrowth; 
a fat child 
*Principles of Therapeutics. 182 
Ultra-Violet 
7. Thyroid subsecretion = slow growth; poor mentality; 
obesity 
8. Suprarenal hypersecretion = early maturity; mentally 
active; physically active; if a female = masculinity 
9. Suprarenal hyposecretion = general weakness; non- 
aggressive mentality; if a male = femininity 
10. Gonads hypersecretion = sexual perversity 
Gonads hyposecretion = sexual insufficiency; obesity 
11. Thyroid hypersecretion = Graves’ disease 
Thyroid hyposecretion = many types of abnormal 
conditions 
Teeth 
1. Thyroid normal = good white teeth 
2. Pituitary hypersecretion = large incisors, separated 
3. Gonad hyposecretion = small lateral incisors 
4. Suprarenal hypersecretion = sharp, long canines 
Hair 
1. Thyroid normal = fine hair; normal growth 
2. Thyroid hyposecretion = loss of hair 
3. Suprarenal hypersecretion = hairy; eyebrows heavy 
and meet 
4. Suprarenal hyposecretion = scanty hair; moles and 
pigmented spots 
5. Pituitary hypersecretion = hairy 
Uses of Thyroid Preparation: “Ordinarily, thyroid 
preparations are indicated only when there is some form 
of hypothyroidism. However, in some depressed condi- 
tions in acute infection without delirium and without a 
rapid heart, small doses of thyroid may be of benefit, and 
perhaps when the detoxicating power of the thyroid 
gland has been exerted to exhaustion during an infection 
a little help may be of advantage to the patient. How- Therapy 
183 
ever, generally, such stimulation or aid to the thyroid 
may be given by a small dose of an iodide once or twice 
a day. 
“When there are indications of defective growth in 
children very small doses of thyroid are generally indi- 
cated. This is true when the teeth do not well develop, 
the hair does not grow, the skin is dry, and there are 
enlarged tonsils and adenoids, subnormal temperature, 
and especially when there is sluggish mentality. The 
nearer the child approaches a cretin, the larger the dose 
of thyroid required, for a time at least. When the 
symptoms of hypothyroidism are but few and not very 
marked, the dose should be small, if it is given at all. 
“It is difficult to determine that a child is a cretin until 
at least he is six months of age, and perhaps it cannot 
be determined until he is a year old, and if the secretion 
is only deficient and not abseat, such deficiency may not 
be determined until after the child is two or three years 
of age. A cretin is evidenced by a thick tongue generally 
protruded between the lips, more or less drooling, sluggish 
dentition, imperfect hearing or at least imperfect recogni- 
tion of sounds, the eyes are far apart, there is often 
conjunctivitis and eczematous patches about the face, 
there is likely to be enlarged tonsils and adenoids, and 
perhaps puffing of the eyelids, especially in sporadic 
cases. These symptoms are associated with slow develop- 
ment of the teeth, slow growth, and later the mentality 
is that of a moron, or even that of idiocy. 
“The dose for a cretin a year old may be considered as 
0.06 gm. (1 grain) two or three times a day. If the thyroid 
is begun when the child is older, the dose is larger. Its 
favorable action is shown by an improved mentality, 
increased general growth, and a better growth of the 184 
Ultra-Violet 
hair, nails and teeth. When improvement is in evidence, 
the dose should be diminished, although a small dose 
should probably be given daily, or at least every other 
day, for months and perhaps years. In these cases the 
undesired action of thyroid is generally a tachycardia, 
and when this occurs the dose is too large and the admin- 
istration should be stopped. After the heart has returned 
to normal rapidity, smaller doses should be given. 
“Thyroid transplants have been tried in cretinism, but 
they must be termed a failure. They may help the child 
until the transplanted gland is absorbed, but the trans- 
plant does not continue to grow. When the thyroid 
secretion is not entirely absent in a child, thyroid treat- 
ment for a time may stimulate the gland to increased 
activity, and the dose of thyroid extract may then be 
much diminished. 
“With the minor symptoms of subthyroid secretion in 
children the dose is very much smaller, even as little as 
0.005 gm. daily being often sufficient, and certainly 0.01 
or 0.02 gm. daily is generally enough. 
“Certain types of eczema which occur in children are 
typical of subthyroid secretion, such as occur at the 
orifices of the body, and as fissures under the ears, at 
the corners of the mouth or around the nostrils. These 
patients are often improved by thyroid. 
“At any age dry, scaly skin, of all grades up to actual 
ichthyosis, with profuse desquamation, are benefited by 
thyroid, as all such cases have subthyroid secretion. 
“Some children have a great deal of headache, cold 
hands and feet, and sometimes great lassitude, showing 
sluggish circulation. Many times these patients are 
improved by small doses of thyroid, all of these symptoms 
disappearing and the child becoming much improved, Therapy 
185 
even when all other treatments have failed. The dose 
for such patients is not more than 34 grain, sometimes 
less, once a day for two or three weeks. In the beginning 
one larger dose may be given, as 1 grain. Many of these 
children show signs of insufficient calcium, and especially 
if there is irritability of the nervous system, which 
suggests parathyroid disturbance, calcium is indicated. 
Sometimes in imperfectly developing children a combi- 
nation of a small dose of thyroid and a fair dose of thymus 
extract is indicated, or calcium in some form may be 
given without the thymus extract. 
“Infantile obesity may be associated with subthyroid 
secretion, but is more likely to be associated with a 
disturbed pituitary secretion, probably a subsecretion of 
the posterior lobe of the pituitary. These children 
improve on small doses of thyroid and coincident doses 
of pituitary. But these cases are likely to be associated 
with disturbances of other endocrine glands, and a care- 
ful study of the patient may show what combination is 
needed and what the exact treatment should be. The 
abnormal growth associated with more or less obesity 
is generally due to pituitary disturbance. 
