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was a step in the direction of progress. Oudin reported many
cases of obstinate eczema which had been treated and cured by
his device. Oudin's results were verified by many eminent
observers.

I shall refrain from any detailed description of apparatus,
taking it for granted that most of you are familiar with the
salient points of the technical auxiliaries. I shall confine myself
to the electro-therapeutic technique of these applications.

There are three principal ways of applying the high-fre-
quency current, to- wit :

1. By means of a glass-electrode, which is brought in direct
contact with and rubbed over the skin.

2. By means of a brush-discharge from a suitable elec-
trode.

3. By means of direct sparks from the electrodal surface.
These different methods of application may be used in turn

on the same patient. There is everything in individualization.
The technical indications differ with each case.



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American Electro-Therapeutic and X-Ray Era. 35a

Oudin is very precise in stating the various conditions which
might affect the technical indications of these applications. He
describes accurately the electrodes he uses — e. g., the glass
electrode and the fine metal brush. When there is no inflamma-
tory reaction, no redness, no acute process, he employs the
fine metal brush. This is his technique in chronic eczema,
psoriasis, etc. Where there is much irritation and inflamma-
tory reaction (acute eczema), or if the seat of the trouble is a
mucous membrane, he uses the glass electrode. Sometimes
there are indications which make the use of the glass electrode
undesirable. If the skin is cracked the minute sparks from the
glass electrode are apt to irritate the fissures and cause violent
stinging pain. In these cases the brush is preferable, since it
does not irritate by sparking. A good deal depends upon the
technical dexterity of the operator in applying and removing
the electrode.

The relative frequency and the duration of the treatments
are important questions which have much to do with the ulti-
mate outcome of the treatment. At first H>egan to make daily
and prolonged applications in order to get quick results. I
soon found that it does not produce good results to push the
treatment. I soon realized that Oudin's rule to make an appli-
' cation every other day and not to prolong it over 5 or 10 min-
utes was a safe rule to follow. How soon can we expect re-
sults ? This depends altogether upon the case. Sometimes we
can accomplish a complete result after two or three sittings.
At other times ten, fifteen or twenty treatments are necessary.

It is a peculiar fact that in some cases the benefit seems to
cease after a certain number of treatments. The case seems
to become stationary, as it were, after a period of rapid and
marked improvement. When this state of affairs becomes
manifest, suspension of the treatment for two or three weeks
is indicated. After two or three weeks the treatment can be
resumed and continued with increasing benefit until the cure
is complete. An occasional interruption of the treatment seems
to have a salutary effect. The subsequent treatments become
more effective. There are no fixed rules by which the fre-
quency and the duration of the treatments can be determined.
We must remember that in many instances we are not treating



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356 American Electro-Therapeutic and X-Ray Era.

an eczema, but a diathesis, a disposition toward eczema, or, if
I may express myself in this way, an eczematous organism.
It is all a question of individualizing. Some patients require
delicate and discreet handling, while others can stand heroic
treatment. If we do not wish to fail we must take into consid-
eration the condition of the patient, the history of the afflic-
tion, etc. The character of the apparatus to be used is of some
importance.

Bollaan de la Haye narrates the following incident : "I was
using the Oudin instrument with the glass electrode on my
first cases and got very poor results indeed. The first seven
cases I treated showed no improvement. Some of them seemed
to get worse. I attributed this state of affairs to my own lack
of experience and dexterity. At times I was tempted to doubt
the efficiency of the apparatus. I had the apparatus looked
after. It was found to be very much at fault It could not
produce the proper kind of a high-frequency current. After
the apparatus had been gone over carefully and existing faults
corrected I began the treatment of my seven cases over again,
and was delighted with the improvements which followed in all
of them." The first sign of improvement is, as a rule, the
disappearance of pruritus. We are all familiar with this most
distressing symptom of chronic eczema and with the difficulty
which is encountered in trying to relieve it by drugs and local
applications. The high-frequency current relieves the itching
in 95 per cent of cases. All authors agree on this point. After
the pruritus ceases the crust gradually loosens and drops off.
Normal conditions are soon established. In the moist and
fissured varieties of eczema the skin becomes dry and the fis-
sures heal up. Sometimes a sudden recurrence takes place.
One or two additional treatments usually make the cure com-
plete and permanent. At times the patient is best treated in
short sittings once every other day. It is important to remem-
ber the harm which is often done by too much treatment.

