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 A manual of electro-static modes of appl 
 
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A MANUAL OF 
 
 electro-static modes of 
 Application, Therapeutics, 
 Radiography, and .■>■■ 
 radiotherapy 
 
 THIRD EDITION 
 
 BY 
 
 William Benham Snow, M. D. 
 
 "Professor of Electro-Therapeutics and Radiotherapy in the New 
 
 York School of Physical Therapeutics, Editor of the 
 
 Journal of Advanced Therapeutics, and late 
 
 Instructor in Electro-Therapeutics in the 
 
 New York Post-Graduate School, etc. 
 
 NEW YORK 
 
 A. L. CHATTERTON & CO. 
 
 1904 
 
r\ c . 1 7 & \ i 
 
 COPYRIGHT, 1904, 
 BY 
 
 WILLIAM BENHAM SNOW, M. D. 
 
 S£7 
 
 THE MERSHON COMPANY PRESS, 
 RAHWAY, N. J. 
 
PREFACE. 
 
 After careful review of the literature treating of static 
 electro-therapeutics, including comments and treatises of re- 
 cent dates, the writer finds no work which will guide the prac- 
 titioner first undertaking to operate a static machine in many 
 important procedures. One only, Hedley, gives more than a 
 suggestion of the most recent and most valuable of all forms 
 of electrical administration — the Morton wave-current. 
 
 Hedley gives an outline descriptive of the method, but no 
 allusion to its therapeutic value and indications. Others de- 
 vote considerable space to the " static-induced," or what some 
 choose to call the " Leyden-jar current," but lose sight of the 
 most important current. 
 
 The writer's association with the ablest living authority on 
 static electro-therapeutics, Professor William J. Morton, M. D., 
 of New York, and familiarity with his work at the time the 
 therapeutic uses of the " wave-current " were developed, af- 
 forded him an opportunity to make many experiments which 
 have helped to demonstrate its great value. He feels justified, 
 therefore, in adding to the present literature a practical work 
 covering some of the gaps not filled in by others. It will be 
 the aim of the writer to make clear, concise, and explicit all 
 practical methods of administration, devoting as little space 
 to pathology, diagnosis, and the study of disease as is deemed 
 necessary to clearly define the course of treatment. Those 
 who care to know more of the physics of static electricity are 
 referred to the standard works on the subject. 
 
 William Benham Snow. 
 
PREFACE TO SECOND EDITION. 
 
 The first edition of this work, which had been prepared for 
 publication in a serial, was written more than two years ago, 
 and contained many imperfections. Care has been taken in 
 the second edition to make such changes and corrections as 
 will place the subject before the reader in a more concise style 
 and include the later developments of the subject. 
 
 It was also the purpose of the first edition, when the work 
 was undertaken, to include Skiagraphy. A section has been 
 added to this work covering this subject and also one devoted 
 to Radiotherapy. 
 
 These great subjects are still in a stage of development, and 
 while it has been the author's effort to treat of them in a con- 
 servative and practical manner, he well realizes that in the 
 future opinions will change as a consequence of the growth of 
 a new science. 
 
 It is hoped that the readers, appreciating the necessity of 
 continued investigation from the fact that there is much yet to 
 be demonstrated, will accept the work in the spirit in which 
 the writer has undertaken it and add their efforts to perfect 
 and make widely known subjects of such value to the suffer- 
 ing. 
 
 At best, a work at this time can only mark the progress of 
 the employment of electricity and the Roentgen ray. 
 
 W. B. S. 
 
PREFACE TO THIRD EDITION. 
 
 The demand for the previous large edition of this work 
 having exhausted the issue within a few months, the writer 
 feels justified in publishing a third edition. 
 
 The short time since the publication of the last edition has 
 created so few changes in methods that this one is essentially 
 the same, except for a few alterations in definition and ex- 
 pression, together with the substitution of some cuts for others 
 showing recent progress in apparatus. 
 
 The writer wishes to express his profound appreciation to 
 the profession for many kind expressions which have greatly 
 exceeded his expectations. 
 
 W. B. S. 
 
CONTENTS. 
 
 SECTION I. 
 
 ELECTRO-STATIC MODES OF APPLICATION AND 
 THERAPEUTICS. 
 
 CHAPTER I. 
 
 PAGES 
 
 Introduction, . . . . 1-4 
 
 Relative Merits of Currents. 
 
 CHAPTER II. 
 
 Apparatus, ... 5-17 
 
 First Type of Influence Machine — Holtz Machine — Toepler- 
 Holtz Machine — Source of Current Voltage — Value of Current 
 Amperage — Test of Capacity of Static Machines — Insulated 
 Platform — Operating Chair — Numerous Electrodes — Muffler — 
 Power for Running Static Machines. 
 
 CHAPTER III. 
 
 Care of the Machine and Management during Periods of 
 
 Humidity, 18-22 
 
 Method of Absorbing Moisture in the Case — Renovation of 
 Static Machine. 
 
 CHAPTER IV. 
 
 Charging the Machine, Determination of Polarity, and 
 
 Provisions for Grounding, 23-26 
 
 CHAPTER V. 
 Classification of Static Modalities, . . . .27 
 
xii CONTENTS. 
 
 CHAPTER VI. 
 
 PAGES 
 
 The Disruptive Methods of Application, . . . 28-32 
 
 History of the Administration of Sparks — Technique of Ad- 
 ministering Sparks — The Indirect Spark — The Direct Spark — 
 The Friction Spark — The Leyden-Jar Spark. 
 
 CHAPTER VII. N 
 
 The Convective Modes of Administration, 33-47 
 
 Static Electrification — Interrupted Electrification — Breeze or 
 Souffle — The Spray — The Brush-Discharge — High-Frequency 
 Discharges — Method of Employing Geissler and Vacuum 
 Tubes. 
 
 CHAPTER VIII. 
 
 Conductive Discharges, . . 48-61 
 
 Static-Induced Current — Wave-Current — • Wave-Current In- 
 tensified — Wave-Current Technique of Application. 
 
 CHAPTER IX. 
 
 Physiological Actions of the Various Static Modalities, 62-66 
 Local Effects of the Wave-Current — Local Effects of Sparks 
 — Local Effects of Brush-Discharge — Local Effects of Breeze 
 and Spray — Local Effects of Static-Induced Current — Consti- 
 tutional Effects of Static Modalities — Effects upon Secretion 
 and Excretion. 
 
 CHAPTER X. 
 
 General Principles of Electro-Static Administration and 
 
 Therapeutics, . 67-71 
 
 The Patient — Idiosyncrasies of the Patient — Doses — Frequency 
 of Administrations — Bridging. 
 
 CHAPTER XI'. 
 
 Therapeutics of Inflammatory Conditions, . . . 72-94 
 
 Pathological Consideration of Inflammatory Conditions — Re- 
 lief of Passive Hyperemia — Stasis — Germ Life — Ozone In- 
 halations — Sprains and Bruises — Rheumatism — Myalgia — Gout 
 — Arthritis Deformans — Rheumatoid Arthritis — Osteo-Arthri- 
 tis — Spondylitis Deformans — Synovitis. 
 
CONTENTS. xiii 
 
 CHAPTER XII. 
 
 PAGES 
 
 The Painful Neuroses, ... ... 95-113 
 
 Neuritis — Sciatica — Brachial Neuritis— Locomotor Ataxia — 
 Neuralgia — Migraine. 
 
 CHAPTER XIII. 
 
 General Treatment of Paralysis, 114-122 
 
 Anterior Poliomyelitis — Bell's Palsy. 
 
 CHAPTER XIV. 
 
 Pathological Muscular Contractions, .... 123-131 
 
 Epilepsy — Convulsive Tic — Blepharospasm — The Occupation 
 Neuroses — Contractures — Athetosis — Torticollis — Spasmodic 
 Torticollis — Tremors — Asthma and Hay Fever. 
 
 CHAPTER XV. 
 
 Static Electricity in Dermatology, .... 132-135 
 
 CHAPTER XVI. 
 
 Psychical and Functional Neuroses, ... . 136-149 
 
 Neurasthenia — Hysteria — Hypochondriasis — Melancholia — 
 Functional Insanity. 
 
 CHAPTER XVII. 
 
 Miscellaneous Diseases, . . . . . 150-156 
 
 Tuberculosis — Chlorosis and Anaemia — Diabetes Mellitus — 
 Bright's Disease — Congestions of the Liver — Myasthenia Gas- 
 trica — Exophthalmic Goiter — Simple Goiter — Hiccoughs — 
 Chorea — Conclusion. 
 
 SECTION II. 
 
 SKIAGRAPHY. 
 
 CHAPTER I. 
 
 Introduction, 157-159 
 
 Uses of the X-Ray in Skiagraphy. 
 
XIV CONTKNTS. 
 
 CHAPTER II. 
 
 PAGES 
 
 General Considerations of the Roentgen Ray, . . . 160-166 ' 
 Nomenclature — Sources and Physical Characteristics of the 
 X-Ray — Fluorescence — Quality of Radiance — Penetrating 
 Power of Tubes. 
 
 CHAPTER III. 
 
 X-Ray Apparatus, .... . . 167-182 
 
 Static Machine — Important Features of the Coil — The Relative 
 Merits of Coils and Static Machines — Interrupters — Considera- 
 tion of X-Ray Tubes — Baking X-Ray Tubes — Tube-Holders — 
 Fluoroscopes. 
 
 CHAPTER IV. 
 
 The Method of Making the Skiagraph and Dependent 
 
 Features, . . .... 183-206 
 
 The Individuality of X-Ray Tubes— The Metal Parts of X-Ray 
 Tubes — The Vacuum of X-Ray Tubes — The Relaticfn of Am- 
 perage of Currents to the Volume of Radiance — Sensitized 
 Plates and Paper — Process of Making a Skiagraph — Position of 
 the Anti-Cathode — The Development of a Skiagraph — Dark 
 Room — Developers — Various Methods of Developing — Print- 
 ing — Stereoscopic Radiography. 
 
 CHAPTER V. 
 
 Practical Skiagraphy, . 207-2,16 
 
 Uses of the X-Ray in Fractures and Dislocations — Localiza- 
 tion of Foreign Bodies — Author's Method of Locating Foreign 
 Bodies — Diagnosis of Calculi — Importance of Development in 
 Diagnosing Calculi— Diagnosis of Biliary Calculi — Diagnosis 
 of Stone in the Bladder — Diagnosis of Tumors — Diagnosis of 
 Aneurism — Diagnosis of Empyema and Pleurisy with Effusion. 
 
 SECTION III. 
 RADIOTHERAPY. 
 
 CHAPTER I. 
 Introduction, . . . 217-210 
 
 History— Individual Idiosyncrasies and Conservatism 
 
CONTENTS. XV 
 
 CHAPTER II. 
 
 PAGES 
 
 Physiological Effects of the Roentgen Ray, . t . 220-224 
 
 Cumulative Action — Stimulating or Tonic Effects — Patholog- 
 ical Changes — Effects upon Germ Life. 
 
 CHAPTER III. 
 
 The General Principles of Radiotherapy, 225-234 
 
 The Length of Exposure — The Distance of Exposure — The 
 Frequency of Exposure — Cumulative Actions — Methods of 
 Screening — Idiosyncrasy — Various Accessories to the X-Ray — 
 Dermatitis — Deep X-Ray Burns — Indications for Therapeutic 
 Employment. 
 
 CHAPTER IV. 
 
 Treatment of the Forms of Sarcoma and Carcinoma, 235-265 
 
 Importance of Pre-operative Raying — Removal of the Glands in 
 Cancer of the Breast — Reaction — Auto-Infection — Metastasis 
 — Malignant Disease of the Bone — Cancer of the Face — Cancer 
 of the Tongue — Cancer of the Female Breast — Recurrent 
 Cancer of the Breast — Method of Making Exposures — Cancer 
 of the Pelvis — Cancer of the Uterus — Special Tubes in Treat- 
 ment of Cancer of the Uterus — Cancer of the Rectum — Cancer 
 of the Bladder. 
 
 . CHAPTER V. 
 
 The X-Ray and Accessory Measures in Affections of the 
 
 Skin, ... ... 266-284 
 
 Effects of the X-Ray upon the Skin — Treatment of Skin Affec- 
 tions — Acne Simple and Pustular — Screening in the Treatment 
 of Acne — The Use of High-Frequency Applications in Acne — 
 Sycosis — Ulcers of All Types — Lupus Vulgaris — Violet and 
 Ultra-Violet Rays in Lupus Vulgaris — Brush-Discharge in 
 Lupus Vulgaris — Lupus Erythematosus— The Treatment of 
 Epithelioma — Herpes. 
 
 CHAPTER VI. . 
 
 X-Ray Treatment of Conditions Characterized by Dis- 
 turbances of Metabolism, 285-289 
 
 Inflammatory Conditions — Locomotor Ataxia — Tuberculosis — 
 The Treatment of Tubercular Joints — Hodgkin's Disesae — 
 Gumma Tumors. 
 
LIST OF HALF-TONE PLATES. 
 
 OPPOSITE PAGE 
 
 Plate I. — Method of Administering the Wave- Cur rent. Frontispiece 
 Plate II. — Method of Administering the Brush-Discharge, . 36 
 
 Plate III. — Administration of the High-Frequency Current with 
 
 the Glass Electrode to the Fauces, . . . . 4° 
 
 Plate IV. — Administration of the Static-Induced Current, Em- 
 ploying the Cleaves Controller, . . . -5° 
 Plate V. — Administration of the Wave-Current and Ozone In- 
 halation, . . ISO 
 Plate VI — Method of Taking a Skiagraph, . . 194 
 
 Plate VII.— Calculi in the Gall Bladder, 212 
 
 Plate VIII. — Diagnosis of Bone Tumors. Tuberculosis of the 
 
 Finger, . . .... 214 
 
 Plate IX. — Method of Shielding when Administering the X-Ray 
 
 in Cancer of the Breast, . . .... 254 
 
 Plate X. — Method of Raying through a Speculum, . . 258 
 
 Plate XI. — Method of Raying Cancer of the Pelvis from above 
 
 the Pubes, .... . 260 
 
 Plate XII. — Microscopical Drawing Showing the Effects of the 
 
 X-Ray upon Sarcoma of the Uterus, . . . 264 
 
 Plate XIII.— Method of Screening when Treating Acne of the 
 
 Face. . ■ 268 
 
LIST OF ILLUSTRATIONS. 
 
 SECTION I. 
 
 FIG. PAGE 
 
 I. — Friction Machine, . . 6 
 
 2. — Holtz Machine, . . 7 
 
 3- — Toepler-Holtz Machine, . ... 8 
 
 4. — Chair for Static Platform, . . .... 13 
 
 5. — Small Ball Electrode . . 13 
 
 6. — Medium-Sized Ball Electrode, 14 
 
 7. — Large Ball Electrode, . 14 
 
 8.— Roller, 14 
 
 9 — Sharp-Pointed Metal Electrode, 14 
 
 10. — Chain Holder, . . . 14 
 
 11. — Stand Electrode, ... IS 
 
 12. — Muffler, . . 16 
 
 13. — Brush Electrode, . 35 
 
 14. — Brush-Discharge Handle, 38 
 
 15.— Brush-Discharge Ball, Wood, 38 
 
 16. — Brush-Discharge Point, Wood, 38 
 
 17. — Brush-Discharge Test Tube Terminal, 38 
 
 18. — Brush-Discharge Terminals, Small, 39 
 
 19. — Geissler Tube Electrode, 42 
 
 20. — Handle for Glass Vacuum Tubes 43 
 
 21. — Surface Vacuum Tube Electrode, .... 43 
 
 22. — Vaginal Vacuum Tube Electrode, ... 43 
 
 23. — Rectal Vacuum Tube Electrode, ... ... 44 
 
 24. — Urethral Vacuum Tube Electrode, 44 
 
 25. — Throat Vacuum Tube Electrode, . ... 44 
 
 26. — Nasal Vacuum Tube Electrode, 45 
 
 27. — Insulated Vaginal and Rectal Vacuum Tube Electrode, . . 45 
 
 28. — Insulated Aural Vacuum Tube Electrode 45 
 
 29. — Insulated Post-Nasal Vacuum Tube Electrode, ... 46 
 
 30. — Representation of d'Arsonval Current, 49 
 
 31. — Representation of Static-Induced Current, .... 50 
 
 32. — Dr. Cleaves' Rheostat, ... .... 51 
 
 33. — Representation of the Tesla Current, .... 52 
 
 34. — The Wave-Current, ... 54 
 
 35. — The Wave-Current with " Insulated Capacity," ■ • • 55 
 
 XIX 
 
LIST OF ILLUSTRATIONS. 
 
 36 
 37 
 38 
 39 
 40 
 
 41 
 42 
 
 43 
 44 
 45 
 46. 
 
 47. 
 
 PAGE 
 
 —Rheumatoid Arthritis Hand, Showing Bone Absorption, etc., 84 
 
 — Skiagraph of Child's Hands, Rheumatoid Arthritis, . . 85 
 
 Case of Rheumatoid Arthritis in Child 86 
 
 — Case of Rheumatoid Arthritis in Child 87 
 
 — Rheumatoid Arthritis, Skiagraph of Hands, .... 88 
 
 ■Design for Soft Metal Electrodes, 89 
 
 •Osteo-Arthritis, Skiagraph of Hands, 91 
 
 •Osteo-Arthritis, Skiagraph of Hands, 92 
 
 — Peculiar Form of Arthritis, 93 
 
 — Combined Tesla, Oudin, and d'Arsonval Apparatus, . . 133 
 
 —Set of Rectal Electrodes, . . . . . 140 
 —Rectal Electrode, . . .141 
 
 SECTION II. 
 
 I. — Cut Showing Varying Penetrations of the X-Ray, 
 
 2. — Cut Showing Varying Penetrations of the X-Ray, 
 
 3. — Dr. Files' Interrupter, 
 
 4. — Type of X-Ray Coil, 
 
 5. — Interrupter in Circuit, 
 
 6. — Willyoung Electrolytic Interrupter, . 
 
 7. — Crookes Tube, 
 
 8.— Modern X-Ray Tube, 
 
 9. — Early Type of X-Ray Tube, 
 10. — A Type of Adjustable Tube and Cut of Regulating Device, 
 11. — A German Tube, . . . 
 
 12.- — Tube Clamp, 
 
 13.— Tube Holder, . ■ . 
 
 14. — Fluoroscope, . ... 
 
 15. — Fluoroscopic Screen, 
 
 16. — X-Ray Tube Showing Heavy Metal Anti-Cathode, . 
 17. — Skiagraph Taken on Sensitized Paper, 
 18. — Showing Radio-active Field and Occasion for Distortion, 
 19. — Developing Tray, . . . . . 
 
 20. — Box for Reading a Skiagraph, . 
 21. — Printing Frame, . 
 22. — X-Ray Stereoscope, 
 23. — Gauge, .... 
 24. — Square and Spirit Level, 
 25. — Localizing Screen, 
 
 26. — Method of Locating Foreign Bodies. First Exposure, 
 27. — Locating Foreign Bodies. Second Exposure, 
 
 162 
 163 
 168 
 . 169 
 173 
 
 • 174 
 
 • 175 
 176 
 177 
 
 . 178 
 
 • 179 
 
 • 179 
 180 
 181 
 
 . 182 
 
 . 184 
 
 190 
 
 192 
 
 197 
 . 200 
 
 201 
 . 204 
 . 208 
 . 209 
 
 210 
 . 211 
 
 212 
 
LIST OF ILLUSTRATIONS. 
 
 SECTION III. 
 
 i. — Large X-Ray Shield, . . 229 
 
 2.— X-Ray Shield, . . . ... 230 
 
 3.— X-Ray Shield for Arm, . 231 
 
 4. — Showing Sarcoma of the Face before Treatment, . . . 243 
 5. — Showing Sarcoma of the Face after One Month's Treatment, 245 
 6. — Showing Sarcoma of the Face after Five Months' Treatment, 246 
 7. — Showing Carcinoma of the Face before Treatment, . . 248 
 8. — Showing Carcinoma of the Face after Five Weeks' Treat- 
 ment, . . 249 
 
 9. — Modified Cossor Tube, . . . . 251 
 
 10. — Jacketed Cavity Tube, . .... 259 
 
 11. — The Pennington Shield, . 260 
 
 12. — The Friedlander Shield, 262 
 
 13. — Lupus Vulgaris, . . ... 272 
 
 14. — Result of Treatment with the Brush-Discharge, . . 273 
 
 15. — Lupus Vulgaris, . . ... 274 
 
 16. — Showing Marked Improvement, . . 275 
 
 17. — Lupus Erythematosus, .... 276 
 
 18.— Result of Treatment, . 277 
 
 19. — Lupus Erythematosus, . 278 
 
 20, 21, 22. — Case of Epithelioma, ... 280 
 
 23. — Epithelioma, . . . 282 
 
SECTION 1. 
 
 ELECTRO-STATIC MODES OF APPLICATION 
 AND THERAPEUTICS 
 
SECTION I. 
 
 ELECTRO-STATIC MODES OF APPLICATION AND 
 THERAPEUTICS. 
 
 CHAPTEE I. 
 INTRODUCTION. 
 
 The growing interest in the electro-static treatment of many 
 forms of disease arises from the results obtained, in many in- 
 stances so startling that to gain the credence of a confrere 
 often requires that he witness the administrations; and of the 
 operator that he have confidence in the veracity of the patient, 
 and his own diagnosis. Many physicians themselves have 
 proved excellent subjects for demonstration. 
 
 The development of this recognized valuable department of 
 electro-therapeutics has advanced step by step with the evolu- 
 tion to perfection of the modern static machine. In England 
 and on the continent of Europe, where at present no such 
 machines are produced as the American apparatus, static 
 electro-therapeutics is not advanced ; and the physicians of this 
 country who are wont to look abroad for advanced ideas are 
 not likely to discover progress at home. In the recent writ- 
 ings of Hedley, Jones, and Bordier the subject receives but 
 brief consideration, Jones acknowledging that the American 
 machines are superior to others. 
 
 Since the introduction of electricity in medicine there have 
 been progressive improvements in methods and the develop- 
 ment of more perfect apparatus adapted to special applications 
 and indications. The crude continuous current batteries, made 
 without reference to size of elements or number or arrangement 
 of cells, and having no means for regulating the current, have 
 been succeeded by batteries designed for special uses, and 
 
2 STATIC ELECTRICITY. 
 
 associated with rheostats for controlling and milliampere 
 meters for measuring the current, thus enabling the operator 
 to make intelligent and safe use of an agent capable of doing 
 serious mischief. 
 
 With the same progress of the science marked changes in the 
 character and utility of the induced-current battery have been 
 evolved. The first crude affairs, having short, coarse second- 
 ary- coils and indifferent means for interrupting, have been 
 succeeded by the perfected apparatus, having long, fine wire 
 secondary coils, and varied devices for fine, slow, or rapid inter- 
 ruptions. The perfecting of these forms of electrical appa- 
 ratus has worked most striking changes from time to time in 
 the medical mind. Principles have been set up based upon 
 some theory of an authority, to be later disproved. Gradu- 
 ally the peculiar polar effects of the constant current have 
 become established, and electrolysis, cataphoresis, and cauter- 
 ization have become its chief fields of usefulness. Little is it 
 valued to-day as an anodyne, tonic, or reconstructive alterative, 
 in which induced current has superseded it; only to be super- 
 seded by more effective currents. Apparatus have been pro- 
 duced generating currents of greater and greater voltage and 
 relatively very small amperage, and results obtained have led 
 on to the introduction of new and more perfect machines. 
 
 The relative merits of currents and the uses of various 
 apparatus should be briefly considered in passing, as the body 
 of this work will deal exclusively with static administrations. 
 We believe that in most cases not calling for the peculiar 
 polar actions of the constant current, the static currents, when 
 they can be administered, are to be preferred. The great point 
 of superiority characteristic of the static wave-current lies in 
 the fact that it is an oscillating one-pole current (always of one 
 polarity) of high or low potential, and great or moderate fre- 
 quency, under perfect control, painless during administration, 
 and of such small quantity as to never endanger the life of the 
 patient. The patient, being insulated, is repeatedly charged 
 and discharged, synchronously with the interruptions at the 
 spark-gap from the. surface of contact with the electrode, pro- 
 ducing local effects, and at the same time the constitutional 
 
INTRODUCTION. 3 
 
 effects peculiar to currents and other modalities administered 
 from one side of a source of high-potential electrical energy. 
 
 The static-induced current, which has received much more 
 recognition because it has been longer known, is of relatively 
 little value, and the writer knows of few indications for its sub- 
 stitution for the wave-current. Static sparks, brush-discharge, 
 breeze and static insulation each meet valuable indications, and 
 all partake of the characteristic of the wave-current, — they are 
 administered with the patient insulated, and are often called 
 currents, though they are not in the technical sense of the term, 
 the resistance of the dielectric permitting the body to become 
 charged before it escapes. 
 
 The currents of great frequency and high potential of the 
 apparatus of d'Arsonval are currents from transformers pro- 
 duced by means of Leyden jars and condensers and are in 
 connection with dynamo currents often of relatively large 
 amperage, and are not safe when administered in currents 
 having great voltage. The therapeutic effects, while sur- 
 passing all but the static currents, accomplish nothing that 
 they do not, and fail absolutely where the latter succeed. The 
 apparatus is elaborate, expensive, and for the reasons above 
 stated, adds little to the armamentarium of the physician who 
 has a static machine. 
 
 The current generated by the sinusoidal machine, adapted 
 only to sanitarium or office practice, because it is not portable, 
 does not approach in value the d'Arsonval currents, but gives 
 generally better results than the faradic. The current is of 
 relatively low voltage and greater amperage than the induced 
 current, and is also a more agreeable current. It has no ad- 
 vantage, however, over the wave-current, and will rarely be 
 called into requisition when the static machine is at hand. 
 
 The induced current, while a relatively feeble agent, will 
 be of service at the bedside or home of the patient, where in 
 but rare instances it will be possible to have more elaborate 
 apparatus present. If an induced-current battery is expected 
 to be of service except for purposes of stimulation it should 
 have not less than 1500 yards of fine wire in its secondary coil, 
 and be provided with a fine ribbon or other device for rapid 
 
4 STATIC ELECTRICITY. 
 
 interruption. When we consider the marked improvement in 
 these instruments over the ancient ones, and take note how 
 greatly inferior they are to other apparatus, it is not surpris- 
 ing that electricity has so often proved disappointing, or that 
 the mass of the medical profession are skeptics. 
 
 The discovery of the Roentgen ray, followed by the prompt 
 adaptation of the static machine to its production, has given 
 Franklinism another field, which is bound to redound to the 
 benefit of two sets of physicians. Those who were already pos- 
 sessors of static machines have had thrust upon them a great 
 aid in making differential diagnosis, localizing an aneurism, 
 stone in the kidney, the presence and site of foreign bodies, 
 fractures, dislocations, etc., as well as its therapeutic uses in a 
 field now so widely recognized. The other set are those who 
 for purpose of employing the X-ray have now at hand, or may 
 have, a means of doing very much valuable therapeutic work 
 that could not be done as well by any other apparatus. So 
 true are these facts that, if for no other reason, one purchas- 
 ing an X-ray apparatus should select the static machine; but 
 there are other reasons : 
 
 So valuable is static electricity in treating a multitude of 
 cases in every hospital and insane asylum in the land, and the 
 ■grave mistake of placing a coil apparatus that will debar the 
 purchase of a static machine is so apt to occur, that the writer, 
 without prejudice, interest, or bias other than the good of 
 humanity, cannot too strongly urge that the additional first 
 cost is unworthy of consideration. 
 
CHAPTER II. 
 APPARATUS. 
 
 There is probably no department of medicine where success 
 depends more upon the kind of apparatus employed than in 
 that of electro-therapeutics. Since the discovery of the 
 Roentgen ray the static machine has come into great prom- 
 inence as a therapeutic measure, and the types and capacity of 
 the apparatus show a remarkable want of knowledge on the 
 part of some manufacturers as to the practical requirements of 
 a static machine for X-ray and therapeutic purposes. 
 
 Professional inexperience and lack of familiarity with the 
 requirements have made it possible for all sorts of static ma- 
 chines to find places in offices of members of the profession. 
 It is, therefore, the purpose of the writer, in the interest of 
 those who manufacture as well as the physicians who employ 
 the static machine, to indicate what constitutes an effective ap- 
 paratus without entering into details of construction. 
 
 The knowledge of requirement will assist the physician in 
 selecting only such apparatus as will best serve his purposes. 
 The manufacturer will then produce an apparatus to meet the 
 demand. There is no reason why any except machines of 
 great capacity should be constructed at all, because there are 
 no patents affecting the essential working features of the ap- 
 paratus. 
 