“If puberty does not occur at the proper time, and 
especially in girls, there is generally a lack of thyroid 
secretion, and small doses of thyroid, with perhaps 
ovarian extract, or perhaps only small doses of iodine, 
is what these patients need, and such dosage should be 
given for a considerable period. Symptoms of nervous- 
ness, sleeplessness, and tachycardia, show that either the 
treatment is not needed at all, or the dose is too large. 
“Chlorosis is often as well cured by the administration 
of thyroid extract as by the administration of iron, and 
when normal menstruation develops and continues the 
chlorosis disappears. Too profuse menstruation in young 186 
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girls shows, generally, too much thyroid secretion, and 
mammary extract should be given as advised under the 
uses of the mammary gland. 
“The importance of iodine saturation in young girls at 
or before puberty has already been described, and such 
iodine or iodide treatment will prevent the development 
of simple goiter, to which they are prone if they do not 
have sufficient iodine in their circulation. 
“Sometimes thyroid extract in small doses combined 
with- pituitary extract will cure nocturnal enuresis in 
children, especially if these children show symptoms of 
lack of development. 
“Amenorrhea is of frequent occurrence in women who 
are not pregnant and is generally associated with more 
or less muscular weakness, a tendency to sleep in the 
daytime, more or less indigestion, and with the deposit 
of fat on the breasts, over the shoulders, on the hips, 
and sometimes on the upper part of the arms. When 
this development is excessive, the type of disease termed 
adiposis dolorosa is in evidence, and that disease is 
undoubtedly due to a disturbance of the endocrine 
glands, and is always associated with subsecretion of the 
thyroid. This disease occurs in all degrees of intensity. 
At least in all of the moderate types, and generally in 
the more severe types, thyroid treatment is successful 
in aiding the patient, and sometimes in curing the condi- 
tion. As soon as the woman menstruates normally and 
sufficiently, all the other symptoms are ameliorated; she 
loses more or less weight, although it may not come down 
to normal. On the other hand, having once shown this 
type of condition, unless her whole life is changed, either 
she marries, she becomes pregnant, or something 
changes the whole condition of the endocrine glands. T h e r a p y 
187 
She is likely to have recurrences of this condition through- 
out her life. Sometimes such patients do not menstruate 
for months, to again begin for a period or two, and then 
stop again. Whatever the other treatment is, whether 
ovarian extract,ovarian residue, or corpus luteum,thyroid 
extract is always of great value. Sometimes an iodide 
is all that the patient requires. The value of thyroxin 
for these patients has yet to be determined. 
“When the menopause develops in women, weight is 
always added, and if the secretion of the thyroid is too 
greatly deficient at this time, weight is added rapidly, 
and more or less symptoms of hypothyroidism occur. 
Thyroid extract is the treatment for this condition. The 
dose required is generally not large, often best associated 
with an iodide. The pulse is always slow in these sub- 
thyroid cases, the skin dry, and there is puffiness under 
the eyes, on the hands, or on the feet without any actual 
edema, i.e., there are symptoms of mild myxedema. 
“If myxedema is really in evidence, the eyelids are 
swollen, the teeth decay, the hair falls, hearing becomes 
impaired, mentality sluggish, the blood pressure low, 
the pulse-rate slow, and there are more or less digestive 
disturbances. Thyroid is the treatment, and it is curative. 
The dose of thyroid is always less when an iodide is added 
do it, and thyroxin may be found to be a most successful 
treatment. The dose of thyroid extract should be suffi- 
cient to cause improvement, and after improvement is 
in evidence, the dose should be diminished and then 
continued at the amount required to keep the patient 
normal. 
“Although there are many causes for obesity that occurs 
before the age of forty-five or that occurs as an individual 
condition in a family that is not prone to stoutness, 
endocrine disturbance is generally at the bottom of the 188 
Ultra-Violet 
condition. Thyroid feeding for this kind of obesity has 
often been carried to excess and has often caused very 
undesirable symptoms; but associated with the proper 
diet and the proper amount of exercise, some thyroid 
treatment is generally advisable, perhaps associated with 
other glandular extracts. It should always be remembered 
that with patients who do not show other signs of sub- 
thyroid secretion, thyroid treatment may precipitate 
hyperthyroidism. On this account, many of the so-called 
obesity cures are dangerous, and the sale of thyroid 
extract should be subject to the same restrictions as are 
the narcotics. 
“Thyroid extract has been given in some of the toxemias, 
and particularly in the vomiting of pregnancy, and many 
times it is successful in this condition, although corpus 
luteum is now suggested for that disturbance; but cer- 
tainly normal thryoid secretion is necessary for the health 
of the mother during pregnancy and if that gland is 
subsecreting, thyroid should be administered in small 
doses. Puerperal eclampsia, in which the urine gives no 
evidence of insufficiency of the kidneys, has been attrib- 
uted to thyroid disturbance, and certainly in these cases 
thyroid extract in very large doses has been successful 
in preventing and stopping convulsions. Also, large doses 
of thyroid will at times prevent the convulsions of uremia. 