I beg to submit to you the reports of eleven cases which I
have treated. The result in these cases was invariably good.
In one case the result was incomplete because the patient
stopped the treatment when he was relieved of the itching.

Fissured Eczema of the Fingers. — M. M., age 40, case being



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American Electro-Therapeutic and X-Ray Era. 357

one of seven years' standing. Fingers show many deep, painful
and angry-looking fissures. Ten applications, one every day,
were not followed by any noticeable improvement. I used the
Oudin instrument with the glass electrode. After ten appli-
cations of the high-frequency current I substituted the static
breeze r the result being prompt improvement after three ap^
plications.

Chronic Eczema of the Wrist. — Mrs. D., cook, 35, suffered
from intolerable itching. Static applications relieved the
pruritus, but had no effect on the eczematous condition. Fif-
teen applications of the high-frequency current resulted in a
cure.

Eczema of Hand. — Mr. D., chemist, 38, sustained a phos-
phorus burn, which led to the development of a large eczema-
tous patch on the right hand, involving the thenar eminence,
palm of hand and the phalangeal articulations of the little and
middle fingers. The eczema was angry-looking and fissured.
Static applications were of no avail. The high-frequency cur-
rent relieved the itching and caused the fissures to granulate
and close. In spite of the fact that the patient did not take
treatment regularly, the result was a complete cure.

Eczema of Right Elbow.— Mrs. G., housekeeper, suffered
from an eczematous patch of the right elbow. Pruritus was
very severe. Itching was promptly relieved. Patient was well
after ten applications of the high-frequency current.

Multiple Eczema. — Miss B., age 21, had eczematous patches
on the forehead, upper lip and thumb of right hand for twenty
years. Patient was cured in ten sittings.

Moist Eczema of tlie Hands. — Mrs. A., 40, had eczema since
childhood. Discharge ceased after the first high-frequency
treatment. The patient, while still under treatment, is fast
getting well.

Eczema Around the Anal Orifice. — Mrs. H. had suffered
for many years. After the third treatment the discharge
ceased, after the sixth the fissures began to heal. Ten treat-
ments resulted in a complete cure.

Four Common Cases of Eczema of different parts of the
body were cured by the high-frequency current in from three
to ten treatments.



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358 American Electro-Therapeutic and X-Ray Era.

In giving a clinical analysis of these cases it behooves me to
state that the good results following the use of the high-
frequency current are due in an almost equal measure to the
general tonic effect of the current on the whole system and to
the local action of the current. Oudin, d'Arsonval and Leduc
have called attention to the powerful action of the high-fre-
quency current on the physiological processes of nutrition,
respiration, metabolism, excretion of urine and the circulation.
The correctness of these observations has been clinically dem-
onstrated by Apostoli and Berlioz. Moutier and Doumer have
verified the statements made in reference to the effect of the
high-frequency zone (intra-solenoid or diasolenic zone) on
the vaso-motors, on the quantity of oxyhemoglobin in the
blood, etc. There is no doubt as to the intense effect which
high-frequency currents will produce on every phase of nutri-
tion.

Locally these currents affect the functional activity of the
nerves of the skin. That these currents possess a decided
germicidal power there is no doubt. Oudin states most em-
phatically that the high-frequency currents influence the body
temperature, combustion, arterial pressure and the function of
the sweat glands. These currents affect the blood supply of the
skin, the erectile functions of the cutaneous papillae and the
nutrition of the excretory glands of the skin. The anti-bacterial
action .of the high-frequency current has been studied by many
observers. Some attribute the effect to the increase of the local
metabolism which follows the application of a high-frequency
current, others believe in the existence of an antitoxic element
in the current itself. The following statement made by Oudin
and Doumer probably represents the stattis quo of this question,
as far as the opinion of the best operators is concerned : "There
is no doubt that the high-frequency current plays a most im-
portant anti-microbe role. We believe that their anti-bacterial
action is due to the manner in which they affect the local cir-
culation and secondarily the nutrition of the cellular elements
of the parts. By actively draining the capillaries they stimulate
phagocytosis, increase the general resisting power of the or-
ganism/'

