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OXFORD MEDICAL PUBLICATIONS



THE PRINCIPLES OF

ELECTROTHERAPY



THE PRINCIPLES OF

ELECTROTHERAPY

AND THEIR PRACTICAL APPLICATION



BY



W. J. TURRELL

M.A., D.M., B.CH. (OXON.), D.M.R. & E. (CANTAB.)

CONSULTING PHYSICIAN, OXFORD COUNTY AND CITY MENTAL HOSPITAL ; PHYSICIAN IN

CHARGE OF THE PHYSIOTHERAPY DEPARTMENT, RADCLIFFE INFIRMARY, OXFORD
MAJOR R.A.M.C.T. ; LATE MEDICAL OFFICER IN CHARGE OF THE PHYSIOTHERAPY

DEPARTMENT, THIRD SOUTHERN GENERAL HOSPITAL, OXFORD

VICE-PRESIDENT, ELECTRO-THERAPEUTIC SECTION, ROYAL SOCIETY OF MEDICINE
VICE-PRESIDENT, BRITISH ASSOCIATION OF RADIOLOGY AND PHYSIOTHERAPY
HONORARY FELLOW OF THB AMERICAN ELECTRO-THERAPEUTIC ASSOCIATION



Siquid novisti rectius istis,
candidus imperti : si non, his utere mecum.

HORACE, Ep. i 6. 67-8.



LONDON
HENRY FROWDE AND HODDER & STOUGHTON

THE LANCET BUILDING
1 & 2 BEDFORD STREET, STRAND, W.C. 2



Published ig22



PRINTED IN ENGLAND

AT THE OXFORD UNIVERSITY PRESS

BY FREDERICK HALL



a



PREFACE

THIS book is the outcome of an attempt to explain the
therapeutic action of electricity upon rational grounds
and upon physiological principles.

In Part I current electricity is discussed. The thera-
peutic action of static electricity is here considered,
because it is mainly the currents derived from the static
machine, and not the static charge itself, which possess
therapeutic action. The static machine serves to generate
a static charge, which, when sufficient voltage has been
attained, discharges as a current of very low intensity,
but of very high potential, and so affords methods of
therapy unattainable by other means.

The necessity of clearly distinguishing between the
polar and inter-polar action of the constant current is
pointed out. The action of interrupted currents of low
frequency is shown to be due to the relatively high
velocity of the hydrogen ion compared to the velocities
of the other ions in the tissues.

The steps by which D'Arsonval was led to the discovery
of high-frequency currents are described, with extracts
from D'Arsonval's original paper. The action both of
high-frequency currents of tension and of quantity are
fully discussed.

The second part of this book deals with the fascinating
and difficult task of explaining the therapeutic action of
radiant energy. Tracing this method of treatment from
its general principles we are led step by step to formulate
a new hypothesis, or, perhaps, to develop an existing
theory of the therapeutic action of the radiation from an
X-ray tube or radium. We first of all note the funda-
mental identity of the mode of action of ultra-violet
radiation with that of the radiation from X-rays and,



26733



vi PREFACE

radium. We realize that radiation, like light, only acts
when it is absorbed, and we next find that Kohler has
shown that the nuclei of the cells in the gill plate of the
salamander are ' particularly opaque to light of the wave
length of the ultra-violet ' (Bayliss). Tracing this subject
farther we learn from Dr. Regaud that it is the chromatin
of the nuclei, at the time of their division, which is the
most radio-sensitive component of the human tissues, and
consequently is the first to be destroyed by the radiation
of X-rays. We are, then, met with the difficulty that the
immediate destruction of the cells does not account for
the latent period which precedes the characteristic
reactions of both ultra-violet radiation and X-rays. To
account for this latent period, we suggest the setting free
of some toxin resulting from the splitting up of the
chromatin. Passing on later to discuss the very important
question of the action of X-rays on the blood, we find that
the presence of such a destructive toxin or ferment,
a leucolysin, has been clearly demonstrated by Cursh-
mann and Gaupp, as occurring after the exposure of
a leukaemic patient to X-rays. We are thus enabled not
only to complete the evidence in support of our theory,
but also to suggest an explanation of the recognized
diminution in the efficiency of repeated radiation by
X-rays in the treatment cf leukaemia, on the possible and
rational ground that, as the outcome of the action of the
toxin, antibodies are developed which render the white
corpuscles less radio-sensitive.

The recent work of the Erlangen gynaecologists,
Drs. Seitz and Wintz, appears likely to revolutionize
to a very large extent our views on radiotherapy. At
first sight we are apt, impressed by the great increase in
the power of their apparatus and the prolonged exposure
which they administer, to lose sight of the careful and far-
reaching experiments upon which their methods are based.