But thyroid is only a small part of the treatment of the 
serious condition of either puerperal eclampsia or of 
uremia, and is only mentioned here to state that all these 
patients in this serious condition are improved by the 
administration of thyroid associated with other proper 
treatment. The dose in these conditions should be 10, 
20 or even 30 grains of the extract in the first six hours, 
and then repeated only as indicated, depending on the 
results and the symptoms of its action. Therapy 
189 
“At times epileptic attacks are associated with subthy- 
roid secretion, especially the epilepsies which occur at the 
time of the menopause. Many of these cases may have 
their actual cause in mouth infection, which has irritated 
not only the brain, but the thyroid and parathyroid 
glands. It is possible that the parathyroids are always 
disturbed in an epileptic attack. Suffice it to say in this 
connection that cleaning the mouth and throat of infec- 
tion, the administration of thyroid extract and of calcium 
salts will always ameliorate and sometimes cure this type 
of epilepsy. Also, the epilepsies that are aggravated at 
the time of puberty, or are aggravated during pregnancy 
should be managed on this same plan. More or less 
bromides should of course be given while the system is 
righting itself and the irritating substances, or the causes 
are being eliminated, but to perpetuate the detoxication 
of the system, unless there is a contraindication against 
it, thyroid should be given with alkaline salts, and espe- 
cially the calcium salts. All intestinal fermentation and 
putrefaction should be prevented in these cases, and 
generally the patients are better without animal proteins. 
The dose of thyroid in epilepsy cases need not be large, 
perhaps 0.05 Gm. a day, and if this causes increased 
heart action the dose should be reduced. 
“In some forms of digestive disturbances, especially in 
spastic constipation, small doses of thyroid are beneficial 
provided such a condition is associated writh other signs 
of subthyroid secretion. Quite probably very small occa- 
sional doses of thyroxin will be found to be of great benefit 
in these conditions, but it should be emphasized that 
thyroxin is very potent, and as it is urged that thyroid 
extract should be given with the greatest of care, it should 
be more strenuously urged that thyroxin should be given 
with still greater care. 190 
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“In increasing blood pressure as age advances, small 
doses of thyroid, given daily, or less frequently, especially 
if the skin is dry and there is a tendency to chronic 
eczema, and the pulse is slow, are of very great benefit. 
Thyroid secretion is generally what the patient has begun 
to lack at this age. This evidence of lack of thyroid 
secretion may occur earlier in life, depending upon what 
the thyroid has had to do. If it is a woman and she has 
had many pregnancies, or if it is an individual who has 
had many serious illnesses, or has had some chronic 
disease that has caused more or less overaction and 
finally lessened action of the thyroid gland, thyroid ex- 
tract is indicated and will be of benefit. 
“Not infrequently the asthma which occurs in old age 
is prevented by thyroid, perhaps because it aids in prop- 
erly combating the irritations from mal-nitrogenous 
metabolism. At any rate, with high blood pressure asso- 
ciated with asthma, thyroid is of benefit. Perhaps at 
times the reason that iodides have been very successful 
in certain forms of asthma is because they increase thy- 
roid activity. 
“While theoretically thyroid extract is contraindicated 
in profuse hemorrhages, as it generally increases such 
hemorrhages, occasionally in hemophilia thyroid has been 
curative, but generally it has been a failure. However, 
in the peculiar hemorrhages seen at the time of the meno- 
pause in women, thyroid extract is sometimes a specific. 
The dose for this condition should be large for a few 
days, and then it should be given in daily, smaller doses. 
Sometimes this treatment is successful after all other 
treatments have failed, it causing cessation of hemorrhage, 
even when the bleeding has been from the bladder, rec- 
tum, mouth, nose and many other parts of the body. Therapy 
191 
“Thyroid treatment is contra indicated when there are 
symptoms of hypersecretion of the thyroid, when there 
are toxic symptoms from hyperthyroidism, when there is 
sleeplessness, delirium, or any cerebral excitation, when 
there is a rapid heart or any irritability of the heart, 
generally when there are acute inflammations of the skin, 
and when there is progressive loss of weight. 
Uses: “The administration of pituitary extracts for dis- 
turbances of the secretions of the gland have not been 
very successful. Not infrequently, however, pituitary 
headache is cured by the administration of extract from 
the whole gland. If the patient is stout and is a woman, 
and amenorrhea is also a symptom, the combination of 
thyroid and pituitary treatment is very successful, unless 
the headache is due to a tumor. It has been stated that 
posterior lobe extracts would increase the mammary 
secretion, but this has not stood the proof of test. When 
administered by the mouth, instead of increasing the 
blood pressure, it may occasionally cause some depression, 
loss of heart strength, and if long given, emaciation. 
These symptoms may develop because these extracts are 
likely to contain large amounts of extracts of nervous 
tissue or histamin. Abel and Nagayama have found 
considerable histamin in commercial post-pituitary ex- 
tracts. 
“The administration of anterior pituitary has its great- 
est value in dystrophy adiposogenitalis, but such treat- 
ment is more successful if combined with appropriate 
thyroid treatment, and probably it is well, in females, 
to add ovarian extracts and, in males, testicular extracts 
to the treatment. 
“The most important use of extract made from the 
posterior lobe (often termed infundibular extract) is in 
obstetrics. For this purpose it is always given hypoder- 192 
Ultra-Violet 
matically in doses of to 1 mil. The drug has been 
used too frequently, and it may cause asphyxia of the 
child or rupture of the uterus. It should never be used 
unless the cervix is completely dilated and there is no 
obstruction to the free passage of the child through the 
pelvis, and it may always be advisable to administer an 
anesthetic as the head of the child is passing over the 
perineum, if the contractions of the uterus have been 
increased by the pituitary injected. Infundibular extracts 
should not be used in normal labor, and perhaps never 
should be used in a primipara, and the dose should be 
small in a multipara. Under its action the uterine 
contractions are brisk and frequent, and unless the child 
is rapidly born it becomes asphyxiated from interference 
with the placental circulation. In post-partum hemor- 
rhage this preparation is not as valuable as is ergot. 