The germicidal action of the current does not seem to mani-



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American Electro-Therapeutic and X-Ray Era. 359

fest itself to such a marked degree if the application is made
by means of the so-called "electric zone" (diasolenic zone,
intra-solenoid zone). In order to produce the characteristic
effects of the high-frequency current locally in cases of cutane-
ous diseases the application should be made by means of a
suitable electrode. For my part I believe that the best and
most permanent effects can be produced by a combination of
both methods, to-wit : The use of the "electric zone" in order
to affect the metabolic process locally and generally, and the
employment of a suitable electrode for the purpose of direct
local application. The treatments are to be from ten to fifteen
minutes every day or two. In all cases the operator must
know how to individualize in keeping with the existing con-
dition and with his knowledge of the therapeutic indications.

It is but fair to state that the pioneer work along the lines
of high-frequency currents was done by the late M". Apostoli,
whose assistant and associate I have had the honor of being.
It was he who first called attention to the remarkable palliative
and curative power of the high-frequency current.

(Translator's Note. — The electric zone of which the author
speaks is that electrically surcharged areola which surrounds
the source and the conductors of high-voltage currents. A
glass electrode which is held in this zone lights up without any
wire or cord. It is this "zone" which gives the solenoids their
peculiar therapeutic power. The diasolenic attachment to the
static machine which has been used very extensively in the
laboratories of the Cincinnati Post-Graduate School of Physio-
logical Therapeutics combines the electrodal and zonal effects
of high frequency.)




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360 American Electro-Therapeutic and X-Ray Era.

RADIOPHOBIA AND RADIOMANIA.

(Read at meeting of Southern California Electro-Medical So-
ciety, June 2nd, 1903.)

At the present time the attitude of the medical profession
toward X-ray therapy is decidedly multiplex; from the most
ardent X-ray enthusiast who believes he can cure all ills of
mankind down to the ultra-conservative, who has not yet ac-
cepted vaccination nor antitoxin, and who is antagonistic to all
forms of modern therapy.

Under the head of "radiomania" we can classify those who
run to extremes with the X-ray and make theraputic use of this
agent upon the slightest provocation. This is the most dan-
gerous type of practitioner to meet with, both for the conserva-
tive radiologist and for the cause of scientific radiotherapy.
Very often this man's knowledge of the X-ray is extremely
limited, being based upon the brief possession of an X-ray
generator, together with some literature, which is still too new
for him to make safe following. His premature results and
sometimes published reports have given our cause a black eye
and greatly discredited more honest efforts. Happily the radio-
maniac is becoming scarce and will no doubt be obsolete in due
time. This is owing to the fact that the X-rays are now being
placed upon a definite therapeutic basis, and their limitations
established with comparative accuracy.

By "radiophobia" we mean, of course, an undue fear of the
X-ray. To this class belong those who are afraid to make
use of the rays or else do not use them sufficiently strong, fear-
ing burns or other untoward results. This is largely due to the
newspaper reports in which are chronicled startling accounts
of alleged X-ray burns and an occasional damage suit. A
wholesome fear of the X-rays is a good thing, both for the phy-
sician who uses them and for the patient, but to treat a case
in a half-hearted way, using an insufficient amount of these
rays is almost as bad as overdosing. From published reports
of cases treated it is evident that not a few suffer from radi-
ophobia when it is stated that twenty or thirty treatments were
given in such and such a case, without producing any effect
on the skin or condition present. Some of these cases could



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American Electro-Therapeutic* and X-Ray Era. 361

undoubtedly have been influenced if proper dosage had been
applied.

A retrospective view of the literature which covers the field
of X-ray science will convince the careful student that very lit-
tle has been added to our knowledge of the physical properties
of this force since Roentgen's original classic paper was pub-
lished to the world. It is true that we have improved marked-
ly in our technique of application and have learned to equalize
the forces at work in our generating apparatus, to the produc-
tion of the best X-radiance. We have, as yet, however, only
fairly entered upon the proper study and application of this
potent factor. Notwithstanding these facts, however, prob-
ably no single agent to-day is applied therapeutically for a
greater diversity of disease than the Roentgen rays.