It is, however, from the latter, and especially from their
systematic tabulation of the varying lethal doses required



PREFACE vii

to destroy different types of cells that the most lasting
and valuable results are likely to spring. A single instance
will suffice to illustrate this point : if 40 per cent, of the
unit skin dose, as Drs. Seitz and Wintz state, has the
effect of stimulating rather than destroying cancer cells,
then the present practice of employing prophylactic
radiation, before operation, and also post-operative
radiation, should be immediately discontinued. For the
doses generally given in this country for these purposes do
not usually exceed this 40 per cent., and consequently
their application is far more likely to prove harmful than
beneficial : moreover, the necessary lethal dose required
to destroy cancer cells is far too drastic and provokes
too grave constitutional disturbances to be used for pro-
phylactic purposes.

It is not possible within the limits of this book to give
more than a broad outline of the work of the Erlangen
technique, and it is far too early to pronounce definitely
upon its merits ; but as it is certain that this method of
treatment will exercise a most powerful influence on the
future of radiotherapy, an attempt has been made to
deal briefly with its essential points.

The third part is concerned with electro-diagnosis. The
chief portion, dealing with the electrical diagnosis of
peripheral nerve lesions, has already appeared in the
American Journal of Electrotherapeutics. A chapter on
the electro-diagnosis of certain diseases has been added.

The fourth part explains the action of electrotherapy
in some of the diseased conditions for which it is applied,
and indications are given of the type of case suitable for
electrical treatment. To this part some practical hints
on treatment are added.

In the compilation of this book I have drawn very
largely upon the writings of French electrotherapists in
no other way would it be possible to deal adequately with
this subject. No student of the history of electrotherapy
can fail to recognize the fact that this form of treatment



viii PREFACE

was first placed upon a scientific basis as the result of the
work of French scientists. Imbued, perhaps, with the
pride of antiquity, we trace the pedigree of this speciality
back to the writings of the ancient Greeks : yet, neverthe-
less, every electrotherapist, whatever his nationality may
be, is proud to claim as the Founder and the Father of
Modern Electrotherapy that great scientist, Duchenne,
of Boulogne, whom a French speaker so well described as
' the man who has played a preponderating part in the
researches and discoveries, upon which the edifice of
neuro-pathology has been erected '. These researches
were based upon, and these discoveries resulted from as
Duchenne himself states ' a method of electrization,
which surpassed his expectation in yielding scientific and
practical results of the highest importance '.

I am especially indebted to the writings of Professor
Bergonie, Drs. Miramond Laroquette, Nogier, Bordier,
Beclere, Larat, Regaud, Max Roques, and MM. David
and Desplats.

Due acknowledgement must also be made of the
assistance in reference to the static machine which I have
received from the writings of Dr. Benham Snow, of New
York, who has done so much to develop the use of this
instrument ; and in connexion with the same subject
I should like to record my indebtedness to Dr. Howard
Humphris, to whose kindness I owed my first introduc-
tion to this useful machine, and also many valuable hints
in regard to the methods of employing the currents
derived from it. In dealing with radiant energy I have
been greatly assisted by Professor Merton's kind advice
and helpful criticism. Like other radiotherapists in this
country I was indebted for my earliest information of the
Wintz method to Dr. Reginald Morton, whose paper,
published in the Proceedings of the Royal Society of Medicine,
I have so largely drawn upon when dealing with that
intensive method of radiotherapy. I have also, in dis-
cussing this important subject, availed myself of some



PREFACE ix

extracts from the comprehensive book of Drs. Seitz and
Wintz.

To Dr. E. D. Adrian, of Cambridge, whose experimental
work has done so much to elucidate the principles upon
which electro-diagnosis is based, I owe my thanks for
his kind permission to utilize the illuminating diagrams
of a case of recovering facial paralysis. Finally, I must
not omit to acknowledge the great assistance I have
derived from repeated and careful perusal of that mine of
physiological information, Professor Bayliss's Principles
of General Physiology.

In conclusion, I would venture to express the sincere
hope that this small book may in some slight degree help
to harness to the service of the healing art, the most
powerful, the most easily regulated, and the most funda-
mental force in nature.