“Pituitary extracts administered by the mouth have 
sometimes been given in menorrhagia or metrorrhagia, 
but they are not as efficient as ergot unless pituitary 
disturbance is a cause of the bleeding. If there is no 
evident cause for menorrhagia or for too frequent men- 
struation in young girls, mammary extract represents 
the best treatment, although if the girl shows signs of 
pituitary disturbance a combination of these two glan- 
dular extracts will be of greater value. 
“In conditions of cardiac failure and in shock with low 
blood pressure and whenever there is dangerous low 
blood pressure, extracts of the posterior lobe given 
hypodermatically in 1 mil doses are of benefit. It acts 
less rapidly than epinephrine preparations, but its action 
is much more prolonged. It also has an advantage in 
these conditions of promoting activity of the kidneys. 
“After abdominal operations when normal intestinal 
peristalsis is not present and there is a tendency to Ther apy 
193 
tympanites pituitary extracts given hypodermatically 
are of great value. One mil may be injected hypoder- 
matically every twenty-four hours for two or three days, 
and then less frequently until normal tonicity of the 
intestine has returned. If from the paralysis. of the 
intestines gas is pressing on the diaphragm and interfer- 
ing with the heart, a second dose of the hypophysis 
preparation may be given within a few hours after the 
first. 
“If after a laparotomy or after parturition the bladder 
does not act and is semi-paralyzed, pituitary injections 
are of benefit. It is also of value, both when given 
hypodermatically and by the mouth, in continence of 
urine both in adults and in children, and it sometimes 
acts very satisfactorily in nocturnal incontinence. 
“In diabetes insipidus which seems so frequently due 
to hypophysis disturbance, hypodermatic injection of 
posterior lobe extracts often act almost as a specific, 
causing the output of urine to be decreased, the urine 
to be of higher specific gravity and thirst to be stopped, 
and at the same time the headache which so frequently 
accompanies this condition ceases. This preparation or 
any preparation of the pituitary will not have this 
satisfactory action if given by the mouth. Also this 
treatment, even hypodermatically, does not cure the 
condition unless the pituitary becomes normal in its 
activity; consequently the injections must be repeated. 
“Some vasomotor disturbances may be due to dysfunc- 
tion of the pituitary, and neuralgias, weariness and 
muscular weakness may be due to such a condition, and 
may be helped by administering by the mouth extracts 
of the whole gland. When the mother, after parturition, 
does not gain her strength and is weak and miserable, 194 
Ultra-Violet 
there may be pituitary deficiency, and pituitary feeding, 
associated with other proper treatment, will benefit her. 
“It is possible that some cases of epilepsy, especially 
in children and youth, are due to dysfunction of the 
pituitary, probably associated with disturbed function 
of other glands, perhaps more especially of the para- 
thyroids. In appropriate cases administration of prepar- 
ations of the whole gland should be tried. 
Even when pituitary preparations seem positively indi- 
cated, if extracts of the whole gland are long given there 
is likely to be an increase in the formation of uric acid, 
and joint pains may occur. Consequently the results of 
such treatment should be carefully watched. 
“The exact cause of rickets is still not known, although 
it is apparently a mistake of nutrition, but probably not 
entirely one of privation. It has not been shown that 
disturbance of the thymus gland is related to rickets. 
It also has not been shown that disturbance of the 
anterior lobe of the pituitary body is a cause of rickets, 
but it is a fact that this portion of the gland is closely 
related to the formation of solid bone. Consequently, 
in the disease of rickets, besides administering cod liver 
oil and phosphates and good nutritious food, anterior 
pituitary extract should be tried. 
“Charles E. De M. Sajous, who has done so much 
research on the adrenal glands, rightly asserts that some 
of the sudden deaths seen in soldiers after violent exer- 
tion, without apparent heart lesion, is due to hypoadrenia; 
and it has been shown that although the heart may be 
normal and even enlarged and ready to do extra work, 
very small adrenals prevent the possibility of severe 
muscular strain, and such individuals fall, faint, are 
prostrated, or may even suddenly die after hard exertion. Therapy 
195 
Sajous states, as has long been known, that digitalis is 
of no benefit in this kind of circulatory weakness, while 
suprarenal gland is at times of benefit, and, if 0.001 gm. 
(1-60 grain) of epinephrine, dissolved in physiologic 
saline solution, is injected hypodermatically, it may save 
life in these shocked cases. Later suprarenal gland 
extracts may be given by mouth, daily, with benefit. 
“Sajous also emphasizes what Crile has also stated, 
that prolonged excitement, fear, rage, and the general 
strenuosity to which a soldier in active warfare is sub- 
jected may use up his reserve adrenal secretions, and the 
medullary portion of the adrenals become insufficient, 
and he suddenly becomes weakened or shocked. This 
probably represents an important cause of the “shocking” 
of soldiers, and explains the considerable length of time 
necessary for them to build up their reserve secretion 
and become again physically fit. 
“In all shocked conditions from injury, in prostrating 
acute infections such as dysentery, typhoid fever, and 
especially in diphtheria, pneumonia and influenza, the 
adrenals have become insufficient, and from* infections 
they may become actually pathologically disturbed. 
There may be hemorrhages into the glands. In all these 
cases suprarenal extracts should be given, but in not too 
large doses, as a secondary fall of pressure may occur; 
also large doses have caused death. Rest, heat, supra- 
renal feeding, and strychnine in not too large doses is 
the treatment. Of course, the blood-pressure-raising 
properties of caffeine and atropine may be needed to tide 
over the condition, but the cure is brought about by the 
administration of suprarenal, or by the return of the 
adrenals to normal secretion. 