Has this new therapeutic entity come up to our expectations
and fulfilled the predictions made for it? I maintain that it
has already done so in a great many directions, and that it gives
promise of becoming the greatest factor in modern medicine
and surgery.

From my own experience with the X-ray I can state in gen-
eral terms that almost any eruptive lesion or neoplasm on the
skin is amenable to this treatment. The acute exanthematous
conditions, of course, being excepted. Epithelioma, rodent
ulcer, lupus, circumscribed eczema and acneaform eruptions
usually yield readily. In deep-seated tumors or involvement
it is a little early to make any definite statement. Symptomatic
relief is often obtained, but it is doubtful if many cases treated
have so far resulted in permanent cures.

In regard to burns — When treating over sound skin it is
often desirable to produce a mild dermatitis or tanning, so
called, for this lowers the resistance of the skin and enables
us to apply more current. Under no circumstances, however,
is it necessary to produce a destruction of the skin which re-
sults in an ugly sloughing wound that may take months and
months to heal. I have under my care at present a lady whose
entire abdomen was denuded while being X-rayed in a local
quack electrical institute for a vague internal trouble. A case
of this kind, which always becomes widely chronicled, /will



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362 Atrierit&n Electro-Therap'euiic and X-Ray Era.

give X-ray therapy a greater set-back than a dozen meritorious
cures can overcome.

" We all know that the public has become very much interested
in the X-ray and are desirous of testing its curative powers.
No one has been quicker to recognize this than the unprincipled
charlatan who has equipped himself with the necessary ap-
paratus and flaringly advertises the sure cure of every disease
fextant. The only way for the legitimate physician to suc-
cessfully cope with these quacks is to prepare himself by care-
ful study and to install the required apparatus for this work.

The future of radiotherapy is assured and it only remains
for this society which has been so successfully inaugurated to
begin the good work.

I sincerely trust that it may be the privilege of this society to
establish radiotherapy upon a firm ethical basis in southern
California and accord it the prominent place in therapeutics it
demands.

ALBERT SOILAND, M. D.,
Instructor in Electrotherapeutics and Radiology, College of
Medicine, Unwersity of Southern California; Lecturer on
Medical Electricity California Hospital Training School
for Nurses; Radiographer to the Southern Pacific and
Santa Fe Rys., Los Angeles, Cal.




A SUGGESTION FOR RADIOGRAPHING THE FOOT
AND LEG OR THE FLEXED ARM IN AN
ANTERO-POSTERIOR DIRECTION.
Professor Sinclair Tousey in the issue of August 29 of the
combined New York Medical Journal and Philadelphia Medical
Journal has an article, "An Improvement in Radiography."
He says that a print may be made by direct exposure and de-
veloped in half a minute without a dark room. In his method
the usual photographic plate is replaced by sensitized paper.



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American Electro-Therapeutic and X-<Ray* Eta. 363

The fact that X-rays act upon sensitized paper has been
known almost since Roentgen's discovery. But every X-ray
expert knows why the usual method of radiographing is far
superior in the vast majority of cases. He knows that the time
saved in the development of the paper does not at all counter-
balance the manifold disadvantages of a prolonged exposure
required in the use of sensitized paper. To this must also be
added the greater detail obtained in the use of the plate.

There is one condition, however, when the plate might better
be replaced by a sensitized film which requires no longer expo-
sure than a plate — namely, in radiographing the flexed arm and
leg or the foot above and below the ankle joint. (See
sketches.)




Fig. 1.

As far as I know, Prof. Hoffa and Dr. Wolffenstein in Ber-
lin were the first to employ this method, and if I remember
well it was at a meeting of the "Berliner Verein fur Innere
Medicin" in the month of March of this year, that he first
demonstrated his results. He employed the method especially
in photographing the ankle joint. A piece of film or sensitized
paper inclosed in a black envelop was closely attached to the



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364 American Electro-Therapeutic and X-Ray Era.