 The earliest type of apparatus for producing Franklinic elec- 
 tricity was a crude machine employing a cylinder of amber in 
 which the current was excited by friction. Gradually, vul- 
 canite and glass came into use and the machines were made 
 in various sizes and shapes. The only static apparatus to be 
 found in the laboratory thirty years ago was one provided with 
 a revolving disk having a means of exciting an electrical dis- 
 charge by friction upon both sides of a revolving plate. The 
 current was collected at one end and conducted to a large 
 
 5 
 
6 STATIC ELECTRICITY. 
 
 condensing ball, the opposite end of the apparatus being 
 grounded. (See Fig. i.) 
 
 Such machines at best and under most favorable conditions 
 excite but a modest current, and are employed for administer- 
 
 Fig. I. — Friction Machine. 
 
 ing sparks in connection with a Leyden jar. Therapeutically 
 the apparatus was destined to accomplish but little. 
 
 The essential requirement for efficient therapeutic work of a 
 modern static machine causes the physician to wonder how any 
 valuable effect could have been derived from the crude devices 
 of the early times. 
 
 The first type of influence machine, the Holtz (see Fig. 2), 
 was invented by Holtz, a German, in 1863, and marked a 
 new era in the possibilities of the static machine. In this 
 type of apparatus, it is necessary to employ some means of 
 
APPARATUS. 7 
 
 exciting the initial charge. In all other respects, the pos- 
 sibilities of the quantity and potential of the current are equal 
 if not superior to the currents produced by the other types 
 of static machines. 
 
 The Toepler-Holtz (see Fig. 3) was the next type in- 
 vented. It is provided with wire .brushes, so arranged as to 
 
 1 " 
 
 "■— ""-"^ 
 
 sy 
 
 ,! 3ptll>| ll 
 
 1 
 
 11 *i |*i |l 
 
 
 1^^^ i'I ■ M 
 
 Fig. 2. — A Modern Hollz Machine. 
 
 come in contact with metal carriers placed upon the sides of the 
 revolving plates, which renders the apparatus self-exciting. 
 While this type of apparatus possesses such advantage, it is not 
 superior to the Holtz type, and is rarely so constructed as 
 to be capable of producing discharges of equally great po- 
 tential. The third type of influence machine, the Wimshurst, 
 is also a self-exciting apparatus provided with brushes upon 
 the outer side of pairs of revolving plates, which revolve in 
 opposite directions. This machine combines both the friction 
 and influence element in the excitation of the current. When, 
 
» STATIC ELECTRICITY. 
 
 however, not combined in some way with the Holtz principle, 
 it possesses no advantages over either the Holtz or Toepler- 
 Holtz. In fact, large machines of this type have not come into 
 general use, for the reason that there are many disadvantages 
 in the character of the current produced, the spark being 
 
 Eig. 3- — A Modern Toepler-Holtz Machine. 
 
 a thin, biting discharge not capable of producing the same 
 degree of therapeutic effect. 
 
 There has been one machine lately introduced which com- 
 bines the Holtz and Wimshurst principle, which may meet the 
 demands of the older types. The writer is not familiar with 
 this apparatus, and cannot therefore express an opinion upon 
 its possibilities. The Wimshurst, however, is a valuable acces- 
 sory of a Holtz machine for the purpose of exciting the in- 
 itial charge, which, however, in a well-constructed Holtz ma- 
 chine, will seldom be necessary if it is properly cared for, as 
 
APPARATUS. 9 
 
 the charge will frequently be held for weeks without the neces- 
 sity of re-exciting. 
 
 During recent years the wonderful increase in the produc- 
 tion of static machines, in this country, is worthy of note, and 
 the fact that all manufacturers are busy bespeaks the inter- 
 est taken in the subject by the profession. It is of the utmost 
 importance, therefore, that the machine shall be constructed 
 in a practical and efficient manner. The writer will consider 
 the relative value of apparatus from the standpoint of the re- 
 quired capacity to do the work demanded for X-ray and thera- 
 peutic purposes, without entering into the details of physics 
 and type of construction. 
 
 The two qualities of all electrical currents are the volt- 
 age, or E.M.F., and the amperage, or quantity, which vary 
 with the conditions and character of the source. The static 
 currents are of relatively high voltage, but possessed of a quan- 
 tity so small that no milliampere meter now manufactured will 
 measure the current of the most powerful machine. 
 
 The voltage of a current is relatively measured by the 
 length of the spark-gap produced, and is approximately 35,000 
 volts for the first inch spark, and some less for each additional 
 inch of the spark-gap. The voltage capacity of a machine de- 
 pends upon the diameter of the revolving plates and the speed 
 of the machine, but can never be greater than one-half the 
 diameter of the revolving plate, or the distance of the shortest 
 arc or space between opposite polarities of the metal parts. In 
 other words, in a machine of any type the distance between 
 the metal portions of opposite polarities at the spark-gap 
 or within the case will measure the limits of the possibilities 
 of the apparatus, no rnatter what the speed or diameter of the 
 revolving plates. If, however, a current is excited under con- 
 ditions of very rapid revolutions, with a machine of a given 
 maximum spark capacity, it will have the frequency relatively 
 increased, but not the voltage, the voltage being measured by 
 the possible spark-gap. 
 
 It is a misconception with some who believe that a high 
 rate of speed increases the possibilities of an apparatus, other 
 things being equal, except in the matter of frequency. The 
 
IO STATIC ELECTRICITY. 
 
 quantity or amperage of current depends upon the number and 
 size of the revolving plates and the condition of the apparatus. 
 Therefore, an apparatus to produce a current of average 
 capacity of amperage and voltage, valuable for therapeutic and 
 X-ray purposes, must be provided with a goodly number, eight 
 or more, of revolving plates, each at least thirty inches in 
 diameter and capable, under favorable conditions, atmospheric 
 and otherwise, of producing a fourteen-inch spark at the spark- 
 gap, without Leyden jars. 
 
 Regardless of the claims of manufacturers, the work done 
 must be the test of excellence. In order, however, to have 
 a machine approach the maximum possibilities, there are cer- 
 tain features of construction essential: (i) The insulation at 
 all points where the charge might escape must be as nearly per- 
 fect as possible. Vulcanite and glass are the materials em- 
 ployed in the construction of static machines which best serve 
 for purposes of insulation. Wood must never be relied upon 
 to prevent the escape of the static current, and the metallic con- 
 ductors of the current must be heavily insulated with vulcanite 
 or glass over the shaft, and at all points where they pass to or 
 through the wooden, case of the machine. (2) The case should 
 be constructed as nearly air-tight as possible, to prevent 
 the influence of humidity upon the working parts of the ma- 
 chine. 
 
 The manufacturer who would convey the idea that any ap- 
 paratus can be so constructed as to not be susceptible to at- 
 mospheric influences impeaches the intelligence of the profes- 
 sion. There are two facts in conformity with the natural law : 
 
 (1) an influence or friction machine to excite a powerful cur- 
 rent requires that the parts of the apparatus be dry, and that 
 within the case the air be relatively free from moisture, and 
 
 (2) a current when excited, to be delivered to the patient, re- 
 quires that the atmosphere outside the case also be dry ; other- 
 wise, it will be conducted away, and only a small portion be 
 administered to the patient. 
 
 The value of the greater amperage of the current pro- 
 duced under conditions of humidity is instanced when admin- 
 istering the wave-current with a static machine of eight or less 
 
APPARATUS. 1 1 
 
 revolving plates to one patient, and observing the difference in 
 the length of the spark-gap from a twelve-plate machine under 
 otherwise similar conditions. When, as above, the spark-gap 
 derived from an eight-plate machine will be but one inch, at 
 the same time a twelve-plate machine will administer a spark- 
 gap of three or four inches. 
 
 The wisdom of operating a static machine having at least 
 twelve revolving plates in a climate subject to humidity will 
 be apparent from the above facts. 
 
 A practical test which is applicable to every type of static 
 machine, and which may serve as a guide to the profession 
 in the decision as to the value of a given apparatus, may be 
 made as follows : ( i ) Ground the negative side of the ma- 
 chine to a direct ground connection, as a water pipe or gas 
 pipe. (2) Place the shepherd's crook from the positive pole 
 to the platform, the latter being removed three feet from 
 the machine, and not nearer than three feet from any con- 
 ducting object. (3) The legs of the platform in justice to 
 the machine being tested should be at least nine inches long. 
 Operate the machine at a rate of speed which will give the full 
 output of the apparatus, and separate the balls of the discharg- 
 ing rods to as great a distance as a spark will pass at the spark- 
 gap. This test should be made upon a day when the atmos- 
 pheric conditions are favorable to all static apparatus — a day 
 when the hygrometer will not indicate more than forty per 
 cent, humidity. The Leyden jars should be detached during 
 the test. A machine in good working order which will not, 
 under these conditions, cause a spark twelve inches long to 
 pass with a frequency of at least sixty per minute is not 
 capable of doing therapeutic service in most difficult cases 
 under varying atmospheric conditions. Another test to be 
 made in connection with a Crookes tube and ball interrupter 
 is given in Chapter III. of Section II. 
 
 These tests are practical, and will enable physicians to judge 
 of the respective merits of apparatus. If static machines are 
 not made to meet these standards, attention to the details of 
 the construction, insulation, and other features will enable all 
 manufacturers to meet the requirements, because the prin- 
 
12 STATIC ELECTRICITY. 
 
 ciples upon which these possibilities depend are in no case pro- 
 tected by patents. Therefore, it is clear that apparatus should 
 be produced to meet the above standard. 
 
 The Leyden jars are of relatively little value, except as 
 used with the static-induced current in connection with a 
 properly constructed static machine. The habit of manu- 
 facturers to make much display of Leyden jars is misleading 
 to those not familiar with static administrations. Those who 
 have longest made use of static electricity seldom employ them. 
 
 The accessory appliances for static administrations are as 
 follows : ( i ) The insulated platform ( see beneath the ma- 
 chine, Fig. 2) should be about two feet three inches by three 
 feet six inches, and provided with glass, porcelain, or vulcanite 
 legs (preferably glass) not less than nine inches in length. 
 There are many machines on the market which are provided 
 with platforms too small to use with a suitable operating chair, 
 and few are made with legs longer than six inches. If a 
 machine is capable of exciting a powerful current, it is un- 
 fortunate to permit it to escape and thus lessen its efficiency 
 by an oversight so insignificant as the length of the legs of the 
 insulated platform. It is clearly demonstrable that nine or 
 ten inches is at least necessary to prevent such escape. 
 
 An operating chair for the purpose of convenience and 
 practicability is a valuable accessory to therapeutic work. 
 Such a chair is shown in Fig. 4. It is provided with a high 
 back, making it possible to hold an electrode against the neck. 
 It is so constructed that the back may be lowered and an ex- 
 tension provided for the feet in order that the patient, if so 
 desired, may lie at full length upon the chair. The seat is 
 twenty inches wide, and arms are provided for the comfort of 
 patients during long administrations. 
 
 Stirrups of wood should also be provided, which will en- 
 able the operator to place his patient in various_ positions for 
 making the necessary administrations. While a chair of this 
 particular design is not indispensable, we believe that it will 
 generally be found convenient. 
 
 The common electrodes and instruments for general pur- 
 poses should be three ball electrodes for administering sparks, 
 
APPARATUS. 
 
 13 
 
 having diameters of two to two and three-quarter inches, one 
 and one-half inches, and one-half inch respectively. The 
 small ball, Fig. 5, is for the purpose of administering sparks in 
 
 Fig. 4. 
 
 the angles and clefts of the body. The middle size, Fig. 6, is 
 convenient for administering sparks to the hands or face. The 
 largest ball, Fig. 7, is for most common use in the administra- 
 tion of sparks and friction sparks, and should be provided with 
 
 Fig. 5. 
 
 a metal portion extending from the brass ball to the vulcanite 
 handle, and will be found convenient if made for application of 
 friction sparks to convex surfaces, curved to adapt to the parts 
 
H 
 
 STATIC ELECTRICITY. 
 
 at the junction with the ball, as shown in the accompanying cut. 
 One roller, which is of no therapeutic value, as the friction 
 
 Fig. 6. 
 
 sparks are more conveniently administered from the brass ball 
 above described (see Fig. 8) ; a roller, however, is of great con- 
 
 
 Fig. 7. 
 
 venience in smoothing out the soft metal electrodes; one 
 metal point electrode, the point of which should be very 
 
 Fig. 8. 
 
 sharp (needle pointed) for administering the spray (see Fig. 
 9) ; one chain holder (for holding the chain during admin- 
 Fig. 9. 
 
 istrations of the direct spark, breeze, or brush discharge, or for 
 preventing the cord from coming in contact with the patient 
 
 Fig. io. 
 
 when administering the high-frequency discharges with the 
 glass vacuum tubes) (see Fig. io) ; an adjustable stand hold- 
 
APPARATUS. 
 
 IS 
 
 ing a long point electrode (see Fig. n) ; a set of wooden 
 brush-discharge electrodes (see cut under Brush-Discharge) ; 
 a variety of vacuum and Geissler tubes (see High-Frequency 
 
 Q^ 
 
 Currents). A quantity of soft metal 
 composition, which is equally good and 
 to be preferred to block tin for electrodes 
 of gauges or thicknesses twenty-two and 
 thirty-two, which correspond to the B. S. 
 mercantile gauge of wire. It may easily 
 be cut with a pair of shears into the 
 desired shapes and sizes indicated for 
 the various applications of the static- 
 induced and wave-currents. There are 
 various other electrodes which will be 
 described in connection with the special 
 administrations in the chapters on thera- 
 peutics. A static cage of wire mesh 
 large enough to let down around the 
 patient. It is of doubtful efficacy, but 
 may be employed if desired. 
 
 A current controller (rheostat) for 
 administering the static-induced current 
 will be found valuable, and is illustrated 
 and more fully described in the chapter 
 which treats of that current. A crown 
 for administering the breeze to the head, 
 while never employed by the 
 writer, is a part of every out- 
 fit, and may be desired by 
 others. 
 
 A muffler (Fig. 12) for 
 lessening the noise during the 
 administration of the spark- 
 gap currents will be appreciated by many nervous patients as 
 well as the physician himself. Such mufflers, however, to 
 
 Fig. 11. 
 
1 6 STATIC ELECTRICITY. 
 
 allow of the best results when employing the wave-current 
 should be at least ten inches in diameter, and are best when 
 made of several thicknesses of papier mache, and provided 
 for the convenience of the operator with a window of isinglass 
 through which the length of the spark-gap may be seen. 
 
 The appliances for use in skiagraphy will be described in 
 the chapters devoted to that subject. 
 
 An electric motor and current controller, a water motor, 
 gas or gasoline engine will be found indispensable if the best 
 results are to be obtained. It is impracticable and impolitic 
 for a physician to endeavor to turn the machine himself, and 
 the presence of a man is often objectionable, and the results 
 
 Fig. 12. 
 
 never so satisfactory as when some other reliable power is 
 provided. 
 
 When employing the alternating current, which always 
 gives a uniform speed, it will be found necessary to make use 
 of some method of controlling the speed, for which purpose 
 there are various mechanical speed controllers on the market. 
 
 When employing the direct current, the controller should 
 be provided with at least ten resistance steps for making the 
 changes slight and corresponding contact points for varying 
 the rate of speed. Of all sources of power for static ad- 
 ministration, a suitable water motor is to be preferred, because 
 the speed may be controlled readily with the cut-off by slight 
 variation to any desired rate. 
 
 The gas and gasoline engines are inconvenient, as they 
 must of necessity be placed in the cellar of the house. If they 
 must be employed, it will be found convenient if they can be 
 connected with a pump and tank, and provision thus be made 
 for raising and storing the water at a suitable height to ob- 
 tain the necessary force to run a water motor. 
 
APPARATUS. 17 
 
 A hygrometer will be found of value in determining the 
 condition of the machine from month to month, for under 
 the same relative atmospheric conditions the discharge from 
 a machine is uniform or the machine is not in a normal con- 
 dition. 
 
CHAPTER III. 
 
 CARE OF THE MACHINE AND MANAGEMENT 
 DURING PERIODS OF HUMIDITY. 
 
 Location of the Machine. — A damp house, either on ac- 
 count of improper construction, as is the case with many of 
 the older brick houses, or from location with reference to the 
 exclusion of sunlight, will cause no little trouble, and greatly 
 impair the working and condition of a static machine, if the 
 most constant care is not exercised. It is of the first impor- 
 tance, then, that a machine be placed in a properly constructed 
 and well-located house. A room on the sunny side of the 
 house, if convenient, will be of marked advantage in caring for 
 the machine. 
 
 It must be borne in mind that; regardless of what manufac- 
 turers say, during periods of humidity moisture will get into 
 the case, and, furthermore, if it should not, the air, as it be- 
 comes more and more saturated with moisture, will finally con- 
 duct away the electricity as rapidly as it is excited, and the 
 patient will get little or none. This is due to conditions not 
 met with in other electric currents, and is therefore little appre- 
 ciated by those unfamiliar with the use of static electricity. 
 The conditions arising during periods of humidity are: (i) 
 The moisture gradually creeps into the machine and interferes 
 seriously with the excitation of the electric currents. (2) If 
 conditions within the case permit the induction of the currents, 
 the air, no longer acting as a dielectric, conducts away the 
 electricity of very great potential and infinitesimal amperage. 
 (3) The consequence is the patient is not treated nor the 
 Crookes tube excited. The first difficulty may be obviated or 
 remedied in several ways, and deserves attention because the 
 maximum current excited insures the delivery of the largest 
 possible amount to the patient. 
 
 To remedy this difficulty to some extent there are various 
 
 18 
 
CARE AND MANAGEMENT OF THB MACHINE. 19 
 
 methods. (1) Some advocate keeping no chemicals within 
 the case for absorption of moisture as it may accumulate, but 
 use means to get rid of it. One method is to fill a large fruit 
 jar with well-mixed, finely cracked ice and salt, in about equal 
 parts, and having wiped the surface dry, quickly place it upon 
 a plate within the case, and promptly close. The moisture 
 within the case rapidly condenses upon the surface of the 
 jar, and in less time than by any other method the moisture 
 is condensed, the. air dried, and the machine will charge. 
 
 This procedure will be practical only when a machine is new 
 or has been recently renovated, because the constant electrical 
 discharge within the closed case of the machine evolves not 
 only moisture but ozone and nitrous acid, which attacks -the 
 metal parts and may form in machines in which CaCL, is used 
 a sticky coating upon the stationary and revolving plates. To 
 lessen this action as far as possible some chemical should be 
 employed which by chemical affinity will engage the detrimental 
 agents, and thereby defer the necessity of renovation. 
 
 (2) Calcium chloride has in the past been regarded as an 
 efficient agent for the purpose of absorbing moisture, but it has 
 failed to engage to any appreciable extent the nitrous acid, 
 which combines with H 2 0, and forms a coating of nitric acid 
 upon the glass plates, and this, together with moisture which 
 accumulates, gradually impairs the capacity of the machine. 
 The crude 1 commercial chloride of calcium seems also to con- 
 tain an excess of chlorine which adds another corrosive to the 
 products of electrical discharge. Some have obtained from 
 chemically pure calcium chloride better results than they had 
 obtained from the crude and report in favor of its use. 
 
 (3) After much experimenting with the preceding methods 
 the writer has adopted quicklime, the ordinary calcium oxide 
 of commerce. 
 
 The only objectionable feature discovered from the use of 
 this agent is the liability of the dust flying about and coating 
 the glass surfaces of the machine. This, however, is obviated 
 by placing the lime in an open box and covering it on all sides 
 with two thicknesses of good muslin. The box may be con- 
 structed with lath sides, the strips being placed one-fourth of 
 
20 STATIC ELECTRICITY. 
 
 an inch apart, adapted in shape to the machine, and large- 
 enough to contain about twenty pounds of lime. 
 
 If the lime is changed monthly under average conditions the 
 machine will remain in excellent order. It may, however, be 
 found in the humid season that the lime will become slacked 
 in less time than one month, while during the cold, dry months 
 of winter it may not be necessary to change it oftener than 
 once in two months. The indications for changing the lime' 
 will be a disposition, when the machine is of the Holtz type, to 
 lose its charge, or to excite less current under the same con- 
 ditions. The writer has known his machine, which was used 
 daily during the humid season, not to lose its charge once or 
 fail to excite a current during one month of more or less humid 
 weather in August when the lime was employed. Further- 
 more, it is noticeable that when lime is used the odor, when the 
 machine is opened, is not nearly so disagreeable as when nothing 
 is used. The presumption, is therefore, that the lime absorbs 
 some of the noxious products of the electrical discharges. On 
 general principles, then, it is wise to keep the lime constantly 
 within the case, and thereby prevent to some extent the cor- 
 rosion and deterioration of the machine ; for, other things being 
 equal, it must be distinctly understood that all static machines 
 do deteriorate, in proportion to the actual time they are oper-' 
 ated. 
 
 (4) A method of which others speak favorably is to place 
 a vessel half filled with sulphuric acid in the case. 
 
 (5) It has been suggested that the air within the machine 
 may be dried by placing a small electric heater in the case. 
 Such a theory is false, because heat does not consume mois- 
 ture, but on the contrary increases the capacity of the air to 
 hold moisture. The only possible gain by such a method 
 would be that by heating the glass parts some of the water 
 would evaporate from the surfaces. And as against that 
 problematical advantage there are the disadvantages that the 
 humidity within the case will be increased, and the glass plates 
 will be in peril of being cracked. If the object be to dry the 
 plates it is far better, when possible, to open the case and place 
 the machine where the sun can shine upon it. 
 
CARE AND MANAGEMENT OF THE MACHINE. 21 
 
 (6) A provision that precludes the necessity of any of the 
 above measures, except the employment of lime and ventilation 
 for the purpose of removing the injurious gases from the case, 
 is to keep the temperature of the operating room at 6o° to yo° 
 F. during periods of humidity, when the machine will always 
 do good work, and the air remain so dry as not to interfere with 
 the administrations to the patient. This is accomplished as in 
 refrigerators employing condensed CO,,. The gas is passed 
 through a series of condensing pipes communicating with a 
 cylinder of liquid CO,,. A device provided with a thermostatic 
 rod may be so adjusted as to automatically maintain any de- 
 sired temperature. With such a provision the moisture within 
 the room is condensed upon the pipes and the room is cooled. 
 Wherever any plan is introduced that will maintain the above 
 temperature of the operating room, it will be possible to ob- 
 tain the best results at all times and seasons. There are but 
 few localities where the necessities for such measures will arise 
 except for a few days during the heated season. In the sani- 
 taria and hospitals of the country the need will be most felt 
 when, in the course of time, the real value of static electricity 
 becomes appreciated and its adoption is universal. 
 
 The Renovation of the Machine. — Every static machine 
 ,will require renovation according to the length of time it is 
 used and the care that is taken of it. Indication that such 
 treatment is necessary will be that the usual methods fail to 
 procure good results. When necessary to perform this task, 
 if the manufacturer's representative is conveniently available 
 it is best to call upon him to do the work. If not, do not de- 
 spair, for common sense and a little patience will succeed in 
 making it work as well as a new one. 
 
 The metal parts and glass plates of the machine must first 
 be thoroughly dried. For this purpose there is no better 
 agency than the sun's rays. Remove the top and ends of the 
 case and place it where the sun can shine upon it for several 
 hours. Nothing more may be required. It will be well, how- 
 ever, at this time to cover the revolving plates of the Wims- 
 hurst (if the machine be of the Wimshurst-Holtz type) with a 
 coating of the best shellac. The latter procedure will be diffi- 
 cult without taking the machine apart and removing the plates! 
 
22 STATIC ELECTRICITY. 
 
 This is not difficult, if pains are taken to obtain the necessary 
 instructions from the manufacturer. It is always well for the 
 physician who lives at a distance from the place where the 
 machines are manufactured to avail himself of the opportunity 
 of observing the construction of the apparatus at the factory. 
 When it is not possible to dry the machine in the sun, and it 
 is not convenient to take it apart, a yardstick, about one end 
 of which is wound a piece of chamois, will remove much of the 
 accumulated^ moisture if the parts are carefully wiped; after 
 which place fresh quicklime within the case. When the ma- 
 chine is renovated the metal parts inside the case should be 
 lacquered. It is well to have a reserve set of these parts that 
 can be put in the machine at such times as renovation is found 
 necessary. A machine thus cleaned is in every respect as good 
 as new. The external metal parts — the prime conductors, 
 discharging rods, and small balls — should be kept well cleansed 
 or polished and free from dust to prevent the escape of elec- 
 tricity from a multitude of small points which accumulate on 
 them. 
 
 Carefully note from day to day the condition of the interior 
 of the machine, and adjust the plates or combs whenever fric- 
 tion of the parts is discovered. The chafing of the revolving 
 plates against the stationary ones, if not otherwise discovered, 
 will be indicated by white spots near the circumference of the 
 revolving plates. It may often be necessary to remove the 
 top of the case to locate and correct the trouble. No special 
 mechanical skill is required to make such adjustments. The 
 greatest annoyance when the case is first opened, however, will 
 be occasioned by the irritating contents of the case. If the 
 weather conditions are favorable, it is always best to let the 
 gases escape. At any rate, take care not to inhale the gases, 
 for, though not dangerous, they will induce paroxysms of 
 coughing and discomfort which may last for hours. Whatever 
 the character of the bearings, keep them well oiled. This in- 
 junction should not be necessary, but it is often neglected and 
 easily avoidable damage done to the only part of the machine 
 subjected to friction and liable to wear. With proper care, 
 a well-constructed static machine will last a lifetime and work 
 satisfactorily. 
 
CHAPTER IV. 
 
 CHARGING THE MACHINE, DETERMINATION OF 
 POLARITY, AND PROVISIONS FOR GROUNDING. 
 
 With the Holtz type of static machines it is necessary to 
 provide apparatus for exciting the initial charge. For this 
 purpose a small Wimshurst, which may be either placed in an 
 apartment in the larger case, where it will not receive the 
 excess of corrosive gases, or in a separate case, should be 
 provided. 
 
 Charging the machine, which, when the charge has escaped, 
 is a prerequisite to every form of static application, under 
 favorable atmospheric conditions, when the machine is in good 
 order, is but a matter of a moment's time. A machine in good 
 condition, which is used every day, may not discharge for 
 months, if care is taken to leave the discharging rods widely 
 separated. If, however, moisture has gotten into the machine, 
 or during periods of humidity, the task will often tax the skill, 
 patience, and energy of an adept. 
 
 (i) Make the necessary connections (which vary with the 
 makes of different manufacturers) to place the Wimshurst 
 in connection with the opposite sides of the Holtz. 
 
 (2) Separate the balls of the discharging rods about one- 
 half inch and give the Wimshurst several vigorous turns before 
 starting the Holtz (if the Wimshurst is operated by hand). 
 
 (3) Next start the machine, at the same time moving the 
 Wimshurst rapidly, and almost instantly a torrent of sparks 
 will pass and continue when the Wimshurst is, at rest. The 
 machine is then charged. 
 
 (4) Cut the Wimshurst out of circuit and gradually sep- 
 arate the discharging rods ; allowing the machine at the same 
 time to run rapidly until a maximum charge is obtained. 
 
 If, for reasons due to the condition of the machine, it. is not 
 possible to excite the necessary charge, the fault must be 
 
 23 
 
'24 STATIC ELECTRICITY. 
 
 with the Holtz or Wimshurst or both. If after ten minutes' 
 effort, employing the following maneuvers, the machine does 
 not charge, prepare to put the machine in order, and either re- 
 place the wet calcium with fresh, rebake it, put in fresh lime ; 
 or, at this time, if the machine is in immediate demand, resort 
 to cracked ice and salt. (See Care of Machine.) 
 
 The maneuvers which often succeed under difficult condi- 
 tions are the following : 
 
 (i) When the Wimshurst fails to give the usual one-half 
 inch or longer spark, if revolved several times in the opposite 
 direction and then reversed, the current may be promptly ex- 
 cited. If, when rapidly moved, the Wimshurst will not gener- 
 ate a spark between the balls of the discharging rods at least 
 three-eighths of an inch in length, it will cost a struggle to get 
 the charge. One-half inch will usually succeed. 
 
 (2) Having carefully removed with a dry cloth or chamois 
 .all dust and moisture from the exposed metal parts of the ma- 
 chine in connection . with the circuit, separate the balls of the 
 discharging rods as far as a spark will pass when the Wims- 
 hurst is revolving rapidly. While rapidly turning the Wims- 
 hurst, start the Holtz slowly, little by little increasing the length 
 of the spark-gap, when after an instant, if sparks continue to 
 pass between the balls, suddenly increase the speed of the 
 Holtz, and the machine will either charge, or the sparks cease 
 passing. Shorten the spark-gap a trifle and repeat the maneu- 
 ver. If this plan is tried over and over again, turning the 
 Wimshurst very rapidly, starting the machine very slowly and 
 then increasing the speed, success will often reward the effort. 
 