“While part of the neuro-circulatory asthenia of enlisted 
men is due to thyroid hyperactivity, part is also due to 196 
Ultra-Violet 
suprarenal insufficiency. Rather typical of adrenal 
insufficiency are cold hands and feet, and bluing of the 
lips on the least exertion. Although it has been shown 
that epinephrine secretion does not seem necessary for 
the maintenance of normal blood pressure, it is very 
necessary to develop an increased blood pressure when 
the pressure is subnormal and the circulation insufficient. 
“The rise in blood pressure after the administration 
of epinephrine, when given on the tongue or hypoderma- 
tically, or when it is absorbed from mucous membranes 
other than the stomach, quickly occurs, but it does not 
last long. This action is not, however, the action that 
causes the greatest help; it is the stimulation that it 
causes to the suprarenal glands. A blood-pressure- 
raising treatment that lasts such a short time could be 
of only momentary help, consequently, as soon as the 
emergency is past, after administering epinephrine hypo- 
dermatically or on the tongue (though such treatment 
may be repeated a few times, especially on the tongue), 
the greatest advantage from suprarenal treatment is 
obtained by giving the whole gland extracts by the mouth. 
When given in tablet, the tablet should be crushed and 
swallowed with water. The blood-pressure-raising sub- 
stance seems to be changed chemically in the stomach, 
so that it does not cause the usual rise of arterial pressure, 
but the rest of the gland seems to stimulate and help a 
depressed circulatory condition. Also, as above stated, 
in Addison’s disease with pigmentation administering 
the chromaffin part of the glandular substance either 
directly causes a diminution of the surface pigmentation, 
or else it stimulates the adrenal glands to furnish the 
substance which is lacking. The gland by the mouth is 
active, as the author has seen pigmentation disappear 
and a blackened skin become white, when the suprarenal Therapy 
197 
glands were later found, after death, to be riddled with 
tuberculous disease. 
“Too much epinephrine given hypodermatically or on 
the tongue, may cause a low blood pressure and a 
serious disturbance of the respiratory center. The treat- 
ment of such overaction would seem to be atropine and 
caffeine hypodermatically, and artificial respiration. 
Suprarenal extracts often stimulate the heart to better 
activity. After injection of "epinephrine the first rise in 
blood pressure may be soon followed by a fall too often 
to be followed by a second slight rise. 
“Development of the genitalia, especially of the testes, 
may be stimulated by the administration of suprarenal, 
and at times sexual precocity in young children has been 
shown to be associated with disturbances causing hyper- 
secretion of the adrenal cortex. In these young children 
who have this abnormal sexual development, it has been 
generally found that there was a growth of the adrenal 
cortex, most frequently, perhaps, a hypernephroma. In 
milder forms of hypersecretion of the adrenal cortex in 
children there is a more rapid development than normal 
of the pubic hair and of the external sexual organs. 
This condition more frequently occurs with females than 
with males. 
“It is impossible to decide what relation the suprarenal 
glands have to high blood pressure which is so much in 
evidence today. There is no justification for removing 
the suprarenal glands for such a condition at the present 
time, because the exact relation of constant high pressure 
to the suprarenal has not been proved. X-ray treatment 
of these glands has been suggested, but such treatment 
seems of doubtful value, as it would be impossible to 
treat these glands without treating other parts of the 198 
Ultra-Violet 
abdomen or back, probably to the disadvantage of other 
organs. 
“Serious burns of the body have sometimes caused 
adrenal insufficiency and homorrhage into the tissues of 
the glands. Seriously burned, as well as other shocked 
patients, therefore, should receive suprarenal extracts. 
“It has been shown that patients who have the mor- 
phine habit have insufficiency of the suprarenals, and that 
they are also more susceptible to all kinds of poisoning. 
It has also been experimentally shown that any insuffi- 
ciency of the suprarenals increases the susceptibility to 
poisoning. 
“Chloroform and ether anesthesia more or less inhibit 
the output of the suprarenals, and depression following 
anesthesia is well-treated by suprarenal and pituitary 
extracts. 
“Associated with Bright’s disease there may be stimu- 
lation of the suprarenals, and this may be a cause of the 
increase of blood pressure besides what is caused by the 
abnormal amount of irritants in the blood. 
“Just what is the relationship of tobacco to the supra- 
renals has not been determined, especially as nicotine 
has been shown by Stewart and RogofT to inhibit the 
epinephrine output of the suprarenals. Certainly, men 
who are used to smoking have their blood pressure raised 
by tobacco, but the excessive use of tobacco does cause 
low blood pressure and weakening of the circulation. 
This has been supposed to be due to action on the heart 
muscle, but as these experimenters state, it may also be 
due to the inhibition of the epinephrine output, and there- 
fore to a lack of tone of the splanchnic vessels. 
“In any condition of low blood pressure, depression and 
circulatory weakness, whether suprarenal will be of bene- Therapy 
199 
fit, or not, cannot always be determined before the clin- 
ical trial. Jf there are other symptoms of adrenal insuf- 
ficiency, suprarenal feeding is often of value, but in 
ordinary fatigue and in low blood pressure from many 
conditions, the treatment is very disappointing. 
“Many times with indigestion of a functional type sup- 
rarenal helps the patient and corrects the condition. It 
has not been determined why hypersecretion and hypo- 
secretion of the thyroid cause so many gastro-intestinal 
disturbances, but the interrelations of the endocrine 
glands should always be kept in mind. Certain it is that 
sufficient suprarenal secretion seems necessary for normal 
gastrointestinal digestion, and adrenal extracts are some- 
times especially valuable in weak muscle activity of the 
stomach and intestines. 