Fig. 2.



foot and then the photograph taken. Even here, however, there
was some distortion produced, as the projection of the different
bones was not equal, because the angle of the rays was differ-
ent for different parts of the film.

In order to overcome this disadvantage I suggest the ar-
rangement shown in Fig. 2. A half cylinder of lead, to which
is attached by clamps the enveloped film, so that it closely
touches the metal, is put in a symmetrical position to the foot
or bent extremity, and then the focus of the anode is put in
the axis of the cylinder. It is evident that by this arrange-
ment the least distortion is obtained ; first, as all the rays strike
the film at right angles, all parts of which are at an equal
distance from the focus, and second, because the shadows cast
by the bones suffer the minimum of distortion.

K. G. FRANK, PH. D.



FOR WHAT CONDITIONS AND HOW SHOULD

X-RAYS BE USED.

Abstract from a paper in the Cincinnati Lancet-Clinic by Edw.

H. Shields, Cincinnati, Ohio.

The author states that the X-ray is no cure-all and that it

is of value only in superficial lesions. He says that rapidly

growing epitheliomata are more quickly influenced by the ray



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American Electro-Therapeutic and X-Ray Era. 365

than those of slow growth because the former are more cellu-
lar and the cells yield quickly to the treatment. He now
protects his patients with a paper mask shellacked upon the
inner surface and covered with four layers of tinfoil applied
externally. This mask is light and conforms to the shape of
the face. The patient is protected from electro-static shdcks.
A metal helmet is used to protect the hair. A window is cut
in the mask large enough to permit the treatment of any
lesion on the face. The convex surface of the tube is placed
about three inches from the part to be treated. He considers
it absolutely necessary to produce a superficial necrosis and
therefore applies the rays daily for ten minutes until the
symptoms of a reaction appear. It is then time to be careful
in order not to produce a too severe dermatitis.

The author treated five cases of lupus vulgaris with good
result. He exposes not oftener than two or three times per
week aiming to give only very mild treatments since the dis-
eased area is very cellular and breaks down easily. He does
not favor the use of the X-ray in the treatment of psoriasis,
acne or eczema, claiming that the more usual remedies are
more efficacious. He found that the treatment was not ef-
fective in the permanent removal of superfluous hair and
regards it as attended with some danger of pigmentation.
The hair is sure to return in six months.

REPORTS OF CASES.

"Thirty-one cases of epithelioma were treated with the
X-ray, and the result in every case with one exception has
been perfect, but we are satisfied that after further treatment
this case will also result in a cure.

"In all of our cases the ray was applied daily from eight
to fifteen days ; invariably a reaction set in between this time,
and from then on the ray had to applied less frequently in
order to keep the reaction within bounds.

"During the course of treatment of the various cases it was
noticed that the base of the ulcers, which were indurated, un-
even and covered with pale granulations, became smoother,
softer and fedder in appearance; that the edges, which were
elevated and indurated, first became undermined, and later,
when they became softer, fell in, making the ulcer smaller.



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366 American Electro-Therapeutic and X-Ray Era.

This process of so called 'cleaning up' continued until all of
the. epitheliomatous structure had sloughed out, leaving a
clean, soft, ulcerating wound, which now possessed none of
: its original characteristics, and from then on filled up rapidly
and cicatrized, leaving a soft, smooth and movable scar, which
in many instances resembled normal skin. The one unfavor-
able case had been treated with pastes, and, there being a
recurrence, she was referred to us for treatment. The epi-
thelioma made its appearance in the scar tissue, and was there-
fore very hard. In cases of this kind the ray acts very slowly
in dissolving the tissues; the atypical structures apparently
come away, leaving the tough scar tissue, and the lesion ha$
the appearance of being well, while in reality much of the
typical epithelial structure is imbedded in the scar tissue, and
if the treatment is stopped too soon you can surely expect a
recurrence; such was our experience.

"In all of these cases we have found that after the ray once
begins to act a steady headway is made, and up to the present
time we have had no unfavorable or disastrous results.

"Our experience in lesions located upon the lip has been



Online LibraryChicago Electro-Medical SocietyArchives of electrology and radiology, Volume 3 → online text (page 33 of 39)