 Failing in this, if the humidity is near eighty per cent, and 
 there are no means for cooling the room and thereby con- 
 densing the moisture, there will be little use in continuing, 
 for under such conditions most of the current excited will pass 
 through the atmosphere, so that no treatment would prove 
 effective. If, however, the fault is in the condition of the ma- 
 chine, and charging involves much exertion, and the busy hours 
 are at hand, do not let it once stop, nor close the conducting 
 rods within one-half inch of each other until the last patient is 
 treated, and then see that the machine is renovated. 
 
CHARGING THE MACHINE. 25 
 
 If plenty of fresh lime is kept within the case during the 
 heated season, such necessities will rarely arise except from 
 extreme humidity. 
 
 The polarity of the machine may change from side to side 
 if discharged when taking a new charge. It is necessary to 
 have some manner of determining which are the positive and 
 negative poles. The operator familiar with the work readily 
 discerns the difference in the appearance of the discharge from 
 the two poles when the discharging rods are separated just 
 so far that a spark will not pass — the fan-tail discharge from 
 the negative radiating in straight lines from the ball, and the 
 broken tree-like discharge from the positive. While charging, 
 note the spark discharge between the balls. The bright dash 
 will be on the positive side. 
 
 It will also be observed that when the balls are a short dis- 
 tance apart the discharges will appear different on the 
 opposite sides, the light end being on the negative and the 
 violet on the positive side. This is the reverse of the preceding 
 observation. It will also be observable that when a wooden 
 stick is placed by the ball of the positive side and moved out- 
 ward from the convex surface, the discharge will follow the 
 stick, which is not true under similar circumstances with the 
 discharge on the opposite side. 
 
 The groundings in connection with static administrations 
 are of greater importance than is supposed by many opera- 
 tors. When administering indirect sparks, breeze, spray, 
 brush-discharge, high-frequency administrations, or the wave- 
 current, it is necessary to ground the side of the machine not 
 connected with the patient or platform if the most pronounced 
 effect is to be derived. The effects are also increased by two 
 distinct groundings having connection with moist earth at 
 points removed from each other. In other words, if the water 
 and gas systems of pipes in modern houses enter the earth at 
 opposite sides of the house, there will be a distinct separation 
 between the groundings. By this plan the influence of the ex- 
 ternal capacity of the earth intensifies the effect. 
 
 A word of caution to the uninitiated in the matter of 
 grounding to the gas pipes whenever connected with the elec- 
 
26 STATIC ELECTRICITY. 
 
 trie lighting or power system of wiring, is important, for the 
 high-potential current of the static machine whenever it crosses 
 a commercial circuit is certain to melt the fuses and cut out the 
 light or power from the premises, often causing serious in- 
 convenience. 
 
 When, therefore, it is not possible to ground to the gas sys- 
 tem for the above reason, it will be a simple matter to carry a 
 small wire to the basement, and connect it with an iron rod 
 driven five or six feet into damp earth. 
 
 Screw-eyes from which wires extend to the two groundings 
 may be placed at convenient points for these two groundings ; 
 one for grounding either pole of the machine, and the other 
 for grounding the chain connected with the operating elec- 
 trode. 
 
 It will be the intention of the writer without further ex- 
 planation to refer to the two groundings, meaning always the 
 two distinct connections provided for grounding the machine 
 and the operating or stand electrode. 
 
CHAPTER V. 
 CLASSIFICATION OF STATIC MODALITIES. 
 
 The forms of application used in the treatment of diseased 
 conditions have been classified as the convective, disruptive, 
 and conductive discharges. 
 
 The convective discharges include static electrification, in- 
 terrupted or constant, administered with the patient seated 
 upon the insulated platform, which is known also as static 
 bath and static insulation; the breeze and spray as given off 
 from metal electrodes (single or multiple) ; the brush-dis- 
 charge, as administered from resistance electrodes usually of 
 wood, and the high-frequency discharges from the glass 
 vacuum tubes. 
 
 The disruptive discharges comprise the various sparks, 
 long, short, and friction. 
 
 The conductive discharges constitute the currents derived 
 from the static machine. They comprise the static-induced 
 current and the wave-current with its modifications. 
 
 These forms of application have been mentioned by many 
 writers as the static currents, a term which is applied to the 
 various modalities, but which, while technically correct, tends 
 to confuse those who are not familiar with the consideration of 
 displacement currents. 
 
 The above classification, therefore, is wisely adopted by 
 authorities, and is deserving of general recognition. 
 
 27 
 
CHAPTER VI. 
 THE DISRUPTIVE METHODS OF APPLICATION. 
 
 The oldest form of static administration is sparks. Abbe 
 Nollet in 1734 was the pioneer. Later Benjamin Franklin, 
 after whom this form of electricity is commonly named, be- 
 cause he first discovered its relation to the lightning of the 
 clouds, also employed the sparks for the treatment of certain 
 diseased conditions. He made use of Leyden jars, which he 
 first charged from a friction machine of his own design. 
 John Wesley (the founder of Methodism), and others, are 
 reported to have performed many cures by their use. Vigo- 
 reaux in Charcot's clinic brought the use of Franklinism into 
 great prominence before the medical profession, and deserves 
 the credit of its institution into more general medical use. 
 Morton, a student of Charcot, brought the first influence ma- 
 chines to this country in 1881, and to his efforts and teach- 
 ings the world is greatly indebted, both for a definite knowl- 
 edge of a proper administration and correct electro-thera- 
 peutics. 
 
 The employment of sparks, unpleasant as is the sensation, 
 performs useful services which no other therapeutic measure 
 can accomplish. In the administration of sparks, there is some 
 diversity of opinion as to the effects of polarity. One patient 
 will tell you that the negative spark is most painful, and 
 another that the positive is. In reality there is little differ- 
 ence : both are painful and both are effective. The choice, 
 however, is in favor of the positive spark — the spark of positive 
 insulation — because a longer, cleaner spark is produced from 
 that connection. The negative is more apt to split or divide, 
 and does not seem to produce the same deep perturbatory 
 effect. The spark of positive electrification is therefore prefer- 
 able in spark administrations. When about to administer 
 sparks, ground the negative pole and connect from the posi- 
 
 28 
 
THE DISRUPTIVE METHODS OF APPLICATION. 29 
 
 tive, placing the shepherd's crook in contact with the plate 
 or chain attached to the plate upon the platform. Take care 
 that all metal parts connected with the machine are about one 
 foot removed from the feet of the patient, lest sparks not in- 
 tended should pass, causing unnecessary discomfort to the pa- 
 tient and producing an unfavorable impression of the opera- 
 tor's neglect or inexperience. Be sure that the platform is 
 removed two and one-half to three feet from the machine ; also 
 avoid placing the platform near or beneath a chandelier or 
 other metal conductor. Place the chair upon the platform so 
 that the patient sits directly opposite the prime conductor of 
 the positive pole (the side connected with the platform). 
 There are two reasons for this precaution : ( 1 ) Should the pa- 
 tient accidentally touch the ball he will not get a spark, and 
 
 (2) he will draw off none of the current and thus diminish 
 the effect which, under certain conditions, may be required. 
 
 The patient being seated upon the, platform, and the operat- 
 ing chain having been connected at one end with the ground 
 (the one not connected with the negative pole of the machine) 
 and the other with the screw-eye in the side of the handle of the 
 ball electrode to be used, see that the prime conductors are 
 widely separated, start the machine at a rate of speed commen- 
 surate with the length of the spark to be administered, which 
 will vary with weather conditions. 
 
 When treating a timid patient, at the instant immediately 
 preceding the application of the first spark, or following in- 
 tervals of rest during treatment, place the ball, or one foot, 
 against the platform to draw off the surplus of charge, or the 
 first spark will be unnecessarily severe. 
 
 There are several common methods of regulating the length 
 of the sparks to be administered : ( 1 ) by varying the speed of 
 the revolving plates; (2) by regulating the proximity of the 
 plate or chain upon the platform with the feet of the patient; 
 
 (3) by placing the discharging rods at varying distances, ac- 
 cording to the length of spark to be administered; (4) by 
 the operator drawing off a part of the current by placing the 
 foot upon the platform, standing off when long sparks are de- 
 sired, and drawing near or placing one foot upon the platform 
 
30 STATIC ELECTRICITY. 
 
 when the shorter sparks are preferred. The latter plan is valu- 
 able when giving a patient a general treatment by sparks, be- 
 cause it is desirable to apply long sparks to some parts of the 
 body and shorter ones to other regions. (5) When powerful 
 effects are sought, the patient may take the chain or shepherd's 
 crook in his hands (a very disagreeable method for the patient, 
 because of the painful contraction of the muscles of the hands), 
 or stand, with the shoes removed, upon the metal plate. This 
 plan will also be valuable during periods of humidity, when the 
 output of electricity to the patient is small. 
 
 When administering sparks, use a wrist movement instead 
 of arm movement, which is awkward and tiresome. Judg- 
 ing at what distance from the patient a spark will be dis- 
 charged, move the ball to that point and immediately with- 
 draw before a second spark escapes. Repeated sparks to the 
 same point are exceedingly disagreeable. With a little pa- 
 tience, employing the wrist movement, the knack of adminis- 
 tration is soon acquired. A swinging motion, allowing single 
 sparks to escape, as the ball is passed to and fro, is another 
 method useful in making application to convex surfaces. 
 When treating anaesthetic areas, or patients who are tolerant 
 from familiarity or hardihood, much time may be saved by 
 rapidly passing the ball electrode parallel with the surface of 
 the body at such a distance that rows of sparks will be dis- 
 charged. 
 
 The application of sparks in hollows or angles is often diffi- 
 cult of performance, as in treating the throat or perineum. 
 The small ball electrode meets the difficulty in treating the 
 throat. 
 
 The size of the ball electrode determines the fatness or width 
 .of the spark. Sparks applied over bony prominences do no 
 good and are exceedingly painful. Do not apply sparks to the 
 breasts of the female, to the external genitals of the male, nor 
 to the nails of the fingers and toes, for these parts are exceed- 
 ingly sensitive. When administering sparks or the convective 
 discharges over wet clothing and fabrics which are conduc- 
 tors, of which cotton is an example, the effect may be abortive. 
 Over such garments place some good non-conducting material 
 
THE DISRUPTIVE METHODS OF APPLICATION. 31 
 
 — a piece of woolen cloth or a newspaper— and the results will 
 be satisfactory. 
 
 Sparks may be distinguished as : I., indirect; II, direct; III., 
 friction, and IV., Leyden-jar. Their peculiarities, indications, 
 and modes of application may be described as follows: 
 
 I. The indirect spark is the form indicated in most in- 
 stances where sparks should be administered. The modes of 
 making the connections are as follows : ( 1 ) By means of a 
 chain connect the negative pole with a direct metallic ground 
 connection. (2) Place the insulated platform two and one- 
 half to three feet from the machine. (3) Connect the other 
 side of the machine with the platform, using the shepherd's 
 crook, rod, or chain — whichever is provided for the purpose. 
 (4) Widely separate the discharging rods. (5) Connect the 
 operating chain, having the ball electrode attached to another 
 good ground connection. (6) The patient having seated him- 
 self upon the platform, start the machine. 
 
 II. The direct method is only employed during periods of 
 humidity, when it is often difficult to use the indirect spark. 
 This spark is very painful and can rarely be administered 
 singly. During the administration, the operating chain must 
 be held by the chain holder in the left hand of the operator 
 in such a manner that it does not come in contact with himself 
 or the patient, while the sparks are administered with the ball 
 electrode in the right hand. The mode of making the connec- 
 tions is as follows : ( 1 ) Place the platform and connect it with 
 the positive pole of the machine by crook, etc., as in the pre- 
 ceding method. (2) Separate the discharging rods widely 
 apart. (3) Connect a short operating chain, having the ball 
 electrode attached to one end, to the negative side of the ma- 
 chine, and place the spiral of the chain holder at about the 
 center of the chain. The patient being seated, start the ma- 
 chine. 
 
 III. The friction spark is administered by rapidly passing a 
 metal electrode over the clothing, all connections being made 
 identically as when administering the indirect spark. Dur- 
 ing periods of humidity, however, the direct method may be 
 employed. The thickness of the material intervening between 
 
32 STATIC ELECTRICITY. 
 
 the surface of the body and the electrode determines the length 
 of the spark. The roller electrode was originally intended for 
 use in this form of administration, but is not nearly so good 
 nor convenient as the large ball electrode provided with a 
 handle, having a long metal portion above the insertion of the 
 insulated part. Applying the ball and the metal portion of the 
 handle in making the applications, the electrode can be moved 
 rapidly and efficiently over any portion of the surface of the 
 body. If making a general application of friction sparks, pass 
 the ball and metal portion of the handle very rapidly over the 
 body by long strokes, and when treating small areas interrupt 
 the application at short intervals, and the patient will submit 
 to the treatment the case demands. This form of administra- 
 tion relieves pain, is highly stimulating to the peripheral cir- 
 culation, acts as a counter-irritant, and promotes secretion and 
 excretion. 
 
 IV. The Leyden-jar sparks are too severe for administra- 
 tion except in cases calling for profound mental effect of dis- 
 cipline or suggestion. They would be administered by the 
 same arrangement as the direct sparks; adding two Leyden 
 jars having their outer coats connected by a device provided 
 for the purpose or a metal rod. 
 
CHAPTER VII. 
 
 THE CONVECTIVE MODES OF 
 ADMINISTRATION. 
 
 The convective discharges are static-electrification, breeze, 
 spray, brush-discharge, and the high-frequency discharges 
 from the glass vacuum tubes. 
 
 Static electrification, also known as the static bath and 
 static insulation, usually administered in connection with a 
 breeze or spray by placing the stand with point electrode near 
 some portion of the body of the patient, is the simplest and 
 to the patient the least objectionable modality. 
 
 Undoubtedly much good can be derived from this form of 
 administration. For, though the electrification in the unin- 
 terrupted form of administration is associated with a minimum 
 of oscillatory or vibratory effect, there is abundant evidence 
 that metabolism is increased and some conditions of nervous 
 patients are greatly improved by its employment. If the breeze 
 or spray is to be used in connection with the treatment, place 
 the stand electrode with the point directed to the part of the 
 patient where its use is indicated. Start the machine at a rate 
 of speed consistent with the demands of the case and adjust 
 the stand electrode according to the effect desired. The con- 
 nections ier this method are as follows : ( i ) Connect the pa- 
 tient with the positive or negative side of the machine (it is 
 observed that the beneficial effect is more marked in some pa- 
 tients from positive insulation and in others from negative, 
 which can only be discovered by trying them alternately). 
 '(2) Widely separate the balls of the discharging rod. (3) 
 Ground the side of the machine not connected with the patient. 
 
 Interrupted electrification, which has been termed by one 
 writer, who also makes the connections in an indirect method, 
 
 33 
 
34 STATIC ELECTRICITY. 
 
 " potential alternation," is in effect more active and beneficial 
 than the preceding method because the interruptions at the 
 spark-gap produce a pronounced oscillatory action upon the 
 tissues of the patient. 
 
 While this form of application has marked therapeutic ad- 
 vantages over the uninterrupted method, it is not nearly so 
 effective as the wave-current and as the noise of the spark-gap 
 is the only feature of the wave-current which would lead to the 
 substitution of either form of electrification it would rarely be 
 employed. If, however, it sho'uld be used, the only difference 
 in making the connection would be the placing of the balls of 
 the discharging rods at a distance which would permit sparks 
 to pass during the treatment. 
 
 The breeze or souffle is a mild form of application and is 
 employed as an accessory to static electrification, constant or 
 interrupted, or the wave-current. The stand electrode is called 
 into requisition and may or may not be connected, according 
 to indications, by the operating chain to one ground connec- 
 tion. The point of the electrode — either bare or having the 
 crown, or a tassel, attached — is placed over the head of the 
 patient, or the point alone near any other part to which it is 
 desired to draw the bulk of the discharge. Another method 
 is to connect the brush electrode with the operating chain, tak- 
 ing care that it is kept at the proper distance while moving 
 it over and around the patient. Though not of special value 
 therapeutically, this maneuver often serves a good purpose 
 when introducing a timid patient to static methods. 
 
 Another mode of administering the breeze is by employing 
 the static cage, which may be suspended around the patient 
 and provided with a direct connection to the ground, the patient 
 at the same time being seated or standing upon the metal plate. 
 This form of treatment has also been administered combined 
 with interrupted electrification, the spark-gap discharging at 
 any desired length. In this event the patient must stand with- 
 out shoes upon the plate, or the passage of sparks through the 
 heels and soles will be intolerable. The objections to this 
 method are ( i ) the suspense of the patient lest he get a spark ; 
 (2) some portions of the person of the patient will be nearer 
 
THE CONVECTIVE MODES OF ADMINISTRATION. 35 
 
 the metal of the cage than others, and from such surfaces the 
 current will nearly all escape, and the treatment intended to be 
 general will become local without reference to the lesion; (3) 
 the apparatus is cumbersome and expensive, and at the same 
 time not so effective in its constitutional effects as the wave- 
 current (see Wave-Current Constitutional Treatment), which 
 it simulates. 
 
 The spray is a warm or hot breeze, differing from the breeze 
 in arrangement only in the nearer proximity of the electrode 
 to the person of the patient. To produce the strongest effect 
 
 Fig. 13. 
 
 of the spray, there must be some non-conducting material, 
 except over the hair, between the surface of the body and the 
 electrode. A thick woolen or silk garment produces the 
 strongest effect. It will be convenient to have a square yard 
 of suitable material (silk or woolen) for use when treating the 
 hands or face, or to throw over damp clothes or fabrics not 
 adapted to the spray or spark. For local use, the spray may 
 be directed to the region affected, employing the point elec- 
 trode or an electrode having many points, and allowed to pass 
 for five or ten minutes, when it will have rubefacient and ano- 
 dyne effects. For general treatment, employ the brush elec- 
 trode in the hands of the operator ; passing it at the proper dis- 
 tance about the body of the patient, taking care not to. dis- 
 charge accidental sparks. Administered in this manner, it 
 acts as a mild peripheral stimulant and is not disagreeable to 
 the patient, producing a favorable impression. Unless per- 
 sisted in for a long time, however, it is not nearly so effective 
 as the friction sparks, which may be applied rapidly and effec- 
 tively. 
 
 The brush-discharge, as the term is employed in electro- 
 
36 STATIC ELECTRICITY. 
 
 therapeutics, is an electrical discharge taking place between 
 a body insulated and connected with a static machine and an 
 electrode of resisting material, as of wood, and from the 
 peculiar interrupted quality of the discharge might be termed 
 disrupto-convective. 
 
 The term brush-discharge is an unfortunate one ; because 
 in electro-physics it is applied to an electrical discharge from 
 one terminal of a high -potential apparatus, without regard to 
 the substance of the conductor between the terminal and- the 
 course of the current, while the term as used in electro-thera- 
 peutics applies to a discharge which passes some distance 
 through a substance of very high resistance that may or may 
 not have a metallic terminal from which the discharge is 
 emitted. 
 
 The only source of electrical energy employed in thera- 
 peutics capable of passing a current without disagreeable con- 
 sequences through such resistance is a static machine. The 
 disparity of amperage and voltage is such with currents from 
 other apparatus that their employment is either impossible 
 or impracticable. The intensity, volume, and effect of the dis- 
 charges vary with the speed and the capacity of the machine, 
 the length, diameter, and character of the resistance electrode, 
 the atmospheric conditions, the character of the material be- 
 tween the electrode and the patient, the nature of the ground- 
 ing, and the insulation. 
 
 ( i ) The most effective discharges are obtained from power- 
 ful static machines, the volume of the discharge being greater 
 from the machines having the larger number of revolving 
 plates, other things being equal. 
 
 (2) The material of which the electrode is made is of great 
 importance, in order that -it may deliver a discharge that is 
 fine or interrupted as desired and without a disruptive -quality, 
 as sparks. Wood is the best material, either the white por- 
 tion next to the bark of the indigenous soft maple or some 
 other wood of even texture, as whitewood or holly. The 
 red or central portion of the maple is not nearly so good, as 
 the texture is porous and dries rapidly, which makes it a too 
 poor conductor. The electrodes may be frequently dampened 
 
THE CONVECTIVE MODES OF ADMINISTRATION. 37 
 
 over the surface with water or better still replaced by new ones, 
 for, as they become dry, the discharge becomes less vigorous. 
 
 (3) The Qpposite side of the machine to which the patient 
 is connected should be grounded to the water pipe, and the 
 end of the electrode held by the operator should be connected 
 by a distinct ground, as the gas pipe, if the strongest effect is 
 desired. 
 
 (4) The insulation of the patient should be as nearly per- 
 fect as possible. Machines having the capacity of those above 
 described should be provided with insulated platforms having 
 glass or vulcanite legs, at least nine inches long. 
 
 (5) The poles of the machine should be widely separated 
 before the patient is connected or the machine started, be- 
 cause it is desirable that the patient should hold the shepherd's 
 crook, when if a spark should pass because the poles are too 
 near, the shock to the patient from such an accident might be 
 discouraging. For application of the brush-discharge special 
 electrodes may be employed. 
 
 (6) It has been demonstrated that the brush-discharge from 
 the positive pole is distinctly irritating, and when administered 
 in a dark room, discharges of a green color will be seen min- 
 gled with the violet. It is therefore, the rule in the treatment 
 of all inflammatory and painful conditions to connect the pa- 
 tient to the negative pole of the machine when administering 
 this modality. 
 
 During prolonged administrations the electrodes, when 
 properly conducting a current, as during the summer or when 
 they have become thoroughly heated, will become disagreeably 
 hot. Under these circumstances the discharge is very rich and 
 effective. It will also be found that during the winter, when 
 the temperature of houses ranges below 70 F. the discharges 
 become feebler, though the output of the machine is greater. 
 The temperature then cools the electrodes and renders them 
 poor conductors. At the same time the air is dried and be- 
 comes a more perfect dielectric. 
 
 Heating the electrodes during cold weather increases the 
 effect of the discharge at first, but soon causes them to become 
 so dry as to be ineffective. It is then best to replace the longer 
 
38 
 
 STATIC ELECTRICITY. 
 
 part of the electrode with a new stick, or keep the surface 
 thoroughly moistened with a wet cloth or sponge during an 
 administration. The effect upon the wet surface or over wet 
 clothing is nil. Cotton or linen, when an outer garment, ma- 
 terially impairs the action, whereas strong effects will be pro- 
 
 Fig. 14. 
 
 duced by placing one or more thicknesses of silk or woolen 
 cloth over the surface to be treated. 
 
 Care should be taken that not too many thicknesses of wool 
 or silk intervene, for, if there are too many, they are apt to 
 ignite. Celluloid hairpins for the same reason should be 
 removed. 
 
 A hot and humid day in summer, if the machine can be made 
 to excite a current, is the time when the brush-discharge is 
 most potent, other things being equal. 
 
 For application of the brush-discharge to the surface of 
 the body the wooden ball electrode of maple, or other wood 
 
 Fig. 15. 
 
 Fig. 16. 
 
 Fig. 17- 
 
 of even texture, meets all requirements, except when it is neces- 
 sary to make the application in a cleft or, depression, as between 
 the fingers or nates, in which cases a pointed electrode will be 
 required. A set of terminals has been devised which may be 
 used from the extremity of a handle at least twenty inches long, 
 of a proper material. This handle should be three-fourths of 
 an inch in diameter, provided with a sliding tube having an 
 eye for the attachment of the grounding chain (Fig. 14), which 
 may be moved to and from the extremity, increasing or de- 
 creasing the resistance as the case or conditions demand. 
 
THE CONVECTIVE MODES OF ADMINISTRATION. 39 
 
 The wooden terminals are of value. The wooden ball ter- 
 minal (Fig. 15) will be most commonly used with this modal- 
 ity. The wooden point (Fig. 16) will be found convenient 
 when making applications of the discharge in the angles and 
 clefts of the body. Another wooden terminal (Fig. 17) de- 
 signed for placing the test tube over the wood is included. 
 This terminal is of the least value because of the liability of 
 the tubes to puncture when using a strong discharge. It may, 
 however, be found convenient under some circumstances and 
 is considered by some physicians to be a valuable addition to 
 the set. The small terminals (Fig. 18) each have certain ad- 
 
 Fig. 18. 
 
 vantages. The discharge may be administered more con- 
 veniently and localized more accurately by their employment. 
 The one terminating in a few fine wires distributes a soft fine 
 spray which may be applied to some organs, as the eye. The 
 metal ball will give a more concentrated discharge than the 
 wooden ball. The brass point will also be found to have ad- 
 vantages over the long wooden point in certain cases. The two 
 insulated tips are designed for applications within the various 
 cavities of the body. These may be used or a glass tube hav- 
 ing a funnel-shaped opening at one end, and made to slip over 
 the handle at the other. By this means it is possible to localize 
 a discharge in a narrow canal without permitting it to escape 
 to the sides, thereby making the application to any desired 
 spot. The value of these insulated terminals will be appre- 
 ciated by all who are familiar with the value of the modality 
 in the treatment of ulcerated and infected conditions. 
 
 High-frequency discharges have been so termed by the 
 French in connection with the current of d'Arsonval. Re- 
 
40 STATIC ELECTRICITY. 
 
 cently, the employment of glass electrodes in connection with 
 the static machine and various X-ray coils has attracted con- 
 siderable attention. The characteristics of the discharge de- 
 pend upon the vacuum tube and vary in color with the high 
 and low tubes. These tubes are made in mam- shapes designed 
 for special treatment. The Geissler tube, which has the wire 
 connection from the exterior to the vacuum, possesses no par- 
 ticular advantage over tubes having no conducting communi- 
 cation from the exterior. It is a singular property of the high- 
 potential currents that they pass apparently through the glass 
 and are discernible in the interior of the tube. The polarity of 
 the electricity within the tube is demonstrated to be the same 
 as that of the side of the machine to which it is connected. 
 This is shown from the fact that when a tube of high vacuum 
 is connected to the negative side, the cathode ray producing 
 the usual green fluorescence appears opposite an object with 
 which the tube is placed in contact, the object becoming the 
 anti-cathode. The induced discharges which appear on the 
 outer side of the tube when it is brought in contact with the 
 patient or any other conducting media are therefore of the 
 opposite polarity. 
 
 The tubes employed are of low or high vacuum, and may be 
 either constructed on the Geissler pattern, having a metallic 
 connection from without, or without wire connection to the 
 interior. This, however, is not of practical advantage in most 
 cases. 
 
 An adjustable insulated handle, Fig. 20, of solid glass or 
 vulcanite is a convenience permitting the operator to handle the 
 electrode during an administration without lessening the dis- 
 charge from the current, which would otherwise pass off 
 through his person. 
 
 When a static machine is employed to produce the dis- 
 charges the positive pole should be grounded and the electrode 
 connected with the holder either placed in some cavity of the 
 patient, or held by the operator and connected with the nega- 
 tive pole. The spark-gap should then be closed to about one- 
 half inch and the machine started, after which the spark-gap 
 is regulated to the condition of the patient. 
 
u C/J 
 
 u 
 
 
 l' to 
 
 ■~ ■S o, 
 
 JO 
 
 J ^6 
 
 — to 
 a; ." 
 
 O rt 
 
 
THE CONVECTIVE MODES OF ADMINISTRATION. 41 
 
 If a coil is used for exciting the tube, a connection may be 
 made from the negative terminal of the coil, connection being 
 made with the patient as before. The current controller con- 
 nected with the coil, if no step-up transformer is used, should 
 be provided with many contact points with resistance changes 
 slight or the increase may be unpleasant to the patient. The 
 current, when using a coil, may also be regulated by making use 
 of a Geissler tube three or four feet long, one end of which is 
 attached by one end of the coil, and provided with a ring to 
 which the operating electrode may be attached. The ring can 
 be moved to and fro from the terminal to regulate the dis- 
 charges, which will then be of secondary induction. In that 
 case, the large tube should be attached to the positive side. of 
 the coil. 
 
 The high-frequency discharges from the two sorts of ap- 
 paratus differ somewhat in the chemical, heat, and vibratory 
 effects. The chemical effects are most marked with the coil 
 current because of the greater amperage ; and the vibratory 
 effect and muscular contraction, invaluable in the treatment of 
 inflammatory conditions, is characteristic of the static machine 
 and absent in the coil current, or when a coil is used in con- 
 nection with a static machine. 
 