W. J. T.



CONTENTS

PART I

THE THERAPEUTIC ACTION OF CURRENT
ELECTRICITY

CHAP. PAGE

I. THE CONSTANT CURRENT i

II. INTERRUPTED CURRENTS OF Low FREQUENCY 29

III. INTERRUPTED CURRENTS OF HIGH FREQUENCY 45

IV. CURRENTS DERIVED FROM THE STATIC

MACHINE 61



PART II

THE THERAPEUTIC ACTION OF RADIANT

ENERGY

I. RADIANT HEAT AND LIGHT ... 91

II. ULTRA-VIOLET RADIATION .... 99

III. X-RAYS in



PART III

ELECTRO-DIAGNOSIS

I. PERIPHERAL NERVE LESIONS . . . 127
II. NERVOUS ANDOTHER DISEASES . . . 143



CONTENTS xi

PART IV

AN OUTLINE OF THE APPLICATION AND OF
THE MODE OF ACTION OF ELECTRICITY IN
CERTAIN DISEASED CONDITIONS

CHAP. PAGE

I. THE GENERAL PRINCIPLES OF ELECTRO-
THERAPY ...... 150

II. DISEASES AND INJURIES OF THE MUSCLES,

LIGAMENTS, AND JOINTS . . . 155

III. THE DISEASES AND INJURIES OF THE NERVOUS

SYSTEM 166

IV. DISEASES OF THE CIRCULATORY AND RESPI-

RATORY SYSTEMS ..... 195

V. DISEASES OF THE DIGESTIVE SYSTEM, AND OF

NUTRITION ...... 202

VI. THE GENITO-URINARY SYSTEM . . .219

VII. DISEASES OF THE BLOOD, AND THE GLANDS. 236

VIII. DISEASES OF THE SKIN .... 248

IX. THE DISEASES OF THE ORGANS OF SPECIAL

SENSE ....... 261

X. ELECTRICITY AS A SURGICAL AGENT . . 262
INDEX . . . .267



LIST OF ILLUSTRATIONS

FIG. PAGE

1. Rectangular vessel divided by membranous partition

to illustrate osmosis and formation of ions . . 3

2. Author's experiment to illustrate transport of ions . 7

3. 4. Chatsky's first and second experiments ... 9

5. Leduc's experiment ....... 10

6. A modification of Lapicque's instrument for the selec-

tive stimulation of paralysed muscles ... 39

7. The author's surger ..... -44

8. Type of unidirectional discharge from a condenser . 46

9. Type of oscillatory discharge from a condenser . . 46

10. Diagram of high-frequency oscillations of tension . 50

11. Diagram of high-frequency oscillations of quantity

(diathermy) ....... 5

12. The electrophorus . . . . . . .61

13. Diagram to illustrate the action of an influence machine 63

14. Diagram of static charge .... ' 7 1

15. Diagram of static breeze .... 76

1 6. The static induced current ..... 83

17. Diagram showing the method of obtaining H.F.

currents from the static machine .... 87

1 8. Diagram of the arrangement of the static machine for

the administration of the Morton wave current . 88

19. The ' self -hardening water boiling ' tube (the Wintz tube) 121

20. Diagram to illustrate Adrian's Curves . . 134

21. Adrian's Curves of Facial Paralysis (peripheral) . 135

22. Myograph of myotonic contraction showing the primary

and the secondary contraction . . . .145

23. Myograph showing a variety of the myotonic contrac-

tion, with the secondary contraction higher than the

primary ........ 146

24. Dr. Sankey's radiograph illustrating the case of double

cervical ribs ....... 178

25. Diagram to illustrate the author's method of surging

the Morton wave current ..... 204

26. Case of alopecia areata before treatment . . . 250

27. The same patient after three months' treatment by

ultra-violet radiation from the tungsten arc . .251

28. Case of congenital hairy mole ..... 258

29. The same patient during a prolonged course of treat-

ment by indirect diathermy ..... 259



THE
PRINCIPLES OF ELECTROTHERAPY

PART I

THE THERAPEUTIC ACTION OF
CURRENT ELECTRICITY

CHAPTER I

THE THERAPEUTIC ACTION OF THE
CONSTANT CURRENT

THE therapeutic effects of the galvanic current vary
with its method of application. If the current is inter-
rupted, reversed, or suddenly varied in intensity, muscular
contractions are excited and influence its action. When
the current is continuous and maintains a permanent
value between make and break (the constant current), its
action at the electrodes is not of the same nature as in the
interpolar path through the tissues : for at the electrodes
electrolytic effects are manifested, and these result in
tissue destruction, both by electrical decomposition and
by the chemical action of the electrolytic products.