“In Addison’s disease there may be periods of inter- 
mission, therefore when suprarenal extracts have been 
given and improvement occurs such improvement may 
not be due to the treatment. However, it seems to be 
a fact when the suprarenal glands are not too seriously 
injured that there is some improvement from feeding 
suprarenal extract, and naturally the whole gland must 
be given, the administration of epinephrine representing 
only a small part of the activities of the adrenals. It 
should be given for a long time, a small close once a day. 
Although some symptoms are improved by such treat- 
ment, especially the pigmentation on the skin and mucous 
membranes, if the adrenal glands are seriously diseased 
this treatment cannot save life. Pituitary extracts in 
small doses may be added to the suprarenal treatment, 
as pituitary extract is known to stimulate the adrenals. 
If the patient is benefited by these glandular treatments, 
there is a rise in blood pressure, a better circulation, and 200 
Ultra-Violet 
an improvement in digestion and nutrition, and, as just 
stated, the pigmentation disappears. 
“The value of suprarenal and especially of epinephrine 
in asthma has now long been noted. An epinephrine 
tablet crushed with the teeth and allowed to absorb in 
the mouth, or five to ten drops of epinephrine solution 
of 1 part of 1000, will usually stop an asthmatic attack. 
Also, the solution has been sprayed directly into the 
larynx with success. Large doses of epinephrine intra- 
venously or hypodermatically have caused death. Not 
every patient, however, is helped by epinephrine treat- 
ment; some patients are more benefited by nitroglycerin. 
“It is not always possible to foretell which patient will 
be improved by which method of treatment, as the two 
treatments are opposed to one another. Theoretically, 
if the blood pressure is high, nitroglycerin would be the 
treatment; if the blood pressure is low, adrenal or epine- 
phrine preparations would be the treatment. There has 
seemed to be some relation between disturbances of the 
suprarenal glands and asthma, and perhaps, the adrenals 
are disturbed in various anaphylactic reactions, espe- 
cially in those that are associated with shock, and asthma 
many times represents an anaphylactic reaction. Rarely, 
however, is suprarenal treatment a cure for asthma, even 
if it is successful in stopping the paroxysms. The cause 
of the action must be sought and treated. 
“It has been suggested that a dose of epinephrine, to 
be absorbed from the mouth, should-be given before the 
intravenous injection of arsphenamine, as tending to pre- 
vent some of the unpleasant symptoms that may follow 
such an injection. The dose should be given an hour 
before the injection, and then perhaps another dose just 
before the intravenous injection is given. Ther apy 
201 
“Auer and Meltzer have shown experimentally that 
there is more lasting blood-pressure-raising effect from 
epinephrine if it is given intraspinally. This would seem 
to be a valuable suggestion for trial in every shocked 
condition that did not react to other methods of treat- 
ment. Sajous advises that in acute shock and in heart 
failure (acute adrenal failure he terms it) during an acute 
infection, hypodermic injections be given of 10 minims of 
a 1 to 1000 epinephrine solution, in a syringeful of saline 
solution, every tw'o hours for three doses, and then four 
times daily, if needed. 
“In morphine and opium poisoning when artificial res- 
piration is apparently saving life, many times death is 
finally due to heart failure. Therefore if the pulse is not 
good, or at any time becomes feeble in such poisoning, 
epinephrine solutions on the tongue, hypodermatically 
or intraspinally, should be considered. 
“Suprarenal spraysand snuffs have been used frequently 
in hay fever, and in the eye in certain inflammations, 
and locally to cause blanching of a part to prevent hem- 
orrhage before minor operations; it has, also, been sprayed 
into the throat or larynx, or swabbed over irritated 
regions of the tonsils or pharynx, to control acute con- 
gestions. The relief from shrinking of the tissues and a 
diminution of the swelling is very great, but unless used 
repeatedly, there is likely to be renewed swelling and, 
sometimes, a greater congestion than before. Occasion- 
ally a patient has considerable irritation from suprarenal 
sprays in the nose or mouth, such as serious sneezing 
and even pain. There is no habit formed from the use 
of suprarenal extracts. 
“Epinephrine is added to different preparations of co- 
caine for local anesthesia, and renders the anesthesia 
more lasting and the bleeding during the operation less. 202 
Ultra-Violet 
There may be a considerable rise in the blood pressure 
from the use of epinephrine solutions on the mucous mem- 
branes, but it should be remembered that the blood- 
pressure-raising substance is destroyed when the solution 
tablets or powders are taken into the stomach. 
“The value of suprarenal in hemorrhagic conditions and 
purpura is not very great. Occasionally, it has seemed to 
have been of some value, but other treatments are better. 
“With patients who are neurasthenic and always have 
a low type of circulation, suprarenal may be of benefit, 
but it must be given for a long period, and unless there 
is good suprarenal tissue to be stimulated, any permanent 
success is doubtful. There seems to be no question that 
there are individuals who always have an insufficient 
secretion from the adrenals. 
“Just how much of the activities of the ovaries may be 
given a female patient by feeding preparations of the 
whole gland is difficult to determine, but many times 
feeding of these extracts after ovarian extirpation has 
caused a cessation of the disturbing symptoms of the arti- 
ficial menopause. Frequently a better treatment is to 
combine ovarian substance with a small dose of thyroid, 
if this gland is apparently under-secreting. 