 The technique of employing the Geissler or vacuum tubes 
 is not difficult either with the static machine or coil. With 
 the former it is not necessary to insulate the patient, as with 
 other static modalities. 
 
 It has been demonstrated by both foreign and American ob- 
 servers that the larger amount of chemical rays are emitted 
 when vacuum tubes are connected to the negative side of the 
 sources of electrical energy. Therefore make negative con- 
 nection with the electrode. 
 
 The discharging spark-gap is essential to the high-frequency 
 discharges from the static machine, for without it there is no 
 appreciable interruption — no frequency. 
 
 To administer this modality, have the patient upon the table 
 or seated in the chair; connect the cord from the glass elec- 
 trode to the negative side of the machine, and if an application 
 is to be made within the rectum or vagina, place the electrode 
 
42 
 
 STATIC ELECTRICITY. 
 
 in position, or, if the operator is to apply it to the skin or some 
 mucous surface, it should be held in readiness by the glass or 
 hard rubber handle and the machine started. The spark-gap 
 between the balls of the discharging rods should not at first 
 be more than one-half inch. It may then be regulated to the 
 condition to be treated. One to two inches will be required 
 in most cases for treatment of the vagina and rectum, and one- 
 
 half to one inch in the fauces and on the surface of the body. 
 
 When using a coil, either in association with a resonator 
 or other apparatus or not, connect with the negative side of 
 the apparatus or, if the alternating current is used, with either 
 side. Having the patient in readiness upon the table or chair, 
 place the electrodes as in the static administration. Then turn 
 on the current gradually, starting from zero. It will be 
 noticed that with currents of larger amperage the violet dis- 
 charges are more numerous, that the sense of warmth is more 
 pronounced, and the application to the surface, either through 
 the clothing or when held at a sparking distance from the 
 body, more painful than the static. 
 
 There is undoubted advantage in some cases in the treat- 
 ment of which a stronger chemical discharge is beneficial from 
 the greater amperage of the coil. On the other hand, the 
 positive vibratory effect and induction of muscular contraction 
 of the static high frequency, which is easily appreciated by 
 holding an electrode in the hands, has its advantages in over- 
 coming local stasis and congestion. 
 
THE CONVECTIVE MODES OF ADMINISTRATION. 43 
 
 Vacuum electrodes of various types and forms are employed 
 for making applications of high frequency, all of which are 
 adapted to both the coil and static currents. 
 
 Fig. 20. — Handle. 
 
 The Geissler tubes, which were first used in connection with 
 high-frequency apparatus, are constructed, as stated, with wires 
 running from without either to a point within the vacuum 
 portion of the tube or extending along the whole length, hav- 
 
 Fig. 21. — Surface. 
 
 ing glass insulation for the purpose of delivering the main force 
 of the discharge at the extremity of the tube as shown in Fig. 
 19. 
 
 These tubes possess no special advantage, and, like the glass 
 test tube used in connection with the brush-discharge, are more 
 
 Fig. 22. — Vaginal. 
 
 apt to puncture during administrations. More recently, the 
 vacuum tubes have come into general favor, and are practical 
 and not so apt to puncture. 
 
 The writer has designed numerous shapes in glass electrodes 
 
44 
 
 STATIC ELECTRICITY. 
 
 which will be found convenient for special applications, which, 
 are used with a handle (Fig. 20), of insulating material of 
 vulcanite or glass adapted for holding the various vacuum 
 tubes. 
 
 Fig. 21 represents an electrode for making applications to 
 the surface of the body over the clothing or next to the skin. 
 
 Fig. 23. — Rectal. 
 
 The same form of electrode may be provided with a metallic 
 button, which is connected by a wire to a grounding, making 
 it possible with a tube of suitable vacuum to make direct ap- 
 
 ^ 
 
 Fig. 24. — Urethral. 
 
 plication to the surface of a low-vacuum X-ray, which may be 
 utilized in the treatment of acne and other conditions. 
 
 .Fig. 22 represents the vaginal electrode constructed with a 
 cup depression at the extremity for receiving the cervix. Fig. 
 23 represents a rectal tube provided with a conical tip for use 
 
 "\ 
 
 Fig. 25.— Throat. 
 
 in treating fissure in ano, rectal ulcers, hemorrhoids, and other 
 rectal conditions. Fig. 24 is of thick glass, and designed for 
 use in the urethra. Fig. 25, provided with a piece of rubber 
 for insulating over the teeth, is for use in the pharynx and 
 larynx. Fig. 26 represents a flattened tube for treatment of the 
 nares. 
 
THE CONVECTIVE MODES OF ADMINISTRATION. 
 
 45 
 
 Another feature of construction of special advantage in vac- 
 uum tubes is a plan for insulating certain portions of the tube 
 with an outer tubing of glass having openings to admit the 
 
 Fig. 26. — Nasal. 
 
 air. Such tubes, under conditions of weak currents as are 
 excited by small machines and during periods of humidity, 
 permit a stronger effect over a small region without the pos- 
 
 Insulated, Vaginal and Rectal. 
 
 sibility of the discharge being emitted from the whole length 
 of the tube, and are also of special advantage in aural and 
 throat work. 
 
 Fig. 27 represents vaginal and rectal electrodes of this type. 
 Fig. 28 represents an aural electrode especially adapted for 
 
 •^BlX!%l : l!SSSiStSS&SSS^!9^^' 
 
 Fig. 28. — Aural. 
 
 making applications to the membrani tympani, or to the cavity 
 of the middle ear for treatment of congested conditions, ulcers, 
 or suppurating processes. Fig. 29 represents an insulated 
 
46 STATIC ELECTRICITY. 
 
 electrode having a flattened portion for making applications to 
 the posterior nares behind the velum. 
 
 Therapeutically, the brush-discharge and high-frequency dis- 
 charges are indicated in the same class of conditions. 
 Wherever congestion and stasis are present, with or without 
 the presence of germ life, these modalities are invaluable. 
 Enough cases of lupus have been reported cured by both 
 modalities to establish their value in superficial tubercular con- 
 ditions. 
 
 The ozone so richly evolved at the seat of application oxidizes 
 organic life, acting as a powerful antiseptic. 
 
 The brush-discharge is especially adapted to the treatment 
 of skin diseases. Lupus, eczema, herpes, acne, scabies, and 
 allied conditions are wonderfully relieved and cured by its 
 action. 
 
 The high-frequency discharges have accomplished such re- 
 markable results in the treatment of ulcer of the rectum, fissure 
 of the anus, hemorrhoids, tonsilitis, and catarrhal conditions 
 as to assure the modality wide recognition when it becomes 
 better known. The application of the brush-discharge within 
 the cavities by means of special electrodes, assures it new fields 
 
 Fig. 39. — Post-nasal, Insulated. 
 
 of usefulness. In this manner it has already been employed in 
 the treatment of otitis media, fissures, ulcers, and fistulse. 
 
 The application of the brush-discharge to the early stage 
 of acute inflammatory conditions, rheumatism, sprains, and ab- 
 scesses, as well as the swelling associated with fractured bones, 
 meets with surprising results. 
 
 The static brush-discharge and the high-frequency dis- 
 charges from both coils and static machines possess the 
 qualities characteristic of all electrical discharges. Decom- 
 position of the atmosphere takes place and, with other prod- 
 
THE CONVECTIVE MODES OF ADMINISTRATION. 47 
 
 ucts, nitrous acid and ozone are evolved. The green-violet 
 and ultra-violet characters of the discharges, which vary with 
 the degree of vacuum of the tubes, possess qualities also of 
 undoubted therapeutic value. 
 
 The physiological actions of the discharges, while similar 
 in many respects, differ essentially in others. The brush- 
 discharge, like other static modalities, lessens local hyper- 
 aemia and congestion by inducing contraction of the subcuta- 
 neous arterioles, and thereby relieves pain, and diminishes 
 swelling to a marked degree. The metabolic processes of the 
 end organs are stimulated to greater activity and a healthy 
 restorative action is induced. When applied for a long period, 
 the effect is first rubefacient and later vesicant, producing pain- 
 ful blisters. From the nature of the electrical discharge the 
 ozone and nitrous acid evolved from the close proximity to 
 the tissue are distinctly antiseptic. In addition to these local 
 effects, there is a marked tonic effect from its employment 
 when a course of treatment is pursued for a prolonged period 
 and the patient, for any reason, has been below the normal 
 standard. 
 
 With the high-frequency discharge from the vacuum tube 
 the local effects are much the same, but possess certain ad- 
 vantages which determine its election for use in the several con- 
 ditions. For example, when treating cavities of the body, such 
 as the rectum and vagina, it is possible to place the electrode 
 in the cavity, leaving the patient for the indicated period of 
 administration under the same conditions. To apply the brush- 
 discharge would necessitate the use of a speculum and an 
 electrode insulated to the terminal extremity from which the 
 application was discharged, and at the same time require the 
 constant attendance of the operator during the period of admin- 
 istration. In addition, the application, if the surface requiring 
 treatment was extensive, would be prolonged. 
 
CHAPTER VIII. 
 CONDUCTIVE DISCHARGES. 
 
 Strictly speaking, all static discharges are currents, pass- 
 ing to and fro through the dielectric, or other media, as the 
 chain or shepherd's crook, which may connect a patient or the 
 platform with the machine or the air of the room. Such pas- 
 sages may be either insensible or associated with disruptive or 
 convective discharges, but are not technically classified as cur- 
 rents, as are conductive discharges. 
 
 The spark-gap, as it occurs between the balls of the dis- 
 charging rods, or in any other part of the circuit, is the dis- 
 tinctive feature of the conductive discharges. From the stand- 
 point of the electro-therapeutist, it was first defined by Mor- 
 ton,* when discussing the static-induced current, in which he 
 referred to it as necessary in the following terms : " A regu- 
 lated interruption in the otherwise inoperative circuit of a 
 Holtz machine would produce in another part of the circuit a 
 current adapted to electro-therapeutic practice." 
 
 In other words, the discharging spark-gap is essential to the 
 production of physiological effect upon a patient placed in the 
 circuit or upon the insulated platform. This is easily demon- 
 strated by placing the two hands upon the opposite prime con- 
 ductors of a static machine, previously charged, and then start- 
 ing it at a rapid rate of speed. The passage of the electricity 
 will be absolutely inoperative and inappreciable. 
 
 Two spark-gap currents having various modifications have 
 been published and are now generally used and understood 
 by well-informed electro-therapeutists throughout the world. 
 Both bear the name of Morton, who introduced them to the 
 profession — the static-induced current in 1881, and the wave- 
 current in 1899. Physicists may criticise the nomenclature, 
 but the names are distinctive and for all practical purposes 
 * Medical Record of March 26, 1881. 
 48 
 
CONDUCTIVE DISCHARGES. 
 
 49 
 
 equally as good as the terms "constant" and "interrupted" 
 used in regard to the older currents of Galvani and Faraday. 
 The static-induced current, first published in the Medical 
 Record of March 26, 1881, and later, more fully and ex- 
 plicitly, in the Medical Record of January 24, .1891, ante- 
 dated even at the later date all therapeutic consideration of 
 currents of great frequency and high potential. For ten years 
 
 ^K5M^ 
 
 Fig. 30.- 
 
 -a, Revolving Plate; i, Collectors; c, Prime Conductors; 
 d, Discharging Rods; e, Leyden Jars. 
 
 it had heen almost unrecognized except by advanced workers 
 and, during that period, was the only published current pos- 
 sessed of such qualities. 
 
 The current was known abroad as " the current of Mor- 
 ton." Later the current of d'Arsonval (Fig. 30) was intro- 
 duced and the consideration of the currents of " high fre- 
 quency and high potential " came rapidly to be a new element 
 in electro-therapeutics. The apparatus of d'Arsonval was the 
 result of an effort to produce, by transformers and condensers, 
 a current similar to the static-induced current — a current safe 
 of administration, of high frequency and high potential. 
 
 The static-induced current is represented in the accomoany- 
 ing drawing (Fig. 31). 
 
 To operate this current, (1) place the two Leyden jars to 
 be used in position, connecting the inner coating of the jars 
 with the corresponding sides of the machine, (2) connect the 
 rheophores with electrodes attached to binding-posts provided 
 
5o 
 
 STATIC ELECTRICITY. 
 
 on all static machines, (3) close the spark-gap of the machine, 
 (4) place the patient (not necessarily insulated) in position and 
 apply whatever electrodes are to be used in the treatment of 
 the case, (5) start the machine at a slow rate of speed and 
 gradually open the spark-gap until sufficient current strength 
 is indicated by the effects upon the patient. If no controller is 
 employed in the circuit, use very small Leyden jars, as the 
 administration will otherwise be too severe. It is necessary to 
 use some method of changing the character of the current if 
 Leyden jars of large size, such as are attached to most types 
 
 ■i- 
 
 Fig. 31. 
 
 of machines, are employed for this purpose. Dr. Margaret A. 
 Cleaves has devised a water rheostat, Fig. 32, which is a 
 modification of the Craido. By this means, it is possible to 
 employ the large-size jars and the longer spark-gap, when the 
 current may be of greater amplitude and less painful than 
 when employed directly to the patient without such device in 
 the circuit. 
 
 The static-induced current may be employed in all condi- 
 tions to which the high-tension coil is adapted, and is a useful 
 adjunct in the treatment of many cases of constipation and 
 painful neurosis when it is necessary to obtain a very powerful 
 local effect. The electrodes employed are preferably of metal, 
 as those covered with felt, sponge, or other similar material 
 
CONDUCTIVE DISCHARGES. 
 
 Si 
 
 must be kept very wet, or disagreeable sparking will make 
 the application intolerable. It is applicable in all cases to which 
 the wave-current is applied for local treatment, but does not 
 combine with it the constitutional effects of the wave-current. 
 It is especially valuable, however, when there are indications 
 for local treatment of two separate regions to which it would 
 otherwise be necessary to make two prolonged administrations 
 of the wave-current. It will repay those who employ this cur- 
 rent to any extent to procure the Cleaves rheostat, because the 
 
 Fig. 32. 
 
 administration is much less painful and generally more effective 
 when it is employed. Another use for this current is in con- 
 nection with step-up transformers consisting of several wind- 
 ings of coarse wire over which are placed glass insulation 
 and a secondary winding. Such may be of the d'Arsonval, 
 Oudin, Tesla, or various modifications of these types, as 
 now in use under the general appellation of " high-frequency 
 apparatus," and are employed both with the static-induced 
 current and coils. The discharges thus derived greatly intensify 
 the voltage and produce discharges peculiarly painless when ad- 
 ministered to the surface of the body from one side of the 
 apparatus. As therapeutic measures they have not been 
 shown to be of great value, except in superficial condi- 
 
52 
 
 STATIC ELECTRICITY. 
 
 tions. In the writer's experience, there are few indications 
 which are not equally well met by the employment of the brush- 
 discharge or high-frequency discharges from the glass or 
 vacuum tubes. 
 
 If currents passing between two poles are to be desired of 
 great frequency, high potential, and small quantity, or of small 
 frequency, high potential, and small quantity, there is ao cur- 
 rent, with the aid of various Leyden jars and transformers, 
 
 a. 
 
 Fig- 33- — a > Revolving Plate; 6, Collecting Combs; t. Prime Conductors; 
 d, Discharging Rods; e, Leyden Jars; g. Electrode. 
 
 more rich in the possibilities of variation than the static-in- 
 duced current. 
 
 Static currents are currents of high potential and small quan- 
 tity, and have the frequency of oscillation under the control of 
 the operator. They are safer than the currents of the d'Arson- 
 val apparatus and to be preferred, unless for some reason a 
 greater amperage may be demonstrated to be of advantage. 
 To the writer this very action, not a characteristic of currents 
 of small quantity, is the objectionable feature of the currents 
 of the d'Arsonval apparatus, except when used with vacuum 
 tubes, and places them in the same category with medicines 
 which are designed to benefit one condition, but require most 
 careful watching lest more mischief than good result. 
 
 The static-induced current, except when conditions requir- 
 
CONDUCTIVE DISCHARGES. 53 
 
 ing quantity, if there are such, enter as a factor, is the most 
 adaptable of all two-pole currents. (The term two-pole cur- 
 rent is employed here as in preceding pages, in a relative sense, 
 and is used in contradistinction to the wave-current, in which 
 but one electrode and one polarity are employed, the dielec- 
 tric, the air, except when saturated with moisture, conducting 
 away but a small part of the electricity.) 
 
 A one-pole current, as the wave-current will be considered, 
 is a current of charge and discharge — an oscillating current in 
 which there is but one connection from the source, the pa- 
 tient receiving a positive or negative charge at the discretion 
 of the operator. Two-pole currents pass between the electrodes, 
 the major part by channels of least resistance, varying in the 
 extent of tissue electrified with the amperage and the amount 
 of potential utilized. One-pole currents, surging from electrode 
 to surface, electrize the whole body of the patient. 
 
 Static electricity, when at rest, surrounds the surface of 
 bodies said to be charged. To reach such surface in its surg- 
 ings it takes the shortest route, as do all currents. It passes 
 through the relatively homogeneous moist alkaline tissues of 
 the bod}% which are good conductors, and not over the dry 
 skin, which is a poor conductor, the relative conductivity being 
 about as one is to one hundred. From the surface of contact 
 with the electrode, electricity radiates in every direction to the 
 surface of the patient and back, with each charge and sub- 
 sequent discharge. To the activities excited in cell protoplasm, 
 both the mechanical, as of a breeze passing through the leaves 
 of the trees, and the electrical, whatever they may be, are un- 
 doubtedly due the remarkable nutritional effect of the one-pok 
 current. But there is another physical effect of a conductive 
 discharge received upon a small area, without a means of exit 
 by a continuance of the metallic circuit. It is as though a 
 stream of water under high pressure had been suddenly pro- 
 jected against a resisting surface. If an electrical discharge 
 of an immense potential is received upon a small resisting por- 
 tion of the skin of the body of the patient who is insulated and 
 placed in the path of the current, the impact at the surface of 
 discharge will be marked, producing a local vibratory effect. 
 
54 STATIC ELECTRICITY. 
 
 The intensity of the effect will depend upon ( I ) the resistance 
 of the skin, which diminishes as it becomes moist, (2) upon 
 the size of the surface receiving the discharge, (3) upon the 
 potential of the current, and (4) upon the conductivity of the 
 tissues beneath the resisting integument. So different, then, 
 are the conditions and effects of currents having a receiving 
 and discharging electrode, and those having but the receiving 
 electrode, that there are reasons to expect different results. 
 And different results are certainly obtained which are now 
 awakening new interest in electro-therapeutics. 
 
 The wave-current (quoting from the paper of Dr. Morton 
 read before the American Electro-Therapeutic Association, 
 
 Fig- 34-—/, Insulated Platform; P, Patient; E, Electrode; 
 G, General Connection; .S. C, Spark-Gap. 
 
 September 23, 1900) " was first so termed because its circuit 
 to be completed produced Hertzian waves emanating from the 
 patient's person." (See Frontispiece.) 
 
 The current was first published in the Bulletin Officiel de la 
 Societe Franchise d'Electrotherapie of January, 1899, and later 
 in the Electrical Engineer of March 4 of the same year, and 
 by the writer both in the Medical Record of March 3, 1900, 
 and in the Transactions of the American Electro-Therapeutic 
 Association for 1900. 
 
 The connections to produce this current are given in Fig. 34. 
 
 " A very important modification of this method is shown in 
 the next illustration (Fig. 35). 
 
 " A metallic foot-plate, upon which the patient's bare feet 
 rest, is connected by a rheophore to an extraneous and inde- 
 
CONDUCTIVE DISCHARGES. 
 
 55 
 
 pendent insulated capacity. I generally employ for this attach- 
 ment a zinc plate, two feet by five feet in size, supported upon ' 
 insulated tripod legs. Any other metallic electrode, in any 
 other situation upon the patient's person, may be substituted 
 for the metallic foot-plate." * 
 
 The wave-current may be intensified and varied by em- 
 ploying an " external insulated capacity," as suggested above, 
 
 Fig. 35 —7, Insulated Platform; P, Patient; E. Electrode; E\ Second 
 Electrode; G, Ground Connection; 5. C, Spark-Gap. 
 
 and by making different connections employing a single Ley- 
 den jar. 
 
 I. When it is desired to intensify or localize the' current by 
 employing an " external insulated capacity " (see Fig. 35) it 
 may be accomplished in the following way: (1) A metal 
 sheet is suspended upon an insulated stand or by insulation 
 material, as a cord, from the point of the standard electrode, to 
 which a rheophore passes from an electrode placed upon the 
 patient, who has previously been connected by an electrode and 
 rheophore to the machine by the usual method of administering 
 the wave-current. (2) By making use of a chair having glass 
 castors or other insulation (ag telegraph insulators) beneath 
 
 * The above, including cuts, was taken, with Dr, Morton's consent, 
 from the report of Transactions of the American Electro-Therapeutic 
 Association for 1900. 
 
56 STATIC ELECTRICITY. 
 
 the legs, the chair placed upon the insulated platform, the 
 patient' being seated on the chair with feet placed upon the 
 metal plate which is placed upon the platform, the patient at 
 the same time having the usual connections for application of 
 the wave-current. 
 
 II. A current of remarkable potency may be produced by 
 modifying the wave-current, as follows : The usual connec- 
 tions having been made, and the electrode placed upon a sur- 
 face requiring an intense local application, place a second elec- 
 trode or plate indifferently on any part of the body or on a part 
 requiring a milder local treatment, and connect the latter elec- 
 trode or plate with the inner coating of a Leyden jar, the outer 
 coating of which is connected by direct metallic connec- 
 tion with the earth. The spark-gap between the balls of the 
 discharging rods will be employed to control the current 
 strength. 
 
 With these currents, above described, the intensity of effect 
 produced upon the patient is greater on the side connected 
 with the machine than on the side connected with the " ex- 
 ternal capacity," or the Leyden jar having a ground connec- 
 tion from the outer coating. 
 
 In these modified currents, the administration is made with 
 the patient insulated, and the effect is local to a marked, and 
 constitutional to a very moderate,- degree. Whereas the un- 
 modified wave-current is constitutional in a very large meas- 
 ure, but requires more energy in the static machine to produce 
 the same degree of local effect. 
 
 The intensity of these currents may be varied with the size 
 of the " external capacity," the size of the Leyden jar, the size 
 and proximity of the electrode, or the length of the spark- 
 gap and the speed and capacity of the machine. 
 
 The writer became familiar with the wave-current during 
 the summer of 1898, while in charge of the office and clinic of 
 Dr. Morton, and was so favorably impressed with its effects 
 that he began its more general adoption in the office and clinic, 
 where it has since been in general use. It has steadily grown 
 in favor with those who have become familiar with the cor- 
 rect method of employing it. During the winter of 1898- 
 
CONDUCTIVE DISCHARGES. §7 
 
 99, the writer in his private office discovered the two most 
 remarkable properties of the current which have now been 
 verified in the practice of many physicians; i. e., the lessening 
 of hyperemia and congestion and the consequent relief of local 
 fain. 
 
 There are various factors and accessories to be taken into 
 consideration if satisfactory results are to be obtained from 
 the administration of the wave-current. The essentials of cor- 
 rect technique calling for special consideration are the insu- 
 lated platform, size and character of electrodes, character of 
 the grounding, polarity, length of spark-gap, etc. 
 
 I. The insulated platform should be provided with glass 
 legs (glass has been demonstrated to furnish the most perfect 
 insulation) at least nine inches in length if a machine of suffi- 
 cient capacity to give the best results is employed. The plat- 
 form should be placed at least three feet from the machine and 
 surrounding objects should be removed to prevent the escape 
 of electrical charge. 
 
 II. The rheophore or cord connecting the electrode with 
 the machine should always be taut to prevent leakage to sur- 
 rounding objects, and is best made of uninsulated copper wire 
 of convenient gauge, because it may be fastened to the elec- 
 trodes and passed beneath the clothing upon the surface of the 
 patient without causing the burning sensation produced by in- 
 sulated rheophores. 
 
 When, however, it is desirable to convey the current to an- 
 other room it is necessary to use well-insulated wires. 
 
 III. The electrodes to be employed with this current call 
 for consideration as to details respecting their application. 
 
 (i) The position of the electrode must be in close contact 
 with the surface treated. Intervening material — as clothing, a 
 small cord, or loose scales of epidermis — will cause an unpleas- 
 ant burning sensation from the passage of innumerable short 
 sparks through them to the surface. The dry skin requires, in 
 a less degree, consideration. This is especially true of " the 
 exposed portions of the neck," * which may be moistened, or 
 * Dr. Lucy Hall-Brown in the Journal of Electro-Therapeutics for 
 February, 190 1. 
 
58 STATIC ELECTRICITY. 
 
 when beginning the administration employ a short spark-gap, 
 and, after a few minutes, as the skin becomes moist, separate 
 the balls to the distance indicated for the treatment of the 
 patient. 
 
 It is well that the electrode applied should be either secured 
 with bandages firmly held by the patient, or by placing a pillow 
 where pressure would hold it in close apposition. Always 
 place a pillow at the back when using the long spinal electrode, 
 and use a chair having a high back, as it is often desirable to 
 place an electrode upon the neck. 
 
 (2) The size of the electrode is a matter of importance 
 and will be governed by the capacity of the machine at the time 
 of the administration, and the effect sought. During periods 
 of humidity, or when, from neglect, the capacity of the ma- 
 chine is lowered, it will be found necessary to concentrate the 
 energies of the current ; the electrode used then must be rela- 
 tively small. It is possible to make only general rules to gov- 
 ern the size of the electrodes, which must depend upon the part 
 treated, the patient, the kind of apparatus, and the lesion. 
 When applied to the muscles of the thigh, leg, or trunk of an 
 adult, an electrode should not exceed twenty-four square inches 
 in size for a spark-gap of four or five inches, and may often 
 be advantageously used with the same spark-gap, when of not 
 more than eight square inches. Muscular contraction or pain 
 over an inflamed area will determine the length of spark-gap 
 relative to the size of the electrode to be employed. 
 
 (3) Special electrodes for treating the mucous surfaces of 
 the open cavities are required ; or various metal sounds, specula, 
 etc., may be utilized in many cases. (These will be considered 
 in chapters on special therapeutics.) 
 
 (4) The material of electrodes must be of some good con- 
 ducting substance, preferably of metal. Sheets of so'ft metal * 
 of suitable thickness may be easily cut with scissors into any 
 desired shape and molded to the surface. 
 
 We employ two thicknesses — 22-gauge for electrodes, he- 
 
 * A better and cheaper material than block tin is Crooke's Composi- 
 tion, manufactured by the John J. Crpoke Company of New York and 
 Chicago. 
 
CONDUCTIVE DISCHARGES. 59 
 
 cause it has sufficient rigidity to permit it to be pushed beneath 
 the clothing; and keep it in close apposition in all cases when 
 molded and applied to the surface. 
 
 Tinsel or tinsel braid, such as is used for trimming (prefer- 
 ably the cheap article used by stage costumers), serves an ex- 
 cellent purpose, and may be applied as a bandage to fingers 
 and to the limbs of children. 
 
 IV. A good ground connection when using the wave-cur- 
 rent to the pole not connected with the patient is imperative 
 if any but the mildest effect is sought, as may be the case when 
 treating the eye, ear, nose, or throat, when it may be made less 
 severe and graduated without becoming too intense to be borne 
 by not grounding. 
 
 V. The polarity of the current, as has been demonstrated, 
 does not especially affect the results of administration, in many 
 cases. But it is noticeable that, under the same conditions 
 and with the same length of spark-gap, there are always about 
 four times the number of oscillations from the positive side, 
 the negative being grounded, than from the negative. The 
 maximum spark-gap, when the negative is grounded, is also 
 slightly longer than when the positive is grounded, other con- 
 ditions being the same. 
 
 It has been observed in the treatment of inflammatory con- 
 ditions that the negative connection for this current is some- 
 times distinctly irritating, and there are no indications of the 
 selection of this polarity for any administration. It is, how- 
 ever, the pole employed with the high-frequency glass vacuum 
 electrode. 
 
 The positive pole, therefore, is preferred in applications of 
 the wave-current, because, other things being equal, it is more 
 sedative, and produces the best tonic effects. 
 
 VI. The length of the spark-gap (the distance between the 
 balls of the ^discharging rods) measures the resistance over- 
 come hy each discharge, and, consequently, the pressure, or 
 electro-motive force, exerted upon the patient when insulated. 
 