It is in the interpolar path through the tissues of the
body that the galvanic current exercises its most impor-
tant action, and produces therapeutic effects which are
more generally useful than any other form of electrical
treatment. It is very difficult, however, to explain
clearly and definitely the nature of this action. The
explanation usually given, that the beneficial effects are
due to the ' ionic interchange ' which takes place in the
tissues, does little more than beg the question : for what
is this ionic interchange that takes place, and how does

TURRELL JJ



2 THE THERAPEUTIC ACTION OF

it affect the nutrition and metabolism of the tissue cells ?
The fact that thermal changes take place in the interpolar
path admits of no question, for they can be readily
demonstrated during the course of a galvanic treatment.
But to what is this increase in temperature due, and what
are its effects ? Is it merely due to the resistance offered
to the passage of the current in accordance with Joule's
Law ? Or is it in part due to chemical action, or to
increased cellular activity due to '.ionic interchange ' in
the tissues ?

Again, take the case of a knee joint with much fibrous
thickening, the result of chronic rheumatism. The skin
of such a joint is glossy, denuded of hair, and is in a
generally atrophic condition. After a prolonged course
for some months of intensive galvanism, the fibrous
thickening is much reduced, the pain is lessened or entirely
removed, the mobility of the joint is increased, the skin
has lost its atrophic appearance, and the growth of hair
on the part is probably in excess of the normal. To what
are we to attribute these changes ? Is the disappearance
of the fibrous tissue due solely to an increased blood
supply consequent on the increased heat produced in the
part by the passage of the current, or has the current
some more direct action, such as by electrolysis, namely,
the splitting up of the newly-formed fibrous tissue, in
a manner somewhat analogous to the destructive effects
of X-rays and ultra-violet radiation by the ionization of
newly-formed fibrous tissue cells? Can the improvement be
in any way attributed to the local action of drugs conveyed
deeply into the tissues by the electrical current, that is to
say, by the action of the so-called ' ionic ' medication ' ?

Further, are the nutritional effects on the skin due to
the direct, or to the reflex effects of its repeated stimula-
tion ? That is to say, are these effects the result of direct
stimulation of the skin by the electrolytic formation of
hydrochloric acid at the anode, and caustic soda at the
kathode ? Or are they due to the reflex action o: such



THE CONSTANT CURRENT 3

stimulation resulting, not only in an increased blood
supply to the part stimulated, but in a hyperaemia shared
by the whole limb ? Finally, does the passage of an
electrical current through the body modify or influence
in any degree the normal or disordered electrical processes
of the organism ?

These questions open a very wide field for discussion ;
it is probable that the action of the galvanic current on
living tissues is a very complex one, and is not due to any




\



FIG. i. Rectangular vessel divided by membranous partition
to illustrate osmosis and formation of ions.

single one of the above-suggested causes. To what extent
each of them may share in producing the therapeutic
results can be best ascertained by a brief resume of the
physical action of the galvanic current.

If we take a rectangular vessel A, divided into two
compartments c and D by a membranous partition B, and
fill these two compartments with a solution of uniform
concentration and character, the osmotic pressure (namely,
the force exciting diffusion of the fluids through the
membrane) is equal ; or, as it is termed, isotonic. But
if the molecular concentration of the solution in D is
greater than that of the solution in c, the osmotic pressure
of the solution in D is said to be hyper-tonic, and that in
c hypo-tonic. In other words, the osmotic pressure of
a solution is directly proportional to its concentration in

B 2



4 THE THERAPEUTIC ACTION OF

unit volume. Certain substances, such as the salts, when
dissolved in water, exercise an osmotic pressure greater
than can be explained by their molecular concentration.
Therefore it is suggested that the molecules have been
divided into smaller particles or sub-molecules. Substances
which give in watery solution this increased osmotic
pressure are found to conduct the electrical current, and
their solutions are at the two poles split up or decomposed
by the passage of the current. These substances include
the acids, bases, and salts. They are termed electrolytes,
or ionogens, and the smaller substances into which they
are split up are called ' ions ' or travellers, a name first
conferred upon them by Faraday, and derived from the
Greek word tor.

Substances such as alcohol, sugar, chloroform, whose
solutions give a normal osmotic pressure and do not con-
duct the electrical current, are termed ' non-electrolytes '.

When a salt, such as sodium chloride, is dissolved in
water, it is split up or dissociated, without the application
of any external force, into a positively charged sodium ion
and a negatively charged chlorine ion On the application
of an electrical current, the positively charged sodium ion
is attracted towards, and carries its electrical charge down
to, the negative pole, and is hence called a kation. The
negatively charged chlorine ion is attracted by the positive
pole, and hence carries its charge up to the positive pole,
and is called an anion. The current is hence a double one.