“Ovarian extract will sometimes wake up a lackadaisical 
patient and greatly benefit the individual, while at other 
times it fails to show any activity. This may be because 
ovarian extracts deteriorate and the active elements in 
them may become disorganized. If there are indications 
for administering corpus luteum, there is no question 
about the activity of that extract; but it cannot be long 
given as it is depressant to the circulation. It is quite 
possible, although not yet well demonstrated, that in 
slowly developing girls the administration of ovarian 
extracts is of value. T h e r a p y 
203 
“If for any reason both ovaries must be removed, the 
administration of ovarian extracts is logical and may be 
a help while the other endocrine glands are re-arranging 
their functions to meet the new condition; there is no 
doubt of such an interrelationship or that the glands 
endeavor to minimize the disturbance caused by the loss 
of one of their number. Whatever the disturbance of 
the individual is, the physician with a knowledge of what 
has happened, plus a study of the symptoms present, and 
a thorough knowledge of the function of each gland, can 
determine wffiat is best for him to give in the way of 
glandular medication. The physician, frequently, should 
prescribe an appropriate combination of the glands whose 
functions he thinks are insufficient. 
“It is probably very frequent in older girls and in young 
women that there is an insufficiency of the ovarian secre- 
tion. Whether this deficiency is best met by stimulating 
the thyroid with iodine, by feeding ovarian extract, by 
small doses of corpus luteum, or by giving ovarian residue, 
must be decided by clinicians, and by clinical studies. 
When the right combination or the right glandular extract 
is found and given, the improvement in the patient is 
sometimes phenomenal. Digestive disturbances, head- 
aches, and dysmenorrhea disappear, and the whole mental 
and physical condition of the patient is improved. 
“With the advance of the science of surgery and the 
ability to preserve normal tissues for most any length of 
time, it will probably be found advisable and possible 
when total extirpation of the ovaries must be done, or 
when both ovaries are seriously diseased, or when they 
have not developed and apparently there is an absence 
of ovarian secretion, that transplantation of healthy 
ovarian tissue will be more frequently and successfully 
accomplished. 204 
Ultra-Violet 
“It has not been shown that the administration of 
thymus is of value in the development of young children, 
although when associated with the administration of 
calcium preparations and phosphates, it may be of some 
value. There would seem to be no question that the 
thymus has something to do with bone formation, but 
whether its oral administration is of any advantage in 
insufficient bone growth is still a question for future 
decision. 
“It has been suggested that it maybe of advantage in 
certain mental conditions, but success with such treat- 
ment has not been proved. Rickets is undoubtedly, par- 
tially at least, due to a vitamine deficiency which may be 
furnished by cod liver oil, or perhaps by butter, but the 
addition of thymus gland extracts to the treatment of 
the child can do no harm. 
“Although thymus extracts injected hypodermatically 
lower blood pressure, given by the mouth it does not seem 
to cause any disturbance of the circulation. The admin- 
istration of these extracts is often of value in some of 
the disturbances of Graves’ disease, some patients being 
repeatedly made better by thymus treatment when they 
have recurrences of the thyroid disturbance. Thymus 
feeding is probably inadvisable when there is uric acid 
disturbance, or in leucocytosis in any form. 
“The dose of thymus is uncertain. Tablets may be 
obtained made from the thymus of the calf, each tablet 
representing five grains of the fresh substance of the 
gland.” INDEX 
Page 
ABBE 92 
Abiotic Action 29 
Abiotic Actinotherapy 156 
Achondroplasia :.. 110 
Acne Vulgaris 130 
Actinotherapy in Metabolism.. . 169 
Active Tonsils 143 
Adapters 27 
Alopecia Areata 131 
Amino-Acid Constitution of Pro- 
teins 177 & 178 
Amino-Acid Dystrophies 181 
Anabolism 41 
Anaphylactic Reactions 100 
ANDREWS 126 
Anemia 120 
Angio-Neurotic Edema 120 
Angstrom Unit 18 
Antritis 152 
Bactericidal Actinotherapy 138 
BARKER 49 
BARNARD 91 
BAYLISS 40 
BECQUEREL 20 
Beri-Beri 180 
Biologic Phosphorescence 106 
Biosensitization 137 
BO VIE 5 
Broken Doses 62 
BUCKNER 100 
“Building-Up” 13 
Cachexia 180 
Cachexia of Cancer 180 
Cachexia of Banti’s Disease. . . . 180 