 The possible maximum length of the spark-gap at the time 
 of administration will depend upon ( 1 ) the capacity of the ma- 
 chine, which will depend upon its condition, type, speed, and 
 
60 STATIC ELECTRICITY. 
 
 the diameter of the revolving plates; (2) the condition of the 
 atmosphere; (3) the character of the insulation (see Insulated 
 Platform) ; (4) the proximity of surrounding objects; (5) the 
 physical characteristics and clothing of the patient, his size 
 and the presence of many points, as hairs, allowing a greater 
 ■escape of electricity. 
 
 VII. The patient before administration, if a female, should 
 remove her hatpins. It is best for patients who are taking 
 ■electro-static treatment to use bone or rubber (not metal or 
 celluloid) hairpins, as the metal ones may cause unpleasant 
 sensations which annoy timid patients, and the celluloid pins 
 have been known to ignite from a strong spray or brush-dis- 
 charge. Rubbers should also be removed before the machine 
 is started. It is always well to advise patients to remove their 
 watches, for, though rarely, they are certainly sometimes af- 
 fected by the currents. 
 
 The patient should be placed in a comfortable position, if 
 "the treatment is to be long, and great care taken that the spark- 
 gap is gradually opened when starting the machine at the be- 
 ginning of the treatment ; or, what is more important to ob- 
 serve, because it is more likely to occur, is that if for any 
 reason the machine is stopped during the administration and 
 again started, or the speed accelerated, the passage of single 
 •or infrequent long sparks at the spark-gap does not occur, 
 "because they produce very unpleasant sensations of shock. 
 Consult the patient's comfort always and employ no admin- 
 istration producing painful muscular contractions or severe 
 pain, when treating inflammatory areas. If the noise of the 
 discharging spark annoys the patient, which it rarely does, 
 make use of the muffler. (See Fig. 12.) 
 
 VIII. The static-induced current (1) produces more pro- 
 nounced local effects, other things being equal, and requires 
 relatively less capacity in the machine, the short spark-gap, 
 and slow speed, making them especially valuable to those hav- 
 ing inferior machines; (2) to all during periods of humidity; 
 (3) to those depending upon hand power for exciting their 
 currents; (4) in all cases where very large areas require the 
 application of powerful currents, and (5) when it is desirable 
 
CONDUCTIVE DISCHARGES. 6l 
 
 to localize the effects between two electrodes. Electrodes may- 
 be employed in connection with one or more joints requiring 
 the same degree of effect connected in series, and the other 
 large electrode placed upon the back or abdomen, or some part 
 requiring more or less potent effect, as the case may be; or 
 the electrodes may be placed upon opposite sides of a region 
 of the body requiring treatment (care being taken that they 
 do not come in contact), for the purpose of localizing the 
 effect within the intervening structures. When for any rea- 
 son a more or less powerful effect is desired at either electrode 
 when employing the static-induced current, it may be regu- 
 lated by placing a smaller Leyden jar to a part requiring less 
 effect or a larger one to a part requiring less. The applica- 
 tion of this principle will be found a great convenience in regu- 
 lating the action of the current to different regions of the 
 body. 
 
 Time will determine the relative value of the various static 
 currents, but we believe that, except for the advantages indi- 
 cated, the unmodified wave-current described in this chapter 
 must be preferred ; for its remarkable effects upon the general 
 nutrition are due, not alone to intensity, but to the great ampli- 
 tude and vigor of the administrations. 
 
CHAPTER IX. 
 
 PHYSIOLOGICAL ACTIONS OF THE VARIOUS 
 STATIC MODALITIES. 
 
 Frankxinism has in it little or no element of danger, and is 
 therefore, the choice of all electric forms of administration to 
 be put in the hands of the novice, for he can do no injury to 
 the patient, and, if fairly cautious, as he is certain to be, will 
 do some good. 
 
 Many neurologists consider the static modalities as " sug- 
 gestive therapeutic placebos," which they are, in cases amen- 
 able to such influences, but they are more. Safety does not 
 preclude the possibility of potency ; as is demonstrated from 
 exceptional results obtained in the treatment of conditions not 
 so effectively relieved by any other measure, such as rheu- 
 matoid arthritis, sprains, and the forms of neuritis. 
 
 Compared with the constant current, the chemical action 
 and transition of ions is insignificant with the static modes of 
 application. Electrolysis, cataphoresis, and cauterization 
 where indicated, are practically impossible to obtain with 
 Franklinism. 
 
 The interrupted and vibratory influences of oscillatory cur- 
 rents of small quantity, high frequency, and great potential, 
 which are administered to the patient while insulated and in 
 a state of so-called charge, are peculiar to the Franklinic forms 
 of administration, and the effects differ, from this fact. The 
 action upon metabolism of vibratory influences has long been 
 recognized by physiologists, such as that attributed to the 
 heart's impulse. Dubois-Reymond taught " that the nutritional 
 effects depend not on the quantity of the electricity, but "upon 
 the variations in the quantity, and the suddenness of these 
 variations," which is true, but requires qualification in the 
 matter of quantity and other features of administration. 
 
 I. The current should be possessed of the maximum power 
 
 62 
 
PHYSIOLOGICAL ACTIONS OF STATIC MODALITIES. 63 
 
 of diffusion consistent with safety, which quality is peculiar 
 to currents of great voltage and small quantity. 
 
 II. That its effect upon organic structures must be to in- 
 duce functional activity, without altering their natural char- 
 acteristics. 
 
 III. That the oscillations of charge and discharge must be 
 administered to the patient while insulated. 
 
 IV. That administrations should be regulated in frequency, 
 dosage, and duration to the demands of individual conditions. 
 
 We believe that it can truly be said that the only modali- 
 ties that can produce such pronounced nutritional effects are 
 currents of high potential administered to the patient when in- 
 sulated. In other words, no form of application employing an 
 electric circuit between two poles, labile or stabile, can pro- 
 duce as satisfactory a constitutional effect as high-potential 
 currents of small quantity alternately charging and discharg- 
 ing during the administration ; the patient being insulated and 
 connected to one side of the source of electrical energy, the 
 other side of which has a direct metallic connection to the 
 earth, because no other currents can be so widely diffused and 
 induce such activity without danger to the tissues. 
 
 The static modalities fulfill the above conditions better than 
 other known forms of administration. So slight are the con- 
 stitutional effects upon the normal individual that a study of 
 the action in health affords no chance of making deductions 
 ■which will form a basis for therapeutic indications. It is, 
 therefore, necessary to study the effects under the different 
 conditions and from them draw conclusions. 
 
 To avoid confusion it is best to classify the effects as local 
 and constitutional and consider the several actions of the vari- 
 ous forms of application. 
 
 The local effects of the wave-current considered from the 
 actions on the normal individual and the clinical effects when 
 applications are made to abnormal conditions are as follows: 
 
 The local and the constitutional, which vary with the differ- 
 ent forms of administration. The local effects are : ( 1 ) a sense 
 of vibration of the structures beneath the electrode, and also 
 of the hairs upon the head and other portions of the body; 
 
64 STATIC ELECTRICITY. 
 
 (2) muscular contraction; (3) physiological tetanus, induced 
 by currents applied to sensitive regions, as of the hands or 
 arms, increased by lengthening the spark-gap, or accelerating 
 the speed of the machine; (4) increased secretion of sweat, 
 beneath the electrode. 
 
 In addition are the valuable clinical effects : ( 1 ) local con- 
 gestion is relieved, often with marked diminution of swelling 
 and pain; (2) relief of local pain, or tenderness arising from 
 many causes, is marked; (3) relaxation of acute muscular 
 spasm not of central origin; (4) increased local metabolism 
 and acceleration of the processes of repair if conditions are 
 sluggish. 
 
 Sparks are in many conditions superior to the preceding, but 
 in the aggregate cannot be considered as equal. The effects 
 locally applied are as follows : ( 1 ) a stinging sensation, ac- 
 companied by muscular contractions following the spark dis- 
 charge; (2) at the point of discharge a blanched spot appears, 
 due to contraction of the superficial capillaries, which is fol- 
 lowed, in a short time, by marked redness, that soon disap- 
 pears, except in weakly patients. In such the effect may con- 
 tinue for twenty- four hours. (3) Wheals, or even blisters, 
 may be produced when sparks are administered successively 
 to the same spot. (4) Sparks, like the wave-current, increase 
 local secretion and general metabolism. Clinically sparks also 
 (1) relax muscular spasm; (2) sedate pain; and (3) lessen 
 hyperemia and congestion. As a diaphoretic, and applied 
 to muscular spasms and rigidity, and also in their general 
 massage effects, Sparks excel every other modality. 
 
 The brush-discharge, like the two preceding, though to a 
 less degree, ( 1 ) increases secretion and activity of the end 
 organs; (2) it is rubefacient and (3) antiseptic; and, clinically, 
 (4) sedates pain, (5) lessens hyperaemia and congestion. The 
 sensation produced is as if hot sand were thrown with con- 
 siderable force against the parts. 
 
 The breeze and spray, which differ only in degree, produce 
 a cool or warm sensation to the surface, varying with the 
 proximity and the character of any material which may inter- 
 vene. Non-conducting materials, such as paper, woolen cloth, 
 
PHYSIOLOGICAL ACTIONS OF STATIC MODALITIES. 65. 
 
 or silk, increase the intensity of the convective discharges. 
 The physiological effects are much the same as those of the 
 brush-discharge, but distinctly more irritating and less effect- 
 ive. 
 
 Of the static-induced current the local effects are as fol- 
 lows : ( 1 ) muscular contraction or physiological tetanus is 
 produced, varying with the length of the spark-gap or the 
 characteristics of the muscles to which it may be applied to 
 respond; (2) local congestion and pain are diminished, but 
 much less than with the other modes of administration. 
 
 This modality has been employed by some experimenters in 
 connection with a step-up coil, which produces effects char- 
 acteristic of extremely high frequency. These effects, how- 
 ever, have not been demonstrated to be essentially different 
 from those produced by the brush-discharge and the high-fre- 
 quency effects of the Geissler and vacuum tubes. 
 
 The constitutional effects observed, when static electricity 
 is administered to an individual in health, are practically nil. 
 To those, however, in whom there is a departure from the 
 standard of health, from either functional or organic derange- 
 ment, the effects are most pronounced. 
 
 I. The effects upon the circulatory apparatus are: (1) 
 general lowering of arterial tension; (2) lessening of the fre- 
 quency of the heart's action, with (3) lengthening of diastole, 
 and (4) increased volume of the pulse. 
 
 II. Respiration ( 1 ) becomes less labored and less frequent ; 
 (2) deepens, and (3) there is found at the same time to be an 
 increased elimination of C0 2 . 
 
 III. Nervous irritability, if the opposite conditions be pres- 
 ent, is relieved to a marked degree. 
 
 IV. The soporific effects are such that patients invariably 
 become drowsy, and often fall asleep during the administra- 
 tions, sparks excepted. Especially is this true of the wave- 
 current or interrupted insulation. 
 
 V. Lassitude may be produced by prolonged administra- 
 tions. 
 
 VI. A general diaphoresis is induced in most patients, if 
 sittings are from ten to twenty minutes, with the wave-current, 
 
66 STATIC ELECTRICITY. 
 
 interrupted insulation, or the convective discharges. No 
 therapeutic measure in normal individuals will induce a general 
 diaphoresis so promptly and without depression as a thorough 
 application of sparks, long and friction. 
 
 VII. Inactive secretions and excretions are more or less 
 induced to activity during a course of either local or constitu- 
 tional administrations. So remarkable are these effects that 
 patients receiving prolonged treatment for a local trouble in- 
 variably show marked general resumption of functional activity 
 to organs not impaired by organic derangement. Especially 
 marked is the aggregate increased elimination of solids with 
 the urine in rheumatic and gouty patients and in those in 
 whom from any cause metabolism has been defective. 
 
 That metabolism is increased in the end organs when a series 
 of administrations are taken there is abundant evidence, (i) 
 Increased oxidation is evidenced by the marked additional 
 elimination of CO.,; (2) the augmentation of the quantity 
 of solids in the urine, with ultimate restoration of the proper 
 proportions of normal constituents. (3) The restored appe- 
 tite and steady increase in body-weight, until the patient's nor- 
 mal standard is reached, are the invariable results, if derange- 
 ments are but functional. 
 
 To summarize in a few words — induced normal activity de- 
 fines the physiological effects of Franklinism, properly ap- 
 plied. 
 
CHAPTER X. 
 
 GENERAL PRINCIPLES OF ELECTRO-STATIC 
 ADMINISTRATION AND THERAPEUTICS. 
 
 The administrations of Franklinism are governed by gen- 
 eral principles which, when once understood, constitute a basis 
 for correct and successful operation. 
 
 The subjects for general consideration are the patient, the 
 dosage, and the frequency of treatment. 
 
 I. The patient who comes for the first static treatment, in 
 this age when criminals are electrocuted, citizens killed by live 
 wires, and buildings burned because of poor insulation, is 
 usually in a state of trepidation, and the numbers who do not 
 come, for the same reason, are legion. Impostors, quacks, 
 and charlatans have made electricity a byword. It has become 
 a subject of jest with the specialist and family physician, who 
 as a rule know little about its use. The patient is therefore 
 terrorized, prejudiced, and skeptical before he comes for treat- 
 ment. It is then necessary to enlighten him and calm his 
 fears at the first interview, which is easily accomplished in most 
 cases, by explaining the absence of danger from currents of 
 high potential and infinitesimal quantity. The administration 
 of the treatment without blunder or accident will greatly aid 
 in winning confidence, as well as the management of the treat- 
 ment in such a manner that some degree of benefit is derived 
 from the first application. 
 
 To convince himself that the maximum output of the ma- 
 chine could not kill a patient, the writer made the following 
 experiment : A mouse was captured and placed in a paper box 
 having one side of glass. A small hole was made in one end, 
 and the box was then put upon a metal plate. The shepherd's 
 crook was then connected from the platform to the machine, 
 and the machine set in very rapid motion. Upwards of forty 
 
 67 
 
68 STATIC ELECTRICITY. 
 
 very long indirect sparks were administered to the body and 
 head of the little animal, and he still survived. That cruel 
 experiment has served as a convincing argument to many 
 timid patients, and fully reassured the writer of the absence of 
 all danger. 
 
 If the patient's affection is such that vigorous sparks are 
 necessary to relieve the suffering at the first treatment, explain 
 that it will be painful and then proceed. The writer recalls 
 cases of podalgia, chronic rheumatism, and sciatica in which 
 nothing else would have given relief. As a rule, however, 
 such heroic measures are not necessary, though they may be 
 required later in many cases. The patient's first few treat- 
 ments may then be relatively mild. Generally, however, it is 
 not good practice to fail to make a favorable impression by 
 giving some marked evidence of benefit in the early days of 
 treatment, and it is rarely difficult to do so in cases to which 
 the treatment is adapted. The first few treatments are often 
 marked by such a degree of improvement that patients are im- 
 patient when it takes a considerable time to effect a complete 
 cure. Accidental sparks, shocks, and surprises may occur with 
 inexperienced operators, but are certain to lessen the patient's 
 confidence and awaken fears and doubts which subsequent 
 arguments and explanations may not satisfy. 
 
 The idiosyncrasy of the patient is not often a factor to be 
 considered when administering static electricity. This is espe- 
 pecially true of all forms of administration except the sparks, 
 when employed (as they should be) without accidents, because 
 there are no shocks, unpleasant sensations, or physiological 
 effects to disturb the patient's equilibrium. Apprehension of 
 impending danger is the only element in impressionable pa- 
 tients with which the operator has to contend, and this will 
 largely depend upon whether the patient has confidence in his 
 attendant. Under such conditions, and possibly in a few 
 others, instead of the usual glow which accompanies the ad- 
 ministration, there may occur a condition, which has been de- 
 scribed by some writers, in which " the patient remains chilly, 
 depressed, and apprehensive." In most of these patients the 
 effect is said to disappear after a few treatments. 
 
PRINCIPLES OF ELECTRO-STATIC ADMINISTRATION. 69 
 
 It is usual for patients whose secretions are inactive, such 
 as neurasthenics, during the first few administrations not to 
 perspire. 
 
 The skin of some patients is especially susceptible to the 
 convective and disruptive discharges ; an unpleasant pruritus 
 appearing which may persist for several days after an admin- 
 istration. Wheals and sometimes blisters have followed an 
 application of the spray or sparks. With patients in whom 
 the circulation is not good, and the reactions are also sluggish, 
 a treatment by sparks may be followed by a mottled appear- 
 ance, which may persist for twenty-four hours and some- 
 times longer. Such effects cease to appear as the general 
 health of the patient is restored. 
 
 When the dosage and form of administration are once regu- 
 lated to the physical and local conditions of the patient, and 
 the harmless character of the application is fully explained, the 
 number to whom the currents cannot be administered will be 
 small indeed. 
 
 II. The dosage, the amount of current or other form of 
 administration to be employed, and the length of time de- 
 voted to the treatment or the number of sparks to be applied, 
 can only be regulated by clinical experience and the study of 
 individual requirements. To obtain a positive impression, gen- 
 erally, for either local or constitutional effects a minimum of 
 fifteen minutes is required when the wave-current or either 
 form of electrification is employed ; and the best results often 
 demand thirty minutes. 
 
 An over-dose or too prolonged treatment may be followed 
 by weariness and a sleepy condition, never dangerous and al- 
 ways relieved by rest. When employing sparks, be governed 
 in acute painful conditions by the relief afforded. If at first 
 the improvement is but partial, and the patient does not ob- 
 ject, persist until relief is complete, or at least nearly so; tak- 
 ing care to give no careless or unnecessary sparks, but apply- 
 ing them directly to the lesion, where they are certain to be the 
 most painful. The patient soon discovers that sparks so ap- 
 plied are followed by greater relief, and enters into the spirit 
 of the treatment and directs the application to such points. It 
 
70 STATIC ELECTRICITY. 
 
 is well, however, to remember that sparks when applied to 
 bony prominences or motor points are always painful. 
 
 In each case be governed by the results of previous ad- 
 ministrations, and regulate the dose to the individual as in 
 other methods of medical practice. The patient's say-so in 
 the matter of dosage is more to be considered in this than in 
 any other kind of medical practice. 
 
 III. The frequency of administrations is of the greatest 
 importance, and the writer is convinced that the oft-repeated 
 remark of those who have carefully employed static sparks, 
 that " the relief is only temporary, and does not cure," is due 
 to want of thoroughness from lack of appreciation of what is 
 taking place, and failure to again administer the treatment be- 
 fore a complete relapse has occurred. 
 
 Bridging is the term the writer has employed to express the 
 timely repetition of treatments to prevent but partial relapse 
 of the condition relieved. Whether treating a painful or in- 
 flammatory condition, or a case calling for a tonic effect, 
 the golden rule is to bridge the condition of relief from 
 treatnmtt to treatment, lessening the frequency . as the 
 requirements permit. Rarely will this rule call for more than 
 one treatment in twenty-four hours. Occasionally, however, 
 in acute inflammatory conditions, two treatments daily may be 
 required for a few days. When employing Franklinism to 
 obtain the nutritional effects, best results are derived from daily 
 administrations for the first two to four weeks, to be deter- 
 mined by the progress of the case. 
 
 The knowledge of the physiological actions and effects of 
 the different forms of administration suggests to the physician 
 a large range of therapeutic indication, and in a general way 
 the choice of modalities. There are, however, definite meth- 
 ods which experience has demonstrated will produce the best 
 results. A classification is adopted in these chapters which 
 groups the conditions with reference to types having similar 
 indications for treatment, without reference to the ordinary 
 classifications in text-books. This is done for the purpose of 
 suggesting to those unfamiliar with the static methods like 
 indications for their employment in similar affections. 
 
PRINCIPLES OF ELECTRO-STATIC ADMINISTRATION. Jl 
 
 By thus particularizing in a number of cases, which demon- 
 strate the various effects, the special applications will suggest 
 themselves to the reader. 
 
 So numerous are the diseased conditions associated with 
 hyperemia and congestion, and so certain are the demonstra- 
 tions that they are relieved in a large number of cases where 
 no other means are so effective, that it is more difficult to dis- 
 criminate in what case electro-static methods are not indi- 
 cated' than to discover indications for their use. 
 
 Paralysis and spasmodic conditions, not of central origin, 
 have been benefited in all recent chronic cases. This is true 
 in peripheral painful neurosis, atrophies, anaesthesia, and func- 
 tional disorders in general. 
 
 When errors of secretion or excretion exist, the prognosis 
 will depend upon the condition of the organ in question. If 
 the derangement is but functional, the prognosis will be good 
 in most cases. Presumptuous as these statements will seem 
 to many, let it be borne in mind that static electricity, scien- 
 tifically applied to the human organism, is the sine qua nan 
 for activity, not of one cell, but of all, not of one organ, but of 
 all organs. 
 
 Equilibrium, to be restored, requires only properly regu- 
 lated frequency and dosage, together with proper adaptation 
 of food, habit, and environment. Functional derangements 
 are cured and patients recovering from protracted fevers have • 
 their convalescence materially hastened. 
 
CHAPTER XI. 
 
 THERAPEUTICS OF INFLAMMATORY 
 CONDITIONS. 
 
 Pathological. conditions are characterized to a greater or 
 less degree by congestive or passive hypersemia. Irritants 
 enter the economy, or are produced from defective action 
 within the organism, and induce local congestion. 
 
 Pathologically considered, hypersemia arises from circula- 
 tory disturbances due to pressure, traumatism, obstruction, or 
 paralysis of the muscular coats of the vessels, of which one 
 type, at first passive, may become active or congestive. The 
 other type of hypersemia is active, leading on to congestion 
 in its early stages. These are induced by traumatism, ex- 
 posure to heat or cold, the presence of germs, tissue necrosis, 
 or of other sources of irritation to which the parts are sub- 
 jected. 
 
 " When a strong stimulus acts upon a muscular part, hy- 
 peremia, redness, and swelling occur. In congestive hyper- 
 aemia under the microscope we see ( i ) dilated blood vessels 
 overfilled with corpuscles; (2) the stream becomes irregular 
 and slower; and next (3) stasis occurs and the blood vessels 
 are plugged. During these processes, the white corpuscles, 
 and, less often, the red, escape into the tissues, plasma exudes, 
 and swelling results. Under favorable conditions the stasis 
 may disappear." * 
 
 If the proliferation is not deferred on account of the in- 
 tensity of the inflammation, regeneration, which takes place in 
 cases in which the congestion is mild in from eight to twelve 
 hours, will be established permanently and without hyper- 
 trophy. If, however, the stasis is allowed to persist, tissue 
 necrosis results and repair may be long deferred. 
 
 The processes of regeneration are often delayed by one or 
 * Landois and Stirling: " Text-book of Human Physiology." 
 
 72 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 73 
 
 more of the following causes : ( 1 ) the exciting cause may still 
 be present; (2) the inflammation may be intense and the 
 stasis and swelling persist; (3) the lymphatics may be in- 
 active and slow in removing the products of inflammation; (4) 
 the exuded fibrin and degenerated blood cells may be de- 
 posited in the vicinity of structures not well supplied with 
 lymphatics, as so often happens in the joints, and there remain, 
 producing anchylosis or other impairment of motion; (5) the 
 presence of micro-organisms which develop characteristic tis- 
 sue change and degeneration, delay restoration, and, if not re- 
 moved eventually destroy the part; (6) there may be retained 
 necrosed tissue, as dead bone; (7) in diathetic diseases, it does 
 seem that irritants have either accumulated at the site of the 
 inflammatory processes or are being constantly poured in. 
 
 In both types of hyperasmia, the indications are apparent. 
 That electricity of great potential, high frequency, and small 
 quantity removes obstacles to regeneration and promotes nor- 
 mal tissue proliferation can be demonstrated both by analogy 
 and experience. 
 
 The properties which effect the results to which we will refer 
 are mainly due to the intense penetrating vibration and con- 
 sequent induction of contraction of the muscles and structures 
 surrounding the congested area and the coats of the circulatory 
 apparatus at the site of administration — which actions are pe- 
 culiar to electricity. The local vibratory or interrupted con- 
 tractions, as of the hand upon the bulb of a Davidson's syringe, 
 give the impetus which starts on the blood stream and over- 
 comes stasis, and we are certain that no other mechanical 
 agent can produce the degree of intensity, frequency, or pene- 
 tration which we obtain from the static machine which has 
 the frequency and amplitude controlled by a spark-gap. in as- 
 sociation with a current output that can be increased or di- 
 minished. Nor has any other interrupter or mechanical vibra- 
 tor been constructed for use in connection with electrical 
 apparatus which will modify all the qualities of fineness, am- 
 plitude, and frequency as well as that produced with the spark- 
 gap and a regulated current output. 
 
 That the electrical action of the currents, electrolytic, cata- 
 
74 STATIC ELECTRICITY. 
 
 pboric, or electro-chemical, are not essentially of value in re- 
 lieving these conditions, we believe is proved from the fact that 
 the best results are obtained from the currents that possess 
 those qualities in the least degree. That an energizing, stimu- 
 lating effect upon cell protoplasm is derived from these cur- 
 rents which is not due to vibration, there is abundant proof 
 from the general sense of well-being that follows an adminis- 
 tration. Nor are the effects caused by the well-known elec- 
 trical actions above referred to, as is proved by experience. It 
 seems more likely that an influence effect by polarization of the 
 tissues, without altering the cell structure, creates normal ac- 
 tion which, in accord with nature's law, leads to regeneration 
 and restoration. 
 
 The induction of local • activity by overcoming stasis, and 
 general by restoring the normal balance of the metabolism, 
 contributes in all inflammatory conditions to the removal of 
 the cause, and to tissue proliferation with regeneration. 
 
 Clinical experience with many conditions has demonstrated 
 the following facts, which it is difficult for controversy or 
 argument to weaken or disprove : 
 
 Electro-static modalities (i) remove stasis; (2) promote ab- 
 sorption of plasma and other detritus, thereby (a) lessening 
 pain and swelling, (b) removing deposits of fibrin and dis- 
 organized blood cells in the vicinity of joints, (c) inducing the 
 reabsorption of organic and inorganic salts which have become 
 locked up in the tissues as a result of defective metabolism. 
 (3) They produce a general equalization of the blood currents 
 to all parts of the body with well-marked lowering of arterial 
 tension, which decidedly lessens the possibility of local con- 
 gestion ; (4) there is positive proof that a local expression 
 of blood from the vicinity of the lesion takes place by the 
 production of mass contraction and contraction of the walls of 
 the arterioles; and (5) regeneration and restitution are has- 
 tened. 
 
 The relief of passive hyperaemia occurring with marked 
 oedema in organic disease of the liver, heart, and kidneys, and 
 in cases of varicose veins, resulting from thrombosis of the 
 large veins of the lower extremities, offers but little encourage- 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 7$ 
 
 ment from electro-static treatment. Those arising, however, 
 from lost tone of the arterial or venous walls, functional de- 
 rangements of some part of the glandular system, pressure due 
 to constipation, or cases associated with surgical oedema fol- 
 lowing operations or accidents, are successfully treated in all 
 but exceptional cases by one or another of the static modalities. 
 Early attention greatly enhances the prospects of a prompt 
 restoration to normal, the principle a priori in all cases, the 
 degeneration and structural alteration either precluding the 
 possibility of restoration or requiring much longer time to in- 
 duce a recovery approaching the normal. When a large gland, 
 as the liver, is the seat of hyperaemia, the application of one 
 of the modalities over the organ will afford relief. 
 
 In cases of surgical oedema, great satisfaction will be de- 
 rived from the static treatment, because tone and activity are 
 restored to the parts, active lymphatic secretion induced, and 
 the stasis and oedema removed. 
 
 The same general action takes place in numerous other cases 
 of passive hyperaemia, which it will be unnecessary to mention. 
 
 To the effect upon acute congestive hyperaemia we turn 
 for the greatest triumph of modern electro-therapeutics. The 
 same rule applies here as in all cases : Early administration 
 insures a prompt restoration ; in all others, time relative to 
 duration, and the probability that recovery will be incom- 
 plete, or if a pus cavity has formed, its evacuation by the knife 
 must precede or replace electrical treatment. 
 
 Therapeutically, the static modalities meet in a most com- 
 plete and satisfactory manner the essential indications in in- 
 flammatory conditions not characterized by the presence of 
 micro-organisms beneath the surface, or of some foreign or 
 necrosed substance which cannot be promptly absorbed. 
 
 The modalities of particular value in influencing these con- 
 ditions are the wave-current, the static-induced current, the 
 brush-discharge, sparks, and the spray, which produce the fol- 
 lowing effects : 
 
 1. Throughout the economy, normal functional activity is 
 induced, associated with the maintenance of the nutritive and 
 secretory processes. 
 
76 STATIC ELECTRICITY. 
 
 2. Stasis, the first disturbing influence to the processes of 
 repair, is promptly removed. 
 
 3. In acute cases the exudate, which may have accumu- 
 lated, is absorbed, and the swelling often largely disappears 
 during an administration. 
 