This process of the dissociation of salts or other ' iono-
gens ' into ions is termed ' ionization '. This term
' ionization ' is used in electrotherapy in a very confusing
and faulty manner ; it is frequently employed to designate
a form of treatment which has no relation whatever to
the correct application of the term. Let us clearly under-
stand what is correctly implied by the term.

The term ionization, when applied to a liquid, implies
the dissociation of a substance into ions without the
application of any external force, as is the case when



THE CONSTANT CURRENT 5

a salt is dissolved in water. The term ionization, when
applied to gases, implies the splitting up of the molecules
of the gas or air into ions, by the application of an external
force, such as X-rays or ultra-violet light : the gas, or air,
is, by means of this external force, rendered a conductor
of electricity in the same way as water is so converted by
the dissociation of a salt into ions, the action of the
X-rays on the air or gas resulting in the formation of
both positive and negative ions.

The kations consist of the metals and hydrogen. The
anions include iodine, chlorine, the bases, and acid
radicles, such as hydroxyl, OH.

It is the ions which convey the current through the
electrolyte ; the anions carrying a negative charge to the
positive pole, and the kations carrying a positive charge
to the negative pole. In the words of Leduc, the move-
ment of the ions in the electrolyte ' est le courant elec-
trique lui-meme '. The dissociated molecules, whilst they
are in the ionic state, do not exhibit their former chemical
affinities.

The electrical charge of the ion, according to Nernst,
momentarily replaces the affinity of the atom. When the
atom or radicle has lost this charge, its affinity reappears
(Nogier). 1

Apart from variations due to temperature and E.M.F.,
ions have a specific rate of movement according to their
nature. The resistance, and conversely the conductivity
o'f electrolytic solutions is determined by the number of
ions they contain, and by the rate of movement of those ions.

The velocity of the different ions is partly in relation to
their atomic weight, and is partly due to their hydration,
namely, the number of molecules of water that they
attract to themselves (2).

1 It would, perhaps, be more explicit to say that the chemical
affinity of an atom in an ionic state is temporarily inhibited by
the electrostatic attraction of a neighbouring and oppositely
charged ion. W. J. T.



6 THE THERAPEUTIC ACTION OF

The conductivity of the following ions is taken from the
tables of Kohlrausch and Holborn :

Kations : Potassium 65-3. Sodium 44-4. Lithium 35-5. Hydrogen

3i8.
Anions : Chlorine 65-9. Iodine 66-7. 1/280469-7. Hydroxyl 174.

It will be noticed that among the kations the hydrogen
ion, and among the anions the hydroxyl ion, is by far the
fastest. It will be also seen that the lithium ion, which
has an atomic weight of only seven, travels at little more
than half the rate of the potassium ion, which has an
atomic weight of thirty-nine. The low velocity of the
lithium ion is due to its hydration, namely, the large
number of molecules of water which are attached to it.

These ions, which are present in millions in electrolytic
solutions, have, on account of the resistance they encounter
and their frequent collision with the undissociated mole-
cules in the solution, a very slow rate of travel.

The ionic velocity in an electrolyte varies directly with
the E.M.F. The larger the surface of the electrodes, the
greater the number of ions which will be included in the
interpolar path, and hence the greater the amount of
current which will be carried with a constant E.M.F. In
an electrolyte of one square centimetre cross-section, with
a fall of potential (Potential Gradient) of one volt per
centimetre length, the hydrogen ion has been found to
move only at the rate of 0-0033 cm. per second, and the
potassium ion at 0-00067 cm - P er second.

According to Kohlrausch's Law of the Independent
Migration of Ions, the conductivity of an electrolyte,
containing a variety of ions with varying velocities, is the
sum of the velocities of the individual ions.

One of the most striking, and, from the electrothera-
peutic standpoint, one of the most important character-
istics of the passage of a galvanic current through an
electrolyte, is the absence of any chemical action in the
general bulk of the electrolyte as the result of the passage
of the ions ; it is only when the ions reach the electrodes



THE CONSTANT CURRENT



and there surrender their electrical charges that they
regain their chemical affinities and exercise their specific
reactions. The following experiment of Hittorf's illus-
trates this : Take a rectangular glass jar, divided by-
means of two porous plates into three divisions. Having
filled each of the compartments with a solution of copper
sulphate, place in each of the outer divisions a copper
electrode, and connect one of these with the positive, and




Kl



A 13 C

FIG. 2. Author's experiment to illustrate transport of ions.

the other with the negative terminal of an electrical


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