Cachexia of Grave Anemia 180 
Cachexia of Hyperthyroidism. . . 180 
Calcium Fixation 100 
Calcium Lactate 101 
Calcium Metabolism 99 
Cancer 103 
Cardiac Spasm 61 
CASE 135 
Central Ray . 116 
Chlorosis 121 
Chronic Ulcerative Radioderma- 
titis 136 
CLARK, JANET 18 
Cod-Liver Oil and Ultra-Violet . 113 
Compression 46 
Cosine Law 117 
CRAMER 103 
Deathpoint of Bacteria 35 
Dehematization 46 
Delayed Union in Fractures. . . . 113 
Dermatitis Seborrheica 133 
Dermographia 23 
Desquamative Erythema 24 
Diabetic Ulcers 136 
Diphtheria Carriers 146 
Diseases of the Bone 108 
Page 
Distinguishing between Air-Cooled 
and Water-Cooled Lamp.... 19 
DRAPER 20 
Dysmenorrhea 67 
ECKER 100 
Effect of Angle of Incidence. ... 31 
Endocrine Therapy and Ultra- 
Violet 181 
Erythema 23 
Ethmoiditis 152 
Exposure Time for Intensive 
Irradiation 27 
Eye Applicator 39 
Factors Affecting Sensitivity.... 26 
Fatty Diatheses 181 
Filters 46 
FINSEN Treatment 163 
Focal Treatment 25 
Fractional Actinotherapy.... 29 & 77 
Fractures 112 
Frontal Sinusitis 152 
Furunculosis 134 
GASSUL 30 
Gastralgia 58 
Gastric Ulcers 65 
Gastritis, Acute 63 
Gastritis, Chronic 64 
General Actinotherapy 29 & 90 
Glass Filtered Sunlight 77 
GLITSCHER 18 
Goldzieher 103 
Gonorrheal Vaginitis 155 
HARRIS 170 
HASSELBALCII 18 
Hay Fever 100 
HEAD 47 
HKALY 100 
Heat, Effect of 20 
HERSCHEL 20 
HESS 105 
HOYT 170 
Human Infection Carriers 145 
Hydrogen Peroxide Decomposi- 
tion 40 
Hyperalgesic Localization 48 
Hyperchlorhydria 60 
Hyperemia 23 
Hypoactive Tonsil 143 
Infected Tonsils 143 
Influenza Carrier 151 
Intensive Actinotherapy 123 
Intensive Treatment 25 
“Ironing” 46 
KARSNER 100 
KASTLE 100 
Katabolism 41 
ICO BE R 170 
KOHLER 92 
LEROY 179 Page 
Leucocytic Pathology 122 
Leucopenia 36 
LEVY 30 
Lobstein’s Disease Ill 
Localizing Tube 28 
LOGRASSO 30 
Low Intensity Treatment 30 
LUCKIESH 21 
Lupus Erythematosus 126 
Lupus Vulgaris 125 
Lymphocytosis 36 
Marasmus 180 
McKEE 126 
“Medicinal" Gastric Ulcers 66 
Meningitis Carriers 146 
Menorrhagia 69 
Mecury Hammer 13 
Metabolism 41 
Metrorrhagia 69 
Modified Rollier Chart 80 
Naevi 130 & 158 
NELA RESEARCH LABORA- 
TORY 21 
Neuralgia '134 
Objective Reactions ' 25 
Optical Contact 138 
Orificial Applicator 37 
OSBORNE 181 
Osteogenesis Imperfecta Ill 
Osteomalacia Ill 
Osteoporosis 103 & 110 
OSTERBAUT 99 
Paranasal Sinusitis 152 
Pellagra 179 
Pelvic Cellulitis 73 
Pelvic Inflammation 71 
Pelvic Peritonitis 72 
Phenylalanin 176 
Phosphorus Metabolism 99 
Photosensitive Amino-Acids.... 176 
Photosensitive Dyes 40. 
Photosensitive Proteins 176 
Phototherapy Lamp 123 
Pityriasis Rosea 133 
Pneumonia Carriers 149 
Port Wine Mark 128 & 157 
Potts Disease 84 
POWER 104 
Properties Air-Cooled Lamp .... 23 
Prophylactic Uses of Ultra-Violet 89 
Prostatic Applicator 38 
Protein Sensitivity Tests 100 
Pruritus 132 
Puerperal Sepsis 89 
Pyloric Spasm 61 
Radium Burns 134 
Regenerative Erythema 24 
Regional Actinotherapy 29 <t 47 
Residual Bactericidal Effect.... 36 
Rickets 104 & 110 
RIDEAL 21 
RITTER 20 
ROLLIER 30 
Rule for Frequency of Exposure 33 
Rule for Increase in Exposure... 32 
RUSS 20 
Page 
Salpingitis 70 
Sargent’s White Line 23 
Scrofuloderma 126 
Scurvy 180 
Selective Affinity of the Nuclear 
Structures 98 
Selective Filtration 18 
Sensitivity of Various Parts.... 26 
SHEPPARD 45 
SHIPLEY 105 
SIMON 145 
Sinusitis 152 
SO RET 170 
Spectrum 14 
SPENCER 92 
Sphenoiditis 152 
Stimulative Erythema 24 
Streptococcus Infections 151 
Subjective Reactions 25 
Systemic Irradiation 29 
Table of Cord Segments 49 
TAYLOR 21 
Telangiectases 127 
Tetany 103 
TISDALL 99 
Tonsils 138 
Tonsil Applicator 39 
Toxic Anemia 121 
Transplants 119 
Tuberculosis of the Elbow 85 
Tuberculosis of the Foot 85 
Tuberculosis of the Hip 84 
Tuberculosis of the Joints 85 
Tuberculosis of the Knee 84 
Tuberculosis Orificialis 126 
Tuberculous Peritonitis 85 
Tuberculosis Verrucosus Cutis. . 126 
Tuberculosis of the Wrist 85 
Tuberculous Lymph Nodes 85 
Tyrosine 176 
Ulcerative Vaginitis 155 
Ulcers 136 
Ulcus Cruris 136 
Ulcus Perforans Pedis 136 
Ultra-Violet Absorption 18 
LTltra-Violet Microscope 94 
Ultra-Violet Microscopy 91 
Ultra-Violet Photomicrographs.. 95 
Vaginal Applicator 38 
Vaginitis 154 
Vasoconstriction 23 
Vasodilatation 24 
Visceral Congestion Following 
Body Irradiation 87 
Visceral Engorgement 30 
WARD 20 
Water-Cooled Lamp 34 
Wave-Lengths of Colors 16 
Wave-Lengths Far Ultra-Violet. 16 
Wave-Lengths Near Ultra-Violet 16 
Wave-Lengths X-Ray 16 
WELLS 102 
WITHER BEE 144 
WOOD 5 
X-Ray and Ultra-Violet 112 
X-Ray Burns 134 
Zonesof Cutaneous Hyperalgesia58-59