 4. In chronic cases, fibrin and other products of inflamma- 
 tion which are deposited in the tissues, as they are especially 
 apt to be in the vicinity of joints, are gradually separated, 
 when not too deeply situated in the structures of the joint, by 
 the vibratory action of the wave-current, or still more effectu- 
 ally by the long percussion sparks. 
 
 5. Healthy active metabolism is induced and the processes 
 of cell proliferation and restitution are undoubtedly accelerated. 
 
 6. When indolent or irritable ulcers, or affections associ- 
 ated with the growth of bacteria, are present in the skin, 
 remarkable anodyne, oxydizing, and stimulating effects are de- 
 rived from the administration of the brush-discharge. 
 
 7. There is marked lowering of the general arterial ten- 
 sion, which is most prompt when sparks are administered 
 and most prolonged after an administration of the wave-cur- 
 rent. 
 
 8. At the same time there are locally induced by the wave- 
 current, sparks, or brush-discharge a mass contraction and a 
 contraction of the arterioles in the structures immediately be- 
 neath the surfaces, with marked diminution of local conges- 
 tion. 
 
 9. Prolonged administration of the brush-discharge 
 or the spray produces beneficial rubefacient effects. 
 
 10. Pain promptly disappears from the first, and will not 
 return if administrations are sufficiently frequent to control the 
 congestion. 
 
 That these effects are produced is demonstrated daily in the 
 experience of those who make correct use of the modalities. 
 
 For convenience of classification, the inflammatory condi- 
 tions will be divided into ( 1 ) those characterized by the pres- 
 ence of micro-organisms, either demonstrated or suspected; 
 (2) those due to tissue necrosis; (3) traumatic affections, with 
 and without solutions of continuity; (4) those arising from 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. J"] 
 
 some dyscrasia, cachexia, or diathesis; and (5) those arising 
 from functional inactivity and unknown causes. 
 
 I. Germ life, like other forms of cell protoplasm, is but 
 slightly affected by the static forms of administration, except 
 those with which ozone is brought in contact, and their vitality 
 destroyed by oxidation. Such administrations are applied with 
 difficulty and uncertainty to all but superficial lesions, which 
 will be treated in a chapter devoted to diseases of the skin. In 
 tuberculosis the bacillus is not destroyed, except superficially, 
 by any direct effect of the static modalities upon the germs, 
 either by cataphoresis or ozone within the tissue, because it 
 is physically impossible to bring ozone in contact with germs 
 beneath the integument. 
 
 II. Ozone inhalations are advocated by some authorities for 
 the treatment of tuberculosis. It must be borne in mind, 
 however, that when high-potential electrical discharges take 
 place, decomposition of the atmosphere results in the produc- 
 tion not only of ozone, but also of nitrous acid (NO,,), which 
 is an irritant and probably likely to do harm. It has been 
 said, however, by an eminent authority that "' possibly nitrous 
 acid was what affected tubercular patients so beneficially." 
 
 That static tonic administrations, however, do assist in cur- 
 ing incipient forms of phthisis, by restoring the general health 
 of the patient and thereby removing the lowered conditions 
 essential to the growth of the bacillus, is unquestionable. 
 
 III. Sprains and bruises, not complicated by fracture, sever- 
 ance of ligaments from their insertions, muscular ruptures or 
 lacerations of the integument, severe though they may be, 
 yield more promptly and completely to electric treatment than 
 to any other. The wave-current, the brush-discharge, and 
 sparks are the effective modalities. The wave-current should 
 be administered to the surface surrounding the joint by plac- 
 ing the metal electrode in close contact, after which the length 
 of the spark-gap should be regulated to the conditions, em- 
 ploying always as powerful currents as can be used without 
 producing painful contractions of the muscles. Continue this 
 treatment for from fifteen to twenty minutes, bearing in mind 
 that the longer time is sure to be effective, while less would 
 
78 STATIC ELECTRICITY. 
 
 often not suffice. In some cases the wave-current will be all 
 that is required, in others the administration of the brush-dis- 
 charge, employing the wooden ball electrode, will still further 
 remove superficial tenderness or swelling. Some cases, espe- 
 cially those about the face and hands, in which the tissues are 
 not dense and deep and the small muscles contract painfully 
 to very mild applications of the wave-current, can be completely 
 relieved by the application of the brush-discharge, for from 
 ten to twenty minutes, the time depending upon the severity 
 of the case and the extent of the area affected. When applying 
 the brush-discharge it must be constantly moved about, or its 
 application will otherwise be unbearable. 
 
 When the deep structures of large joints are involved, or 
 with very stout patients, it will often be necessary to employ 
 long sparks directly to the affected region. The indication 
 for the application of sparks will be the persistence of pain on 
 motion, felt deep in the .structures of the joint during the 
 progress of the treatment. 
 
 The results from these methods are uniformly good. The 
 pain and swelling will be much diminished at the time of the 
 administration, and cases of not more than twenty- four hours' 
 standing will be cured in from three to five days, during which 
 time the patient should be permitted to use the part. In 
 sprains of long standing the length of time required will vary 
 with the characteristics of each case, but improvement in most 
 cases will be marked and satisfactory from the first. Severe 
 sprains, complicated by rupture of the ligament, are satisfac- 
 torily treated in the same manner, and though the time re- 
 quired to effect a cure is longer, progressive improvement will 
 be marked. 
 
 When there is an abrasion in the vicinity of the sprain or 
 bruise, avoid placing the electrode or making an application 
 of the brush-discharge directly over the open surface, as it will 
 be too painful, the most of the current entering the injured 
 spot. 
 
 The treatment may be properly instituted as soon as the 
 swelling appears and should be administered until the parts, 
 are no more sensitive to the administration than the surround- 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 79 
 
 ing surfaces. The frequency should be regulated to the in- 
 dications of the individual case. 
 
 IV. The treatment of fractures associated with splints is 
 of great interest, because it is possible to allay much of the 
 suffering and hasten the complete recovery of the case. The 
 brush-discharge is the only modality indicated, because the 
 sparks and the wave-current cause such active contraction 
 that the fractured parts are apt to be thrown out of position. 
 The danger of anchylosis is greatly lessened. This feature will 
 be highly appreciated in the treatment of fractures and disloca- 
 tions in the vicinity of joints. Success in this class of cases 
 may be directly attributed to the effects of lessening conges- 
 tions, and at the same time hastening the process of repair. 
 
 V. Dislocations and all other traumatic injuries will be 
 treated upon the same general principle and with a degree 
 of success that will in time guarantee the general adoption of 
 the method. 
 
 VI. In the management of the rheumatic and gouty 
 diatheses, as well as the conditions present in rheumatoid 
 arthritis, the results of treatment are threefold. (1) Most 
 cases are promptly relieved of the local conditions. (2) 
 Marked improvement follows in the patient's general health. 
 (3) Decided increase in the aggregate of solids eliminated with 
 the urine, as well as marked diuresis in many cases, will be 
 noticed. 
 
 RHEUMATISM. 
 
 Medicinal treatment in the above disease, of which the 
 aetiology is so imperfectly understood, is and always has been 
 empirical. 
 
 In rheumatism undoubtedly, as in gout and myalgia, there 
 are two indications for treatment — that of the diathesis and 
 the local manifestation. In acute rheumatic fever, the indica- 
 tions and means for medical treatment are undoubtedly too well 
 established to be questioned. In the rheumatic diathesis, how- 
 ever, all medicinal treatment seems to fail and opinions and 
 remedies are numerous and variable, as in all diseases for 
 which no satisfactory plan of treatment is recognized. 
 
80 STATIC ELECTRICITY. 
 
 The associated conditions present with the rheumatic diath- 
 esis may be attributed largely to functional inactivities result- 
 ing either from physical organic defects, or improper habits 
 of diet or exercise. 
 
 Franklinism is well calculated to meet the requirements for 
 relieving both the constitutional and local conditions in all 
 cases of chronic articular rheumatism as well as having proved 
 a valuable aid to the usual methods in acute cases. 
 
 The constitutional treatment should be pursued with 
 thoroughness because it meets so well the indications, unlock- 
 ing the secretions and promoting the elimination of the ac- 
 cumulated products of defective metabolism, which are recog- 
 nized as exciting causes of the disease. Apply the metal elec- 
 trodes closely, securing them with bandages to the affected 
 joint and employing the wave-current, regulating the spark-gap 
 by the effects produced — pain and muscular contractions to 
 govern the gradual lengthening of the gap. Continue each 
 administration for at least twenty minutes. If two or more 
 large joints are affected, or for some reason it is desirable to 
 make an application to the abdomen, or back, or over the liver, 
 with a view to increasing the activity of their functions, the 
 modified wave-current or the static-induced current may be 
 employed. 
 
 The advantages of either of the latter are that with them 
 two or more large joints can be treated at one time, whereas 
 with the wave-current there might not be sufficient energy to 
 produce the desired effect upon both. Whenever it is possible 
 to obtain enough current to treat two or more joints at one 
 time, the wave-current should be employed because of the 
 marked constitutional effects not produced by the other cur- 
 rents. It must be borne in mind that the local effect is relative 
 to the surface area of the electrodes and the character of the 
 structures treated. As a rule, the muscles contract in propor- 
 tion to their size, other things being equal, therefore, when con- 
 necting several electrodes which have been applied to parts to 
 be treated together, and to one side of the machine, observe 
 that they are equally responsive to the current. When employ- 
 ing the static-induced current, therefore, connect several sensi- 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 8 1 
 
 tive parts together to one side, employing relatively large elec- 
 trodes and to the other side small electrodes to less sensitive 
 parts. The proof that they are right will be that about the 
 same vibratory sensation is appreciated in all parts. 
 
 It will easily be seen that by such means much time can be 
 saved when many joints require treatment; but, to obtain the 
 best results, considerable tact and experience will be required 
 to equalize the effects. 
 
 To obtain the best results upon local congestion, the applica- 
 tion should be localized and the oscillations not frequent. 
 When there are few joints requiring treatment, and the capacity 
 of the machine at the time is capable of producing the desired 
 intense vibratory effects, the wave-current is to be preferred 
 because of the tonic effects produced. In any event, one ad- 
 ministration of the wave-current for at least fifteen minutes 
 should be given during each sitting, for its effect in stimulat- 
 ing secretions and excretions is important for the relief of rheu- 
 matic conditions. The time devoted thus to each joint should 
 be not less than fifteen minutes, and excellent reports are noted 
 from administrations of more than one hour duration. The 
 treatments should be daily, and severer cases require two ap- 
 plications during twenty-four hours. 
 
 In addition to the wave-current, sparks will be indicated 
 when the lesions are deeply seated and chronic. No form of 
 administration is so effective in the production of the local 
 effects upon deep structures, and for removing the products of 
 inflammation, as long, indirect static sparks. They are espe- 
 cially indispensable, and effective, in rheumatism affecting the 
 hip, knee, ankle, and shoulder joints, and often beneficial in the 
 smaller joints as well. Their use should, as a rule, follow an 
 application of the wave-current. 
 
 A general administration of sparks (in lengths proportional 
 to structures), ending with an active general friction ap- 
 plied very rapidly over the whole person of the patient, is a 
 very valuable means of promoting a general and active 
 metabolism. 
 
 Another measure invaluable in the treatment of rheumatism 
 is the brush-discharge. It will be found of advantage in the 
 
■82 STATIC ELECTRICITY. 
 
 treatment of each case, and sufficient for its local effect in a 
 very large number of cases. No form of administration will 
 give greater satisfaction in any affection than the brush-dis- 
 charge in many cases of acute articular rheumatism, after an 
 administration of ten minutes, during which interval the 
 wooden ball is moved rapidly about over the affected surface. 
 The relief from pain is usually prompt and enduring; much 
 swelling often disappears during the administration, and a com- 
 plete disappearance of the trouble may take place in a few days. 
 The technique is simple and requires but little skill. The ma- 
 terial of which the wooden electrode is made and its condition 
 are matters of the utmost importance if the modality is to be 
 successfully administered. The literature up to the present 
 time on the subject is not in accord with the above plan of 
 treatment; but it has been demonstrated by the writer in an 
 ample number of cases that electro-static treatment of young 
 and robust adults, when continued for sufficient periods, will 
 effectually cause the elimination of the materials which seem 
 to induce the acute attacks. It is remarkable that in the treat- 
 ment of acute cases a very marked degree of diuresis is induced. 
 
 MYALGIA. 
 
 Muscular rheumatism is one of the affections in which 
 ■electricity, especially static, has long been recognized as a 
 specific. Sparks — long, short, and friction — have held monop- 
 oly in these cases, but the wave-current greatly aids in the 
 severer forms of lumbago, and may be wisely employed in all 
 chronic and severe forms ; as may also the brush-discharge, 
 which very effectually meets the indications. It is possible to 
 relieve them and therefore advisable in nervous patients to 
 administer prolonged, applications of the wave-current before 
 resorting to sparks. 
 
 GOUT. 
 
 An acute attack of gout can either be cut short or greatly 
 alleviated by the use of the brush-discharge, or the wave-cur- 
 rent, in conjunction with the usual specifics. The relief af- 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 83 
 
 forded by an application of the brush-discharge to an acute 
 gouty arthritis is most gratifying to both physician and patient. 
 If the attack is acute, and it is possible for the patient to receive 
 two treatments in twenty-four hours, during the first days of 
 the attack, it will hasten favorable results. We believe that 
 time will demonstrate that no plan of constitutional treatment is 
 so well calculated to promote the elimination of gouty accumu- 
 lations in the system as the properly regulated and systematic 
 administration of static electricity ; employing the same general 
 plans advised in the treatment of rheumatism. The constitu- 
 tional treatment of gout, employing static electricity in connec- 
 tion with dry hot air, following the same general plan pre- 
 scribed above in the treatment of rheumatism, should be thor- 
 ough and persevered in for months, in conjunction with a well- 
 regulated diet, when the. results are certain to be satisfactory. 
 
 ARTHRITIS DEFORMANS. 
 
 When Yirchow named a class of conditions characterized by 
 arthritis and deformity, arthritis deformans, he inadvertently 
 .included under one name at least four distinct affections oc- 
 curring from as many different causes. They comprise two 
 diseases commonly encountered, rheumatoid arthritis and osteo- 
 arthritis, and two others which are more rarely seen, gouty 
 arthritis and a peculiar type which has not been named or 
 described, to the writer's knowledge. 
 
 To rheumatoid arthritis belong all cases characterized by 
 the presence of an anjemic and depleted condition arising in 
 most cases from some other traceable cause. The joint process 
 is well denned and easily differentiated, beginning with a 
 slight pain in one or more joints which will be in most cases in 
 the middle phalangeal joint of the finger. In some cases this 
 pain is ushered in with great severity. A swelling soon ap- 
 pears in the affected joint and other joints gradually become 
 involved. The destructive process once begun, it has been 
 rarely known in unmolested cases to stop until the joint is 
 permanently destroyed and anchylosed. This affection is uni- 
 formly bilateral, indicating a central origin as in locomotor 
 ataxia. 
 
8 4 
 
 STATIC ELECTRICITY. 
 
 The degree of destruction and deformity varies from fixed 
 flexion with absorption of all the cartilaginous structures of the 
 joint, to destruction of the articular ends of the bones, as well, 
 in severe cases. (See Fig. 36.) The suffering and deformity 
 
 Fig. 36. 
 
 are more marked and the progress more rapid, than with the 
 other conditions with which rheumatoid arthritis has been 
 confused. 
 
 The changes in the bone which take place in rheumatoid 
 arthritis in children are quite remarkable, as is shown in the ac- 
 companying skiagraph, Fig. 37. It will be noticed that the 
 joint between the metacarpal and the first phalanx of each 
 hand is disarticulated and that all the phalanges and metacarpal 
 bones are wider than normal. The latter condition, we believe, 
 takes place in all cases of rheumatoid arthritis in young chil- 
 dren. 
 
 Once established the disease may involve many or all of the 
 joints of the body. 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 85 
 
 It is characteristic of no age or sex ; young children are 
 affected and it may also commence in the aged. It is far more 
 common, however, with women during active menstrual life. 
 The case shown in Fig. 38 is that of a child seven years old. 
 This case was reported at the meeting of the American Electro- 
 Therapeutic Association held at Washington in 1899 and pub- 
 
 Fig. 37- 
 
 lished in the Transactions of the Association for 1899 and 1900 
 and in the Post-Graduate for October, 1899. The effects of the 
 treatment upon this case, together with the favorable results 
 obtained upon an adult patient at about the same time, led the 
 writer to devote much attention to the study of the disease. 
 The case shown in Fig. 39 is another instance of the manner in 
 which the disease attacks young children. 
 
 The aetiology of rheumatoid arthritis is a question of doubt. 
 Bannatyne and Spender adhere to the notion that it is due to 
 a germ. This view has not, however, been confirmed by most 
 
86 
 
 STATIC ELECTRICITY. 
 
 observers, and the writer's experience in the treatment of the 
 disease leads him to doubt the presence of such a cause, be- 
 cause of the success obtained in the treatment of the disease, 
 employing a means that does not unfavorably affect cell pro- 
 toplasm or the germs known to be present in other diseases. 
 
 Fig. 38. 
 
 There is, however, abundant evidence of an affection of the 
 trophic nerve centers from the muscular atrophy, pigmenta- 
 tion, absorption, and destruction of the soft parts in which it 
 resembles to some extent the similar conditions of locomotor 
 ataxia, progressive muscular atrophy, and allied diseases. In 
 the writer's cases, which number more than fifty, there has in 
 most cases been present some exhausting condition or chronic 
 affection such as Bright's disease or syphilis, but most corn- 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 87 
 
 monly some of the affections associated with menstrual de- 
 rangements. This makes probable the theory that the trophic 
 conditions which seem to cause the disease arise from mal- 
 nutrition. 
 
 The prognosis is relative to the length of time that the 
 disease has been present, to the nature of the complicating 
 
 Fig. 39- 
 
 conditions, to the extent of the affection, and to the faithful- 
 ness with which the patient follows the proper treatment. 
 
 Whenever the inter-articular cartilages are intact, as indi- 
 cated by the light line between the phalanges, experience 
 teaches that the other joint structures are also unaffected, and 
 recovery of the affected joint will be complete; while in joints 
 where that cartilage is more or less involved the joint can never 
 be normal, but will remain entirely or partially stiff after the 
 active processes are checked. Radiography has also demon- 
 strated the absence, in every case examined, of so-called chalky 
 
08 STATIC ELECTRICITY. 
 
 accumulations, and has diagnosed classes of cases distinct in 
 every way from rheumatoid arthritis. 
 
 The treatment is essentially the same as the treatment of 
 rheumatism and other inflammatory conditions. The consti- 
 tutional treatment is of the utmost importance and never to be 
 neglected. Each finger should be covered with soft metal — 
 narrow strips bandaged about the fingers. When applying 
 
 Fig. 40. 
 
 metal electrodes about large joints, the writer usually slits 
 square or rectangular pieces (see Fig. 41), so that they may 
 be adapted to the joints. For best results the wave-current 
 or derived currents should be administered to each joint af- 
 fected, for some fifteen to twenty minutes during the first weeks 
 of treatment. For this purpose much time will be saved by 
 connecting several joints for one administration. When treat- 
 ing in this manner, take care that the joints simultaneously 
 treated are about equally sensitive to the current. For ex- 
 ample, the hands, wrists, forearm, and temporo-maxillary 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 89 
 
 articulation will endure about the same current, and the 
 shoulders, ankles, and feet a much larger voltage. As a rule 
 the knees, singly or together, will require in an adult as much 
 current as a machine will excite (an eight- to twelve-inch 
 spark-gap with the wave-current). The writer has frequently 
 employed a spark-gap ten to twelve inches in length when 
 treating the knees with the wave-current. The longer the 
 
 Fig. 41. 
 
 spark-gap that can be employed in every case without causing 
 discomfort, the greater the effect upon the deep local conges- 
 tion. 
 
 A very liberal application of sparks — short ones, one-half 
 to three-quarters of an inch in length, to the finger-joints, and 
 relatively longer ones to the other joints — is indispensable, if 
 success is to attend the treatment of chronic cases of rheuma- 
 toid arthritis. Painful as they are, an average of about ten 
 sparks to each finger-joint seems to be required. These are 
 best borne when the operator takes a single spark from each 
 joint, and, passing back and forth along the rows of knuckles, 
 completes the required administration. 
 
90 STATIC ELECTRICITY. 
 
 The brush-discharge affords great relief when applied to the 
 affected joints in rheumatoid arthritis. It should be applied 
 until the administration ceases to cause the characteristic pain 
 occasioned by its use over, inflammatory areas. It is remark- 
 able how much relief can be afforded by this modality, and it 
 should be employed in all cases, especially when initiating a 
 timid patient to the treatment. It takes much more time, 
 however, than sparks and it is difficult to say that it accom- 
 plishes more. 
 
 Patients should be treated daily until the effects will bridge 
 longer periods. The intervals should not be longer than three 
 days, until cured. The promptness with which relief follows 
 will vary greatly with the cases. Some will be cured within 
 two months and others will require as many years. Particular 
 attention must be paid to the constitutional treatment and the 
 removal or relief of the primary disease, and satisfactory re- 
 sults will generally follow. 
 
 OSTEOARTHRITIS. 
 
 This affection is distinct from rheumatoid arthritis, and has 
 long served to confuse, the professional mind and literature on 
 the subject. It occurs usually in healthy, well-nourished indi- 
 viduals of the better classes, and begins to appear at or about 
 the menopause in women, and is very rare in men. 
 
 The examination of a large number of these cases with the 
 Roentgen ray has convinced the writer that what have so often 
 been considered chalky deposits are true osteophyte enlarge- 
 ments of the bones and usually appear at the last phalangeal 
 articulations, as shown in the accompanying illustration. It is 
 incorrect to consider them of gouty origin, or in any way allied 
 to gout. There is no cure for the condition when once devel- 
 oped. The application of sparks, as in the treatment of rheu- 
 matoid arthritis, will in most cases relieve the local pain and 
 inflammatory swelling, and render joints otherwise painful 
 constantly useful. The case represented in Fig. 42 has for four 
 years received on an average two or three treatments monthly, 
 going frequently two or three months without suffering or 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 
 
 91 
 
 treatment. The osteophyte enlargements have not increased 
 in size, nor diminished, since they have been under observation, 
 as is shown in the skiagraph, Fig. 43, which was taken four 
 years later than that shown in the preceding cut. 
 
 Sparks associated with the brush-discharge give the best 
 
 Fig. 42. 
 
 results, and should be administered in frequency according to 
 the indications. 
 
 The fourth type of arthritis deformans, of which a skia- 
 graph is shown in Fig. 44, has an unique characteristic in 
 that only a single finger of each hand is similarly affected, it 
 being the corresponding finger on both. This case was in an 
 otherwise healthy patient, an artist by profession, with no his- 
 tory of any other joint affection. The fingers were curved as 
 by equal contraction of the muscles, anteriorly and posteriorly, 
 the fingers at the end phalanx being turned towards the thumb 
 and at the middle joint in the opposite direction. The patient 
 recovered under the treatment given for rheumatoid arthritis 
 with the finger only partially movable, and in an extended 
 
9 2 
 
 STATIC ELECTRICITY. 
 
 position — not flexed. The writer has seen no description of a 
 similar case, and it cannot be classified with either of the other 
 types of arthritis deformans. 
 
 Spondylitis deformans is a rare affection which, to the pres- 
 ent time, has received no relief from the surgeon or physician. 
 It belongs properly in the same class with rheumatoid 
 
 Fig 43 
 
 arthritis, and is characterized by destruction of the inter- 
 articular vertebral cartilages. The disease is probably due to 
 -causes similar to those which induce rheumatoid arthritis. It 
 may or may not be associated with a rheumatic history, and the 
 course of the disease is always to progress from bad to worse. 
 The deformity is characteristic, the back being gradually 
 curved forward as the cartilages become thinner. 
 
 No case of this affection, so far as the writer can ascertain, 
 has ever recovered. The plan of treating rheumatoid arthritis 
 and the success with other spinal affections caused the writer to 
 advise in these cases the trial of the static wave-current and 
 sparks to the spine. This should be done in conjunction with a 
 
THERAPEUTICS OF INFLAMMATORY CONDITIONS. 
 
 93 
 
 plaster jacket beneath which the electrodes may be readily 
 placed. The current should be administered daily for two or 
 three weeks, employing an electrode two inches wide by eight 
 or ten inches long, placing it first from above downward and 
 giving as long a spark-gap as the patient will permit without 
 
 Fig. 44. 
 
 discomfort from the muscular contractions or pain over an in- 
 flammatory area which will usually be from five to seven inches 
 in length ; then place it from below upward, employing the 
 same rule as to length of spark-gap. These administrations 
 should be for fifteen minutes each, at the close of which a few 
 long sparks may be administered parallel with and near the 
 spinous processes. This treatment should be kept up daily for 
 the first two or three weeks and upon alternate clays for a long 
 period — until the active process seems to be stayed and the 
 patient, if possible, is able to get along without the plaster 
 jacket. 
 
94 STATIC ELECTRICITY. 
 
 The success that will attend this procedure is so far an open 
 question. The writer, however, is observing the treatment 
 with excellent prospects of benefit. As there are no contra- 
 indications and the procedure promises much, there can be no 
 mistake to endeavor to spare these sufferers by the methods 
 suggested. 
 
 SYNOVITIS. 
 
 This affection, when not characterized by the presence of 
 pus, should be treated in the same manner as the other forms of 
 arthritis, employing the wave-current, sparks, and the brush- 
 discharge. The results are uniformly successful, the time 
 necessary to complete the cure depending upon ( i ) the, length 
 of time since its appearance, (2) the general health of the 
 patient, (3) the presence of dense layers of fat over the joint. 
 In the latter very long percussion sparks will be imperative, 
 and much time will be necessary to effect a cure, because the 
 vibratory action of the electro-static currents, or sparks, can- 
 not be brought so effectively to act upon the muscular, cir- 
 culatory, and lymphatic structures through a thick, almost non- 
 conducting cushion of fat. 
 
 Many other affections might be included in this chapter, — 
 as neuritis, coccygodynia, and myelitis, — but it is thought best 
 to include them with other special classifications. The fifth 
 class, including nephritis, tonsilitis, and those conditions aris- 
 ing from functional inactivities and unknown causes, will be 
 considered in a chapter on Miscellaneous Diseases. 
 
CHAPTER XII. 
 THE PAINFUL NEUROSES. 
 
 Diseases of the nervous system characterized by pain may 
 be due to (i) inflammatory conditions, as neuritis, or (2) arise 
 from affections of the central nervous system, as tabes, or 
 (3) as a symptom of malnutrition, or chronic poisoning, occur- 
 ring with various cachexias, or (4) from reflex causes and from 
 depleted conditions, as neuralgia. 
 
 Most of these painful neuroses can be relieved, and the larger 
 part of them cured, by static applications, when they have not 
 become too chronic, or if some internal organic lesion is not 
 present to preclude the possibility. The greatest obstacle to 
 successful treatment with these, as with other cases, is the 
 presence of a thick layer of fat between the surface and the 
 seat of the trouble. Deeply seated affections, as neuritis of the 
 sacral plexus, or in a bony canal, as of the chronic cases of tic 
 douloureux and cases of neuritis in regions where muscles are 
 sensitive and contract under strong administrations of the 
 wave-current, as of the branches of the brachial plexus in the 
 arm and forearm, require special methods of application, q. v. 
 Pathological conditions which interfere materially are the 
 forms of sarcoma and carcinoma, now in many cases satisfac- 
 torily relieved by the X-ray ; tubercular disease of the bone or 
 lymphatic glands, and various tumors pressing upon deep 
 structures. 
 
 NEURITIS. 
 
 The various types, as the name implies, arise from exposures 
 when, from fatigue or a lowered state, the reactions are below 
 the standard ; from strains or traumatisms, or from complicat- 
 ing inflammatory conditions, as rheumatism, rheumatoid 
 arthritis, or Pott's disease of the spine. 
 
 Any nerve may become the site of neuritis. It occurs most 
 
 95 
 
96 STATIC ELECTRICITY. 
 
 commonly in the sciatic nerve, the branches of the brachial 
 plexus, and the facial nerve. Neuritis is the condition present 
 in many so-called neuralgias. 
 
 SCIATICA. 
 
 Neuritis of the sciatic is perhaps the most common and in- 
 tractable of the forms of neuritis, when treated by methods 
 other than the static. The localities most commonly the seat 
 of the inflammatory process are at the sacro-sciatic notch where 
 the nerve emerges from the pelvis, and the pain most marked 
 is in the branches distributed to the foot. Quite often cases 
 are met where it is difficult at first to determine the location of 
 the lesion. In these it will generally be located in the sacral 
 plexus, or in the region of the cord, when the prognosis may 
 be in doubt from the various pelvic conditions that may compli- 
 cate the case. 
 
 The diagnosis of the site or extent of the sciatica, or of any 
 neuritis except within the cavities of the body or bony canals 
 of the head, is easily made by applying sparks, the brush-dis- 
 charge, or the high-frequency discharges employing the glass- 
 vacuum electrodes along the course of the nerve, noting the 
 points at which the severe pain begins and ends, and at the 
 same time comparing the effect at corresponding points of the 
 opposite side of the body. A spark over a nerve, especially at 
 the motor points, is always painful, but when applied over the 
 part of the nerve that is the seat of the neuritis, the pain is 
 intense. When determining the extent of the neuritis, it is only 
 necessary to watch the facial expression of the patient during 
 the application to mark the limits of the inflammation, as we 
 map it out' with the sparks. 
 
 The prognosis of uncomplicated neuritis, when accessible, is 
 very satisfactory. 
 
 The treatment will vary with the conditions of the case. 
 In acute recent cases, when the patient is muscular and not 
 too fat, the wave-current is all that will be required to effect a 
 complete cure in a few days; the more recent the case the 
 shorter the time needed, other things being equal. In fat pa- 
 tients, and chronic cases, it will be necessary to make use of 
 
THE PAINFUL NEUROSES. 97 
 
 long sparks to obtain the desired result. Over the foot and 
 leg, prolonged applications of the brush-discharge will give 
 satisfactory results. Over the affected region, when it has 
 been located, place an electrode of soft metal and see that it is 
 firmly held to the surface and administer the wave-current. 
 When employing the wave-current, or one of the modified cur- 
 rents, select an electrode with reference to the capacity of the 
 machine or current used, the extent of the lesion, and the tis- 
 sues of the patient. It is an intense vibratory effect that is 
 required, to which the affected nerve must be sensitive when 
 but a small part of the possible current strength is employed. 
 It may then be gradually increased until the sedation is com- 
 plete, which will be determined by lengthening the spark-gap' 
 without increasing pain. The electrode should rarely be larger 
 than 4x4 inches. 
 
 At the beginning of the administration of any static current, 
 the electrode having been secured so that it will be firmly 
 pressed to the affected spot, open the spark-gap to a point at 
 which the patient cannot, without much discomfort, take any 
 more. As the sensation becomes less severe gradually lengthen 
 the spark-gap, when, at the end of at least fifteen or twenty 
 minutes, the sedation will in most cases be complete. If the 
 result be satisfactory, there will often be little or no pain what- 
 ever for twenty-four hours. In such, a daily administration 
 will effect a cure in a short time. In others, the pain may re- 
 turn sooner, and require, for a few days, morning and even- 
 ing treatments, after which the periods may be gradually 
 lengthened. In other cases, especially those of three or more 
 weeks' standing, the wave-current will fail to produce the com- 
 plete sedation required; in such, long sparks should be ap- 
 plied directly to the affected nerve over the whole extent of 
 the lesion, and they will, as a rule, accomplish the desired re- 
 sult. Test the effect by having the patient exercise the muscles 
 in the vicinity of the affected nerve, by stepping off and on 
 the platform, standing with the weight upon the affected leg, 
 and by moving the body in various positions. If it is found 
 that the sparks are giving relief, persevere until it is com- 
 plete. Others say that they have known cases to be aggra- 
 
98 STATIC ELECTRICITY. 
 
 vated by the sparks. The writer, however, in records of more 
 than one hundred cases has found none but what sparks would 
 partially relieve, and not one was aggravated. The brush-dis- 
 charge, or prolonged administration of the spray, may assist 
 in relieving some who are not too fat, or cases that are not too 
 chronic. The latter invariably require sparks. Bridging is of 
 the utmost importance, and, when properly observed, we are 
 satisfied that every uncomplicated case of sciatica can be cured 
 by one or another of the electro-static modalities. 
 
 Neuritis within the pelvis occurs so often as a complica- 
 tion of other conditions, due to pressure or inflammatory proc- 
 esses in that region, that it is important to exclude a possible 
 Pott's disease, carcinoma, or other tumor before undertaking 
 the case, and certainly before giving any but a most guarded 
 prognosis. That these conditions may be satisfactorily treated, 
 when uncomplicated, the writer's experience has led him to 
 believe. 
 
 Some cases which the writer has treated have been success- 
 fully managed by the use of the wave-current. When the 
 lesion is in the lumbar plexus, it will be discovered by the 
 effect of the intense vibratory action of a powerful current 
 (4- to 6-inch spark-gap) applied at the back over that region, 
 producing a painful sensation along the course of distribution 
 of branches of the obturator and crural nerves. Place a soft 
 metal electrode (22 gauge) directly over the affected region 
 and connect the patient for the administration of the wave- 
 current. Make the spark-gap as long as is possible in each 
 case without causing severe pain or muscular contraction of 
 the structures in the vicinity of the affected area of congestion. 
 Then place the point electrode upon the standard at a point 
 directly opposite the electrode in front of the patient, at a dis- 
 tance which will not interfere with a regular discharge of the 
 spark-gap. By this means the affected region is placed in a 
 vibratory field of greater intensity. If the length of the spark- 
 gap has been limited by the local pain caused by the action of 
 the current, it may be lengthened from time to time, as in other 
 cases until sedation is complete. 
 
 This may require from twenty minutes to half an hour. 
 
THE PAINFUL NEUROSES. 99 
 
 The vibrations over the lesion, and the coincident induced in- 
 terrupted muscular contraction of the arterioles and muscular 
 structures in the vicinity of the congestion, relieve the conges- 
 tion and hasten the cure of the patient. The observance of 
 bridging — regulating the indicated frequency of administration 
 — must be adhered to, as in the treatment of all conditions. 
 The same general plan applies to cord affections or neuritis of 
 the sacral plexus. 
 
 Brachial neuritis differs in no essential characteristic from 
 the conditions which have just been considered, and the prin- 
 ciples of treatment are the same. In the branches which 
 supply the arm and forearm it is impossible to employ a spark- 
 gap of more than an inch or two, because the muscles are 
 thrown into a state of painful contraction. Nor is it necessary, 
 for the same reason. Sparks give great relief in many cases 
 and may be administered directly over the inflamed and pain- 
 ful portion of the nerve. The great relief which follows these 
 severe applications encourages the most timid patients to en- 
 dure them. During the course of the application of sparks or 
 the convective discharges, the patient should move the arm 
 about, making all movements that had caused pain ; at the 
 same time indicating the painful spots and those to which 
 sparks give relief. Let the operator bear in mind that the 
 motor points and bony prominences are always painful to 
 sparks, and that to the latter they do no good, and to the 
 former only when the nerve at that point is the seat of neuritis, 
 and much needless suffering from a superfluity of sparks will 
 be spared the patient. 
 
 With patients who do not bear sparks well and in acute cases, 
 it may be possible to cure those in whom the nerve is not cov- 
 ered with thick muscles of fat, by using the brush-discharge 
 or the spray following the wave-current during each adminis- 
 tration, until the pain ceases. When pain on movement is 
 thus relieved it is always fair to suppose, in any inflammatory 
 condition, that the congestion is lessened ; but experience with 
 each case, noting the length of duration of the cessation of pain, 
 will be a guide to the degree of effect upon the inflammation. 
 If the relief is for but one or two hours, the next administration 
 
IOO STATIC ELECTRICITY. 
 
 should be continued until a marked rubefacient effect is pro- 
 duced over a considerable area; failing in this, induce the pa- 
 tient to submit to sparks, which will succeed. The rube- 
 facient action of the brush-discharge is valuable in all cases 
 of brachial neuritis, when the necessary time to produce it can 
 be spared. 
 
 It should be borne in mind in all cases, when treating regions 
 of congestion, that muscular contraction of the coats of the 
 vessels and the muscles surrounding them induces normal cir- 
 culation and overcomes stasis by forcing onward the blood 
 stream. As pressure thus exerted relieves the more superficial 
 congestion, the pain caused by a current measured by the spark- 
 gap employed at the time ceases, while upon lengthening 
 the spark-gap the effect which is deeper causes a return of pain 
 each time and is repeated until the local congestion is relieved. 
 At this stage of the treatment sedation of pain from relief of 
 the inflammatory conditions at the time of the first administra- 
 tion may not be complete, but it will be effected in curable 
 cases within the first days of treatment. 
 
 Great relief may be given in these cases and recovery has- 
 tened by the employment of the brush-discharge or high-fre- 
 quency administered with glass vacuum electrodes. Acute 
 cases may even be cured by the last-mentioned modalities. In 
 all chronic cases of neuritis sparks will be found indispensable, 
 and in brachial neuritis should be employed from one and one- 
 half to three inches in length. 
 
 Neuritis in various other regions requires the same general 
 plan of treatment as in the preceding special cases. Facial 
 neuritis will be considered with the neuralgias, because it is 
 generally so classified. 
 
 LOCOMOTOR ATAXIA. 
 
 Tabes is characterized by a degeneration of the central and 
 peripheral sensory nervous system. 
 
 The (vtiology is obscure, no certain cause being traceable in 
 most of the cases. The fact that many patients present a 
 syphilitic history has induced some writers to consider it the 
 specific cause. Such observers, however, are largely in the 
 
THE PAINFUL NEUROSES. IOI 
 
 minority. The position is taken by Gowers " that there is 
 nothing in the histological character of the lesion that can 
 be compared with the morbid processes that are certainly 
 syphilitic." " There is nothing, therefore, to warrant the 
 opinion that any morbid germs existing in the cord or nerves 
 lead to the development of the disease." " It is probable that 
 syphilis leaves behind it a predisposition to nerve degenera- 
 tion, lowers in certain nerve elements the capacity for resist- 
 ing morbid influences, leaves many patients in a condition 
 analogous to one who inherits a predisposition to neural dis- 
 ease." Much diversity of opinion exists as to the percentage 
 in which a syphilitic history can be traced. Some place it as 
 low as forty per cent, and others as high as seventy-five per 
 cent. It evidently does create a predisposition, but is not the 
 cause ipso facto. The same conditions which may be attrib- 
 uted to syphilis are produced by other exhausting and enervat- 
 ing causes, as accidents (particularly concussion of the spine), 
 exposure to cold, fatigue, exhausting diseases, excess of ven- 
 ery, and many others. 
 
 The pathology of the disease is characteristic. Cerebral cen- 
 ters are but slightly affected, while the centers in the cord, 
 generally most marked in the lumbar region, are largely the 
 seat of the trouble. 
 
 Evidences of inflammatory processes, so generally absent in 
 congested conditions after death, are indicated by changes 
 in the blood vessels (thickening of their walls) and overgrowth 
 of the neuroglia which lies between and supports the gangli- 
 onic cells. The primary changes seem to take place in the 
 ganglionic cells, which become atrophied or disappear, to be 
 replaced by connective tissue. It is most probable that the 
 lesion is of a congestive or inflammatory nature associated 
 with a lowered constitutional state and marked by varying 
 degrees of activity, the results of which are to be found only 
 after death (pressure destroying and impairing the functional 
 activity of the cells), but of a type favorable to the growth of 
 connective tissue. 
 
 The symptoms, briefly considered, that are characteristic, are 
 (i) the pains; which vary from mild pains, apt in the first stage 
 
102 STATIC ELECTRICITY. 
 
 to be mistaken for neuralgia, to the severe boring and lancinat- 
 ing pains, (2) the ataxic walk, (3) girdle sensations, (4) 
 Argyll-Robertson pupil, (5) areas of anaesthesia, (6) abolished 
 reflexes, (7) impaired function of the rectal, vesical, and 
 sexual apparatus, (8) and joint and tissue degeneration. Sev- 
 eral of these symptoms are more or less constant in every case, 
 and most of them occur at one time or another with sufferers 
 in whom the disease runs an uninterrupted course. In no dis- 
 ease are the symptoms so variable and unaccountable as in 
 tabes dorsalis. 
 
 The prognosis is variable; depending upon the stage of the 
 disease, the severity of the lesion, the physical condition of 
 the patient, and the character and frequency of the treatments. 
 We believe that, in patients not afflicted with other organic 
 disease, it can be stayed in its progress and many of the 
 symptoms be decidedly relieved, and that in the first stages 
 it can generally be cured ; only conditions referable to irrepara- 
 ble or destroyed cells remaining. 
 
 Treatment of locomotor ataxia must meet at least three 
 indications — the improvement of the general status, the arrest 
 of the processes, and the relief of symptoms. 
 
 (1) If degeneration is the primitive condition, and the cause 
 not a specific organism, but a lowered vital state, especially 
 of the nervous system, the indication for treatment is the 
 employment of means of restoration or regeneration. 
 
 (2) The inflammatory processes which are undoubtedly 
 present and productive of destruction or atrophy of the gan- 
 glion cells, either by the pressure exerted by congested tissue, 
 or by the action of the inflammatory process attacking the cell 
 protoplasm itself, must be interrupted if the local lesion is to 
 be arrested. 
 
 (3) The treatment which arrests the lesion will relieve the 
 symptoms to some extent, and the electrical treatment, when 
 applied to the symptoms in the manner to be described, cre- 
 ates by " ingoing impression," as taught by Morton, a return, 
 at least partial, to activity of many centers, even during the 
 administration. 
 
 Electrical treatment has for a long time been recognized 
 
THE PAINFUL NEUROSES. 103 
 
 by medical electrologists to possess merit in the treatment of 
 tabes, but neurologists generally prescribe it only as they do 
 the iodides. The fact is that favorable results can only be 
 obtained from electrical treatment with a devotion to technique, 
 which must be directed to the conditions, and time devoted to 
 each administration sufficient to obtain the desired effect, and 
 a frequency of administration which will bridge over the gains. 
 Observing these measures, electro-static treatment, at least, will 
 meet many indications, and generally prove satisfactory to both 
 physician and patient. 
 
 Ganglion cells that have been destroyed cannot be replaced 
 or regenerated in any case. The patient must, therefore, be 
 made to understand that restoration, other things being equal, 
 will be relative to the number of cells destroyed, and the con- 
 dition and surroundings of the cells impaired, which are un- 
 known. 
 
 The first indication is met with possibly the judicious use 
 of tonics and attention to diet, together with twenty to thirty 
 minutes' administration of the wave-current. The effects of 
 tonic static administrations upon all nutritional derangements 
 are energizing and restorative ; evidenced, as has been shown 
 in the preceding chapters, by improvement in appetite, nutri- 
 tion, and activity of every body function. Such are the effects 
 in all cases with locomotor-ataxia patients not affected with 
 other organic disease. No special administration of the wave- 
 current will be necessary when the local use is for a long 
 enough period of time, and employing sufficient voltage, to 
 insure the required effect. 
 
 The second indication to be met — the relief of the inflam- 
 matory characteristics of the lesion — is not only demonstrated 
 to be relieved, but the fact that such lesion exists, if other 
 evidence was not adducible, is also demonstrated ; or else some 
 other reasonable theory must be presented for the restoration 
 of the functions, which does take place in so many patients 
 that the results seem to be confirmatory. 
 
 The removal of the pressure from the ganglion cells, by the 
 withdrawal of the congestion, permits a general restoration of 
 their function, to a greater or less degree; while a theory of 
 
104 STATIC ELECTRICITY. 
 
 regeneration, or the substitution of new ganglion cells, would 
 be contrary to fact. When it is so certainly a fact that con- 
 gestion is removed from the deep structures of a knee or hip 
 joint by static administration, it is not presumption to expect 
 that the same thing will take place within the spinal cord. 
 Certainly, no other fact will explain the relief afforded cases 
 of anterior polio-myelitis as reported in a subsequent chapter. 
 
 For relief of the cord affection, place over the region or 
 regions affected a soft metal (22 gauge) electrode two inches 
 wide, and secure it firmly by placing a pillow against the pa- 
 tient's back; connect with the positive pole of the static ma- 
 chine, and administer the wave-current, employing a spark- 
 gap of four to six inches in length for at least fifteen minutes. 
 Follow this with the same administration of short sparks to the 
 soles of the feet. 
 
 For this purpose the writer has adopted the following plan : 
 Place upon a metal plate in front of the patient a piece of felt 
 or several thicknesses of woolen cloth upon which the patient, 
 having removed his shoes, should place his feet. Place the 
 shepherd's crook from the metal plate to the positive side of 
 the machine. The spark-gap having been closed, separate it 
 again gradually until it begins to produce a disagreeable sensa- 
 tion to the patient. Continue this administration for ten min- 
 utes. This procedure assists materially in relieving the anaes- 
 thesia in the soles of the feet. Follow this application with a 
 general administration of friction sparks to all anaesthetic and 
 painful areas on the body of the patient. Make these applica- 
 tions rapidly over the surface until the effect, at first mild, be- 
 comes disagreeable to the patient. '(The fact that during a 
 prolonged course of treatment these areas do become more 
 sensitive is to the writer inevitable proof that the correspond- 
 ing centers in the cord have been released or made active.) 
 Long sparks liberally applied over the region of the cord are 
 indicated in all cases, especially so in plethoric individuals, 
 for insuring relief to the congested conditions of the cord. 
 
 The third indication, the symptomatic, is of great impor- 
 tance, and contributes no small amount to the relief of the cen- 
 tral lesion and the awakening of the liberated, but dormant, 
 cells. 
 
THE PAINFUL NEUROSES. 105 
 
 Pain, the most interesting symptom of tabes, yields satis^ 
 factorily in almost every case to one or another of the modali- 
 ties. Patients who were taking many grains of morphine daily 
 for relief have, to the writer's knowledge, been able to aban- 
 don the drug altogether after a few weeks' treatment. The 
 wave-current, sparks, and brush-discharge have each given 
 temporary relief when locally applied. The greatest measure 
 of relief from this symptom, as from all others, is derived from 
 the general and direct spinal application. 
 
 The Argyll-Robertson pupil and other optic symptoms, 
 when once present, have never been benefited by treatment 
 in the writer's experience, nor in cases in records examined. 
 
 The ataxic walk is caused by the anaesthesia and dimin- 
 ished sense of co-ordination, and is improved, as a rule, in pro- 
 portion to the restoration Of sensation. 
 
 The abolished reflexes are rarely, if ever, restored by any 
 treatment. 
 
 The impaired vesical, rectal, and sexual functions may 
 each be greatly benefited by the stimulating effects of the wave- 
 current locally applied, and friction sparks 'above the pubes, 
 and to the penis and perineum. 
 
 To the tissue and joint degeneration we would administef 
 the brush-discharge. When assuming charge of a case of loco- 
 motor ataxia the serious nature of the affection should be 
 explained to the patient, and he should be instructed that no 
 definite prognosis can be given as to the length of time the 
 treatment must be continued. It will vary with the severity 
 of the symptoms, the general health, environments, and hab- 
 its of the patient. No case should be undertaken with an ex- 
 pectation of satisfactory results within one year. And so long 
 as pain persists the lesion may be considered to be active. The 
 patient should also be enjoined to abstain from all excesses, 
 especially of alcohol and venery. Under systematic regimen 
 and the thorough and scientific employment of Franklinism 
 the majority of cases of locomotor ataxia will be considerably 
 relieved and the progress of the disease will be brought to a 
 status quo. 
 
106 STATIC ELECTRICITY. 
 
 NEURALGIA. 
 
 Neuralgia is another name for pain and has long been rec- 
 ognized as a misleading and unscientific term — classing a symp- 
 tom as a disease. It is not correct to permit such professional 
 license because an obscure or remote condition is difficult to 
 diagnose. It would be better to admit ignorance, and, when 
 possible, find out the cause. 
 
 When a local pain is persistent, a local cause may be pre- 
 sumed to be present; in a few cases, however, the lesion will 
 be found in the central nervous system, or at an injured point 
 in the course of the nerve. 
 
 The pains associated with adynamic conditions, such as the 
 cachexias, anaemia, and chronic malarial poisoning, are never 
 constant, but flitting, and demand the indicated constitutional 
 treatment. 
 
 Reflex pains also are not constant, but vary with the con- 
 dition of the organ from which they originate. 
 
 The treatment of neuralgia should not, on general prin- 
 ciples, be instituted when it is possible to locate a lesion until a 
 diagnosis has been made. When, however, it is possible to 
 locate a cause the local application of Franklinism will often 
 relieve the pain. In other cases an application will become an 
 aid to diagnosis by exclusion — a condition not yielding will, 
 as a rule, be due to an organic lesion, local or central. 
 
 For the relief of pain all of the static modalities possess 
 merit. We place them, from our own experience, in the fol- 
 lowing order of preference, viz., wave-current, brush-discharge, 
 high-frequency applications, sparks, breeze, spray, static in- 
 sulation (nutritional), and the static-induced current. The 
 first five meet all demands, and will be treated according to 
 special indications in the following pages. 
 
 Coccygodynia is due in most cases to either an arthritis or 
 neuritis; both generally intractable to all but electrical treat- 
 ment. The constant and induced currents have achieved small 
 success in this painful affection, and electricity has therefore 
 ■been rated a failure by many. The old currents are im- 
 potent because they do not relieve the local congestion which 
 
THE PAINFUL NEUROSES. IO/ 
 
 is always present in an arthritis or neuritis. It has been 
 demonstrated that the static modalities are successful in every 
 case which has continued the treatment, when the products 
 of inflammation had not formed deposits which restricted mo- 
 tion. The prognosis is generally good, and the time neces- 
 sary to effect a cure will depend upon the chronicity and extent 
 of the injury. 
 
 The wave-current will give satisfactory results when applied 
 by adapting a tin electrode to the region, and after securing 
 it, employing the current in the manner in which we treat 
 neuritis for fifteen to twenty minutes. If a trace of pain 
 remains, it may be relieved, in most cases, with either the 
 brush-discharge or sparks ; the former being indicated in acute 
 cases associated with tenderness and possible ecchymosis re- 
 sulting from an injury; and the latter in chronic cases, to 
 promote the reabsorption of the products of inflammation. 
 
 Intercostal neuralgia (generally neuritis), when not due to 
 pressure other than congestion, will be promptly cured by the 
 same processes described in the preceding affection. 
 
 Facial neuralgia, of the trigeminus, is a common and often 
 stubborn affection. The exposure to which the face is sub- 
 jected and the fact that many branches of the nerve in this 
 region pass through bony canals or across bony prominences 
 make it prone to injury. When slight pressure, from con- 
 gestion of either the neurilemma or the structures surround- 
 ing the nerve, or from small tumors or exostoses, is present, 
 pain of a more or less permanent character results. One 
 writer says that " neuralgia of the trifacial is the most fre- 
 quent form, when the disease is due to malaria." So often 
 is the condition due to a congestive hypersemia that the early 
 treatment of tic douloureux by the wave-current, brush-dis- 
 charge, or sparks, acts as a prompt cure in most cases, and 
 these methods promise very much in cases of longer standing. 
 When a tumor, an exostosis, or aneurism is the cause, tem- 
 porary relief may be afforded, but nothing more should be 
 expected. So, when due to malaria, much relief may result 
 from treatment; but the question of first importance is the 
 treatment of 'the malaria. 
 
108 STATIC ELECTRICITY. 
 
 The diagnosis of the cause of facial neuralgia is not 
 always easy, or the term neuralgia would not be so often 
 employed. 
 
 The prognosis must be guarded in all but the recent cases, 
 which yield promptly when due to local congestion not caused 
 by abscess or bone necrosis. 
 
 The treatment by exposure to the Roentgen ray, if caused 
 by epithelioma, offers great encouragement. ( See chapters on 
 Radiotherapy.) 
 
 The application nf the wave-current to a violent case of tic 
 douloureux was the first revelation to the writer of its re- 
 markable anodyne effects, which are now recognized by many 
 electro-therapeutists in tbis country. When employing the 
 wave-current, select an electrode which will cover the face on 
 the affected side, requesting the patient to hold it in position 
 with the ball of the thumb ; pressing it firmly to the affected 
 or painful spot, connect by a rheophore, and start the ma- 
 chine, employing a very short spark-gap ; opening it until the 
 pain begins to be severe. At this juncture, in acute cases, 
 many of the motor points of the face in distribution of the 
 nerve become painful. If so, the patient should press the tin 
 firmly with the fingers to such spots. The administration 
 should be continued for twenty minutes, during which time 
 the operator should gradually lengthen the spark-gap. Care 
 should be taken that this be done in the most cautious and 
 delicate manner, as a sudden shock will be very painful and 
 greatly disturb any patient. By gently withdrawing the rod 
 with a screwing movement, at the same time consulting the 
 sensations of the- patient, if may be easily accomplished with- 
 out casualty. 
 
 The brush-discharge will give very great satisfaction in 
 •facial neuralgia. It should be applied over a surface consider- 
 ably larger than the painful area (unless the whole face is 
 involved, when the entire surface should be treated) until a 
 distinctly rubefacient effect is produced. 
 
 Short sparks may be found of service in some chronic cases, 
 but as a rule avail little when the other modalities fail. Strict 
 attention to bridging will insure the best results. Acute cases 
 
THE PAINFUL NEUROSES. 109 
 
 will often require two administrations daily during the first 
 days of treatment. 
 
 Podalgia and plantar neuralgia deserve attention here, be- 
 cause in most cases the static modalities give prompt relief. 
 
 Podalgia (painful heel) is a condition which may be associ- 
 ated with flat-foot, rheumatism, gout, or neuritis, and is espe- 
 cially liable to occur in persons who are much on their feet. 
 The extent of the affection will vary from a small circum- 
 scribed spot to the whole surface of the heel. A few will 
 prove intractable, even to the electro-static treatment. Such 
 will usually be associated with flat-foot, which in early cases 
 is not sufficiently marked to be detected. 
 
 The usual means for treating painful affections have merit 
 in most of these cases, and should be employed herqically, 
 if the case demands it. The best results have been obtained 
 by the writer from the application of sparks, applied directly 
 to the painful spot. 
 
 Plantar neuralgia is apt to occur, says Osier, after " cold- 
 bath treatment of typhoid fever." It also occurs as neuritis or 
 with. gout or rheumatism, and is satisfactorily treated by the 
 wave-current and brush-discharge. In this affection sparks 
 are rarely necessary. 
 
 Gastralgia, cardialgia, nephralgia, also neuralgia of the 
 liver, rectum, ovary, and testicles, occur with neuropathic 
 conditions, and are often associated with cachectic and other 
 lowered constitutional states. All call for both constitutional 
 and local treatment. There is probably no one agency that ac- 
 complishes more for these painful conditions than Franklin-* 
 ism. At the same time, far be it from us to disparage the use 
 of other tonics or safe alteratives which, associated with proper 
 diet and good hygiene, will hasten recovery. 
 
 The tonic effects of the wave-current work wonders in these 
 conditions and cannot be too strongly advised. It matters 
 little where the electrode is applied to produce the energizing 
 effects. Experience with very many cases, which were uni- 
 formly improved in general health while receiving local treat- 
 ment and no medication, both to the body and the extremities, 
 has impressed the writer that with patients in whom there is a 
 
IIO STATIC ELECTRICITY. 
 
 lowered condition of health, without organic disease, they are 
 coincidently restored. On general principles, apply an elec- 
 trode to the spine or over the epigastrium for tonic effects. 
 It is not considered necessary, however, with administrations 
 aggregating from twenty minutes to half an hour, with a wave- 
 current measured by at least a four-inch spark-gap, wherever 
 applied, to make other applications for the purpose of improv- 
 ing nutrition. Therefore, when called upon to treat these 
 neuralgias, apply an electrode having a surface of sixteen 
 to twenty square inches directly over the painful surface, and 
 continue the administration for at least twenty minutes, and 
 the local and constitutional treatment will both have been ac- 
 complished. Daily administrations should be given for at least 
 two weeks, and continued later every second day until health 
 is restored. 
 
 Gastralgia is cut short during the attack in most instances, 
 and when the treatments are continued for a sufficient period, 
 generally ceases to recur altogether unless some persisting 
 cause be present. 
 
 Cardialgia, induced by a poorly nourished or overworked 
 heart, is greatly relieved by the local administration, and after 
 a period df treatment often cured and the patient restored to a 
 normal condition of health. 
 
 For angina pectoris we believe no treatment promises so 
 much, — if atheroma of the coronary artery is not in an ad- 
 vanced condition, — because it lowers arterial tension, promotes 
 the elimination of mineral salts, and preserves a constitutional 
 equilibrium. In the treatment of false angina, occurring in 
 neurasthenic and hysterical individuals, it is successful, as it 
 is also in removing the associated affections. 
 
 In treating these conditions, apply an electrode about four 
 inches square over the precordial region, and treat the pri- 
 mary affection according to indications. 
 
 For relief of neuralgia of the liver or kidneys, apply the 
 electrode and continue the administration for at least twenty 
 minutes. 
 
 Ovarian neuralgia requires tonic treatment, as well as relief 
 of local pelvic congestion so often associated with the condition 
 
THE PAINFUL NEUROSES. HI 
 
 to which, when present, the pain is secondary. Apply the 
 wave-current over the painful spot, employing a large elec- 
 trode when weather conditions are favorable to the use of a 
 long spark-gap ; continuing for fifteen or twenty minutes. An- 
 other method, often successful, is to employ a large vaginal 
 electrode connected to one side of the machine, and the ab- 
 dominal electrode connected to the other side, employing the 
 static-induced current, or the wave-current with a rectal elec- 
 trode in the vagina or rectum. (See Dysmenorrhea.) 
 
 The brush-discharge, applied over a considerable area until 
 a rubefacient effect is produced, will give marked relief, and, 
 when applied daily over the lower abdominal region, will have 
 a pronounced effect in lessening or removing pelvic conges- 
 tion. 
 
 Neuralgia of the rectum should be treated by placing a 
 large special electrode in the rectum and employing the wave- 
 current. If the case is not due to structural changes or foreign 
 bodies, the result will be satisfactory. 
 
 Neuralgia of the testicle is best treated by application of 
 the brush-discharge for from fifteen to twenty minutes. Few 
 painful or congested conditions of the testicle will not yield to 
 this modality. Great care should be taken that during the ad- 
 ministrations accidental sparks do not pass to the testicle or the 
 penis. (See Administration of Brush-Discharge.) Sparks 
 are not harmful, but are so painful that a timid patient might 
 be greatly annoyed. 
 
 MIGRAINE. 
 
 This superficial or deep-seated pain is usually confined to 
 the temporal or orbital region of one side of the head, and in 
 most cases is associated with nausea. Heredity, neuropathic 
 and adynamic conditions predispose to the attacks ; and, in 
 proportion as such influences can be checked, allayed, or normal 
 condition restored, can these sufferers be relieved. As in all 
 nervous diseases of hereditary origin, those cases in particular 
 are most intractable, and must be taken carefully in hand from 
 the first appearance in childhood. The indications must be di- 
 
112 STATIC ELECTRICITY. 
 
 rected (i) to improving the general nutrition; (2) to lessening 
 the nervous irritability by restoring, or establishing, a proper 
 stability of the nervous system; (3) to correcting or removing 
 exciting causes as far as possible which induce attacks; and, 
 (4) to relieving the attacks when they do occur. 
 
 The first two and last of the indications are perhaps better 
 met by static electricity than any other plan of treatment, while 
 the third will call for attention to various physical derange- 
 ments — as eye strain, nasal affections, uterine disorders, gastro- 
 intestinal derangements, and overwork or worry. 
 
 What has been already said of the nutritional effects of 
 Franklinism applies here, as in all other conditions. That 
 which induces general functional activity restores an equi- 
 librium, and takes the strain from the overworked parts and 
 sets the sluggish organs to their task, unless a physical dis- 
 ability (as an organic lesion) is present, and thereby does much 
 to lessen nervous irritability. High-potential electricity, how- 
 ever, does more than this to an overstrained and irritated 
 nervous system. It quiets, soothes, and rests exhausted nerves, 
 producing a sense of well-being, repose, and refreshing sleep. 
 
 The prognosis will vary with many conditions. 
 
 When treating for this affection, no specified time that it 
 will take to effect the desired result can be promised. It will 
 always depend upon the peculiarities and progress of the indi- 
 vidual case. It will take months, and, in neuropathic individ- 
 uals, a longer time, and in a few it may be necessary to keep 
 up treatment indefinitely to maintain an improved status that 
 has been established; and in still other rare cases, especially 
 with otherwise healthy individuals, the treatment will neither 
 influence the frequency nor the severity of the attacks. 
 
 The treatment during the intervals between the attacks 
 should consist of administrations daily, or upon alternate days, 
 of the wave-current for from twenty minutes to one-half hour 
 at each time. Apply an electrode, having a surface area of 
 from sixteen to twenty-four inches, to any portion of the trunk 
 of the body where there may be indications for local treatment, 
 over the upper or lower abdominal or lumbar region; or a 
 long spinal electrode over the vertebral column. Adapt the 
 
THE PAINFUL NEUROSES. 113 
 
 spark-gap to the physical conditions of the patient. During 
 an attack observe the same rule of applying the electrode, and 
 at the same time place the point of the stand electrode over 
 the patient's head, at a distance at which it will not interrupt 
 the spark-gap. In some patients the breeze, thus applied to 
 the head, seems to aggravate the pain; with such, the point 
 placed in front of the knees, at the same distance as before, 
 will, as a rule, have the desired effect. The polarity affects 
 patients differently. We generally employ the positive insu- 
 lation, adapting it to the idiosyncrasy of the patient. The 
 noise of the discharging spark-gap will aggravate some of the 
 patients ; then the balls must be widely separated. The brush- 
 discharge, applied to the aching head, will afford great relief 
 in very many cases, while to a few it will prove an aggravation. 
 
 If care is taken to discover the idiosyncrasies of patients 
 and regulation of dosage, few indeed will not be relieved. 
 
 The same general principles apply to the treatment of other 
 headaches as to migraine ; and care should be taken to remove 
 the cause, when possible. 
 
CHAPTER XIII. 
 GENERAL TREATMENT OF PARALYSIS. 
 
 Paralysis is " a loss or diminution of the powers of con- 
 tractility in the voluntary or involuntary muscles, or of per- 
 ceiving sensations." 
 
 Such a condition, occurring in a large or small portion of 
 the body, may be induced by injury, degeneration, or pressure 
 exerted upon the corresponding centers in the brain, the spinal 
 ■cord, or in the course of the nerve between the centers and 
 its peripheral distribution. The two former are termed cen- 
 tral, and the latter peripheral, paralysis. 
 
 The degree of recovery will depend upon ( i ) the prompt- 
 ness with which the cause, if a central lesion, is removed; 
 (2) the maintenance of the nutrition of the parts paralyzed in 
 the interval between the onset and the recovery, if possible, 
 of the normal function, and (3) the employment of physical 
 or medical measures which facilitate the removal of the cause 
 or the maintenance of nutrition, or both. 
 
 The continuance of pressure upon ganglion cells, whether 
 from a clot, congestion, or gumma, causes their destruction 
 within a brief period of time. Likewise, cells cut off from 
 nutrition by obstruction of the blood channels, by thrombosis, 
 or embolism, soon degenerate. Ganglion cells, once destroyed, 
 a.re never restored, nor the function of the parts of the cor- 
 responding nerve distribution. 
 
 The prognosis of a given case of paralysis, then, will depend 
 upon so many unknown conditions that, in most cases of cen- 
 tral origin, it should be very guarded. In peripheral paralysis, 
 however, the prognosis is generally favorable. 
 
 Paralysis caused by brain lesions will be associated with 
 a very small degree of atrophy, from which the cases due to 
 lesions of the cord show a decided contrast. The marked 
 atrophy in the latter is undoubtedly due to the involvement 
 
 114 
 
GENERAL TREATMENT OF PARALYSIS. I I 5 
 
 of the trophic centers which influence nutrition, while in the 
 former, and in peripheral paralysis, only the atrophy of disuse 
 will occur. Peripheral paralysis will, in most cases, be recog- 
 nized by the history, peculiar features, and generally prompt 
 recovery. In some, however, it will be difficult to locate the 
 lesion. 
 
 The general indications for treatment are, (1) if possible, to 
 remove the cause, (2) to preserve the local nutrition of the 
 parts paralyzed, and (3) to preserve the patient's general 
 health and nutrition. 
 
 The causes, for the purposes of consideration, will be classi- 
 fied as (1) obstructive, (2) traumatic, (3) congestive, and (4) 
 specific. 
 
 The treatment in many instances will combine with the elec- 
 trical administration, medical or surgical measures, to which 
 it is only possible to allude in the most general way, for, while 
 such measures are often invaluable, it would not be practicable 
 to treat them to any extent in a work on electro-therapeutics. 
 
 The remedy for removal of obstruction or pressure due to 
 pathological conditions (which amounts to the same thing) is 
 one which will assist or promote reabsorption, or the estab- 
 lishment of the collateral circulation to supply the parts cut 
 off. In this line very little can be accomplished — nature's 
 provisions alone can bring about the restoration. Strychnine, 
 to quicken the activities, and tonics and nutritious diet do 
 much. But when possible for the patient to receive the tonic 
 static administrations, which increase secretion, promote ab- 
 sorption, improve general nutrition, and relieve arterial tension, 
 their value is certainly apparent. 
 
 Traumatic cases, when associated with depressed fragments 
 or portions of bone, or a disarticulation or fracture of the 
 vertebral column, first demand surgical measures. Later these 
 cases, as well as those of concussion, in which congestion, active 
 or passive, from the very nature of things must result, call 
 for the same active local treatment as congestions generally, 
 the consideration of which follows. 
 
 The congestive lesions of the brain or spinal cord are the 
 most common causes of paralysis, being largely the factor in 
 
Jl6 STATIC ELECTRICITY. 
 
 all cases due to mechanical obstruction, and therefore we look 
 for the greatest measure of success from electro-static ad- 
 ministrations in the earliest stage of the affection. When 
 making this statement it is with a full realization that it is 
 in direct opposition to the long-established dictum of neu- 
 rologists and electrologists. In defense of this departure it 
 can be explained that when electricity has been employed in 
 paralysis, until possibly within the past few years, it has been 
 either the constant or the interrupted (faradic) current. To 
 the former can be attributed injurious effects due to electro- 
 chemical action, and the latter was so deficient in electro- 
 motive force that no effect whatever was made upon the in- 
 flammatory conditions within the spinal canal. Now that it 
 can be demonstrated that either the vibratory or electrical 
 effects of currents of great potential, or the combined effects 
 of both, do materially and efficiently lessen deep local con- 
 gestion, what contra-indication can be presented against their 
 employment in inflammatory cord or brain affections? If 
 a deep knee or hip- joint affection of such character can be 
 relieved, so can a congestion within the spinal canal. Such 
 was the writer's premise more than four years ago; and ex- 
 perience with an ample number of cases of his own, and by 
 his advice in the cases of other physicians, has proved that 
 the theory was correct. 
 
 Anterior Poliomyelitis. — The modus operandi of the treat- 
 ment of two typical cases of anterior poliomyelitis 'follows : 
 The first case was reported by the writer in a paper read before 
 the Post-Graduate Clinical Society of the New York Post- 
 Graduate Medical School, entitled " The Electro- Static 
 Treatment of Some Forms of Paralysis." A child thirteen 
 months of age, after six weeks' treatment in the clinic of an 
 able neurologist in New York, was referred to the writer in the 
 following condition : " Complete paralysis of both lower limbs, 
 except power to move the toes on one foot, and the reaction 
 of degeneration well marked. When the child was brought 
 to the office on the morning after the first administration, he 
 could move the feet at the ankle joints, and on each subsequent 
 day there was additional power of motion, and after six treat- 
 
GENERAL TREATMENT OF PARALYSIS. I 17 
 
 ments he could move ankle, knee, and hip joints with ease 
 and considerable force. The case then disappeared; the 
 mother, a Polish Jewess, thinking the child cured." The other 
 case was referred by Dr. A. H. Ailan of Gouverneur, N. Y. ; 
 and the doctor's report of the case is herewith -given from a 
 communication received about one year later: 
 
 " F. F., a boy aged fifteen, previously healthy, was taken in 
 the night of March 3, 1900, with fever, vomiting, and pains 
 in the back and legs. On trying to get up in the morning 
 he was unable to walk. During the next forty-eight hours 
 he became entirely paralyzed, except his right shoulder mus- 
 cles, which did not become involved. The paralysis also ex- 
 tended to the right side of his face. He was completely help- 
 less. I prescribed the usual remedies, but there was no im- 
 provement in his condition. 
 
 " A few days after this business called me to New York, 
 and I consulted Dr. Wm. Benham Snow in regard to the case. 
 He advised me to begin treatment at once with static elec- 
 tricity, and instructed me in the method of using the current 
 for this particular case. On my return, two weeks after the 
 boy was ■■attacked, I found there had been no improvement. 
 The muscles of his limbs were very flaccid, and atrophy was 
 well marked. March 18 I had the boy well wrapped in 
 blankets and brought to my office, and began the electrical 
 treatment, as instructed by Dr. Snow, which consisted of the 
 Morton wave-current to his spine and frictional and indirect 
 sparks to the whole surface of his body and extremities. 
 
 " For the wave-current I employed an electrode 10 inches 
 in length by 1 1-2 inches in width. I employed the current 
 for twenty minutes to the upper portion of his spine and then 
 the same length of time to the lower portion, following this 
 with the frictional and indirect sparks. This treatment was 
 employed daily for two weeks, and then every second day. 
 
 " The effect of the treatment was almost magical. After 
 the sixth treatment he was able to walk through two rooms 
 in my offices to the operating room. He continued to im- 
 prove steadily, but his left hand and arm were least responsive 
 
1 1 8 STATIC ELECTRICITY. 
 
 to the treatment, and he did not regain their entire control 
 until some time in August. Since then I have been treating 
 him very irregularly, as he thinks he is well. 
 
 " He was able to row a boat and play ball and football dur- 
 ing the latter part of the summer and fall. 
 
 " There is still some atrophy of the muscles of both hands 
 and forearms, and a little in both legs below the knees. To 
 see him walk one would hardly notice anything wrong with 
 him, unless he was very observing. The boy does any kind of 
 work he chooses to do, and there is no difference in the 
 strength of the limbs on either side. 
 
 " Each treatment was of about forty-five minutes' duration ; 
 twenty minutes each to the upper and lower portions of the 
 spine, and about five minutes to the indirect and friction sparks. 
 With the wave-current, the spark-gap was about one inch at 
 the beginning of each treatment, but was gradually lengthened 
 to five or six inches. (The machine was an eight-plate Holtz 
 machine, having plates thirty inches in diameter.) 
 
 " I am fully satisfied that, had the treatment with electricity 
 been commenced as soon as the disease showed itself, the 
 atrophy of the muscles would have been prevented. 
 
 " This seems to me an exceptionally good result for so 
 severe a case of anterior poliomyelitis." 
 
 This case so well illustrates both the method and results 
 of static treatment that, with the doctor's consent, the record 
 is included in full. 
 
 The same results have been obtained in other cases, and 
 without exception, when the treatment has been instituted early. 
 After two months have elapsed, however, the prognosis is 
 very different and the treatment less satisfactory. In other 
 words, when the pressure of the inflammatory process, or its 
 effect, has not been relieved for so long a period, the ganglion 
 cells perish, and paralysis then persists. It is certainly wise, 
 however, to pursue the treatment so long as there is any im- 
 provement, , because the disability may have resulted from a 
 temporary involvement of the trophic centers, and some gan- 
 glion cells may not have perished, but their relations to the 
 
GENERAL TREATMENT OF PARALYSIS. 1 19 
 
 affected muscles have become such that the performance of 
 their functions remains unimpaired. The results from treat- 
 ment can be explained in no other way. After a year has 
 elapsed the chances of improvement are poor indeed. Cases 
 of anterior poliomyelitis have been chosen to illustrate the fact 
 that congestive conditions can be relieved by the electro-static 
 modalities. The other affections of a congestive or inflam- 
 matory character are to be considered in the same category, 
 as has been shown in the preceding chapter, when considering 
 the treatment of tabes. The management in all cord cases is 
 practically the same as there described, and will not be repeated, 
 except' to impress the importance of administering the current 
 with sufficient energy to reach the part affected; while, when 
 treating very large muscular or fat individuals, it may require 
 relatively small electrodes and a spark-gap of ten or twelve 
 inches. There is no danger of making it too great, if it is not 
 disagreeable to the patient. An intense penetrating effect is 
 demanded. 
 
 When the lesion is of the brain, less can be accomplished, 
 but the wave-current over the cervical region, and the brush- 
 discharge vigorously applied over the scalp, will be fairly 
 effective. 
 
 BELL'S PALSY. 
 
 With cases of Bell's palsy no other measure is so prompt and 
 effective, because it is, as a rule, due to a congestive lesion. 
 The writer has -not infrequently known cases, which have come 
 under observation within the first days, to be cured within a 
 week. The cases in which the lesion is supra-nuclear or 
 cortical, which are relatively rare, are recognized from the fact 
 " that the upper muscles of the face are but little affected (the 
 orbicularis palpebrarum and frontal muscles), the muscles 
 which go to the angle of the mouth suffering chiefly." 
 
 The peripheral cases are most commonly of neuritic origin, 
 arising from exposure to cold, as from draughts of cold air, and 
 are promptly relieved by the administration of the wave-current 
 and brush-discharge, if treated early. 
 
120 STATIC ELECTRICITY. 
 
 The application of static electricity to the relief of conges- 
 tion is to all intents and purposes the same, without regard 
 to the location, for it is never employed with danger or possi- 
 ble risk to the structure of organs, even of the brain or spinal 
 cord, — because, however high the voltage, the amperage is 
 infinitesimal. Only judgment, tact, and patience are required 
 to obtain generally satisfactory results. 
 
 Paralysis arising from a specific cause, as syphilis, calls for 
 specific treatment, with a view to removing the gumma tumor 
 that is supposed — rarely demonstrated — to be present, and the 
 mixed treatment, or some other, may be followed by recovery. 
 In such cases the administration of Franklinism for its nu- 
 tritional effects, if for no other, is certainly beneficial. 
 
 The second general indication, to preserve the local nutri- 
 tion of the parts paralyzed and promote the general health 
 and nutrition, requires attention from the onset of the affec- 
 tion if an early and complete restoration is to be expected. 
 
 The maintenance of nutrition in health requires activity of 
 the vital functions and a regulation of the activity of the 
 motor mechanism. When either is interrupted, every part 
 suffers. 
 
 If the action of the trophic centers' in the cord, which are 
 now believed to control the nutritive processes, is impaired, 
 thereby complicating the paralysis, the part affected rapidly 
 becomes soft and atrophies. In brain lesions the motor 
 mechanism suffers only from disuse, and thereby only secon- 
 darily affects the general nutrition. In peripheral paralyses, 
 if exercise of the other portions of the body is not thereby im- 
 paired, only the part paralyzed suffers. 
 
 If the general health of the individual is not good at the 
 onset of an attack of paralysis, restitution will be relatively 
 slow, and the utmost must be done to assist and even stimu- 
 late the normal activities. 
 
 It is certain that, while attention to diet, daily evacua- 
 tions, judicious use of tonics, and regulation of exercise 
 (when possible) are all important, no measure so well meets 
 all the indications for improving or maintaining nutrition as 
 static electricity, (i) It tends to preserve the balance of the 
 
GENERAL TREATMENT OF PARALYSIS. 1 21 
 
 nutrition of exercise and the nutrition of restoration, and 
 thereby retards the process of regeneration. (2) The qualities 
 of the currents are such that no unfavorable electro-chemical 
 action takes place to impair the beneficial results. (3) The 
 effects are searching, penetrating, and potent; in which quali- 
 ties it surpasses all other forms of electrical administration. 
 (4) Applied with the patient insulated, local administrations 
 are tonic and constitutional as well. (5) Local applications 
 induce reflex actions in cerebral cases, acting as a vis a tergo; 
 not performing the action for the part, as when it is massaged. 
 In other words the normal relations of center, nerve, end 
 plate, and muscle to action are preserved, pending a possible 
 recovery, in which the masseur fails, because he moves the 
 limb while the parts are passive. (6) Contractures never take 
 place during a course of electro-static treatment, nervous ir- 
 ritability is allayed, sleep promoted, and normal equilibrium 
 preserved. 
 
 The static modalities of value in preserving and promoting 
 nutrition are sparks (long, short, and friction), the wave-cur- 
 rent, and the brush-discharge. No modality calls forth so 
 well a healthy responsive reflex action as sparks, long and 
 short, according to the indications — short sparks to small 
 muscles, and longer ones to large muscles, and when a thick 
 layer of fat overlays the muscles to be treated. 
 
 Over paralyzed muscles the applications should be numer- 
 ous, not alone for exciting muscular contraction, but also to 
 stimulate all local activities. For the same reason it is the 
 writer's custom to make a thorough application of the friction 
 sparks over the paralyzed areas. When anaesthesia is present, 
 the friction sparks should be applied for a considerable time, 
 after which in many cases partial or complete return of sensa- 
 tion will be experienced during the administration, to be fol- 
 lowed later by partial or complete recovery. In paralysis of 
 cerebral origin, peripheral paralysis, and in the treatment of 
 tabes dorsalis sparks are of inestimable value. 
 
 The wave-current may be applied, when possible, for its 
 general nutritional effects, in cases of paralysis. 
 ' Its local application, when a spark-gap of at least four 
 
122 STATIC ELECTRICITY. 
 
 inches in length is continued for a period of twenty to thirty- 
 minutes, will preclude the necessity also of a tonic administra- 
 tion. The wave-current is also indicated over local peripheral 
 congestion and paralysis originating from affection of the 
 cord, as previously shown. When the brain is the seat of the 
 lesion, applications to the cervical region may be of some 
 service. Except the scalp is shaved the wave-current cannot 
 be applied, and even then the writer's experience to the pres- 
 ent time has derived no results that warrant its employment. 
 
 In the treatment of anterior poliomyelitis in young children, 
 in addition to application over the spinal cord, the limbs may be 
 put up in a bandage of tinsel braid, and the wave-current 
 employed with a spark-gap just as long as can be used without 
 inducing muscular contractions. It is best in these cases, we 
 believe, unless the child is very small, to treat but one lower 
 extremity at a time, but always both at the same sitting. 
 When treating very small children it will be necessary to tie 
 the child to the chair, or to instruct the mother to hold the 
 child, at the same time pressing the palm of the hand constantly 
 against the outer metal surface of the electrode or braid — 
 otherwise the mother could not hold the child, because of the 
 passage of sparks through the clothing. 
 
 The brush-discharge is valuable for its effect over areas of 
 congestion and hyperesthesia, for relief of pain, and as well, 
 to a satisfactory degree, for its nutritional effects. It is the 
 form of application par excellence to the scalp, and often af- 
 fords great relief to an aching head. 
 
 The other modalities may be found of some value, but are, 
 as a rule, not sufficiently effective to be indicated. 
 
CHAPTER XIV. 
 
 PATHOLOGICAL MUSCULAR CONTRACTIONS. 
 
 Muscular contractions are induced by stimulation or irrita- 
 tion of a nerve center, axis cylinder, or the end plate, — cen- 
 trifugal or centripetal, — and are voluntary or involuntary. The 
 voluntary contractions, subject to the will in certain instances, 
 from habit and without manifest source of irritation in neuro- 
 pathic individuals, become involuntary, as is the case in one 
 type of convulsive tic which is amenable to suggestive treat- 
 ment. The involuntary contractions are reflex in character, 
 and comprise those which act in performance of nature's nor- 
 mal functions governed by special centers which control the 
 natural processes of life, and those which arise from central 
 or peripheral pathological conditions. 
 
 Muscular contractions classified by symptoms may be di- 
 vided into spasms, contractions, and tremors. The first may 
 be subdivided into two types, clonic and tonic. Clonic spasms 
 are characterized by alternate contraction and relaxation of the 
 muscle or group of muscles affected. Tonic spasms are those 
 in which the action of the stimulant is constant or recurrent, 
 with a frequency that maintains the muscle in a state of fixed 
 contraction. When clonic spasms are general, they are known 
 as convulsions. A contracture may be defined as a condition 
 in which the contraction of a muscle or a group of muscles 
 maintains a limb in a fixed condition of some degree of flexion 
 or extension. Tremor is a condition of slight recurrent con- 
 traction, -physiological after exertion or fright, or pathological 
 under certain abnormal conditions. 
 
 The indications are, as in all cases, the removal of the cause 
 — either an existing source of irritation, when present, or a 
 nervous susceptibility which permits undue reflex contractions 
 which, under normal conditions, would not be induced. 
 
 The prognosis in all cases will depend upon the chronicity 
 
 123 
 
124 STATIC ELECTRICITY. 
 
 of the case, or the organic character of the lesion, as concerns 
 the central nervous system. 
 
 Peripheral affections, when not of over two years' standing, 
 .as a rule are capable of being cured, but may require persistent 
 application. In accord with the rule in all affections, the time 
 necessary to effect a satisfactory result, other things being 
 «qual, is in proportion to the time which the condition has ex- 
 isted. In cases of central origin, if the affection is functional, 
 from whatever cause, the prognosis again is favorable in pro- 
 portion to the chronicity. The history of the case and the care- 
 ful differentiation and diagnosis must afford the basis for prog- 
 nosis. 
 
 In the treatment of these cases the high-potential electrical 
 modalities, associated with hygienic and tonic measures in cases 
 of non-specific origin, offer effective means of relief. 
 
 In these, as in the pathological conditions considered in the 
 preceding chapters, such favorable results are due to (i) the 
 constitutional tonic effects; (2) the local effects upon inflam- 
 matory ( irritating) conditions; and (3) the sedative effects 
 upon overwrought nervous conditions. The general principles 
 ■of administration apply here as in other affections, but some 
 special features of method call for consideration. 
 
 EPILEPSY. 
 
 When not due to traumatic causes, but occurring in children 
 of neuropathic parentage, very much can be accomplished to 
 prevent it from becoming established by removing all irritat- 
 ing influences, correcting diet, and employing systematic ad- 
 ministration of static electricity, and for its general tonic effect 
 for the relief of nervous irritability. The wave-current is 
 the choice of modalities in these cases. Place over the ab- 
 domen or back a metal electrode having a surface of about 
 sixteen square inches. The administrations should be daily, 
 or every second day, for a period of not less than twenty min- 
 utes, employing a spark-gap of from two to five inches, accord- 
 ing to the age or condition of the child. This course should 
 be kept up for at least a year, or longer if there is improvement, 
 
PATHOLOGICAL MUSCULAR CONTRACTIONS. 1 25 
 
 but a disposition to recurrence. If no lessening of frequency 
 is noted after months of treatment, continuance will as a rule 
 be of no avail. 
 
 CONVULSIVE TIC. 
 
 Very many of these are cases of habit, induced by some 
 trivial local source of irritation or reflex influence not of cen- 
 tral origin. In such, static electricity plays a double role, and 
 is uniformly successful if applied early. (1) It lessens the 
 irritability, and (2) acts as a powerful suggestive influence 
 when systematically employed. 
 
 Most cases of central origin are not due to any traceable or- 
 ganic defect, but are induced by functional derangement. 
 Such are capable of being cured if not of too long stand- 
 ing. For treatment apply a metal electrode covering the 
 affected muscles to be held in position with the hand, and em- 
 ploy the wave-current with as long a spark-gap as can be used 
 without causing painful muscular contractions. Sparks to the 
 region will also render the results more effective in some cases. 
 If the condition is suspected to be of central origin, a large 
 electrode to the back or abdomen should be used, as in epi- 
 lepsy, for an additional fifteen minutes for its general effect. 
 Under this regime there are few cases of not more than two 
 years' standing that will not yield. 
 
 BLEPHAROSPASM. 
 
 This affection is in the same category with convulsive tic, 
 and treated in the same manner. It may be necessary, in 
 making the application over the eye, to take off the ground 
 chain when using the wave-current. In this be guided by the 
 patient's sensation. With the ground chain in position it will 
 not be possible to use a spark-gap of more than one-quarter 
 inch, which, during periods of humidity, will discharge the 
 machine. An advantage with sensitive subjects, in using the 
 current with the ground chain removed, is the fact that the in- 
 crease may be made by insensible gradations, and without 
 causing unpleasant shocks to the patient. When using the 
 
126 STATIC ELECTRICITY. 
 
 current grounded, lengthen the spark-gap with the greatest 
 care, to avoid unpleasant (not dangerous) sensations to the pa- 
 tient. This is best accomplished by a screwing movement with 
 the hand upon the handle of the discharging rod. 
 
 CHOREA. 
 
 This disease is favorably affected in many instances by the 
 use of the various static modalities, sparks excepted. Either 
 employ static insulation with the administration of the spray 
 or brush-discharge, taking care that no sparks be administered 
 to the surface of the patient, or else use the wave-current. 
 In most cases, the latter will give the best results and should 
 be administered daily for periods of from twenty to thirty 
 minutes, employing a spark-gap not long enough to create 
 any disturbing sensations to the little patient. It is essential 
 in these cases that the patient be placed completely at ease by 
 a reassurance of the freedom from any possible accident or 
 danger. A cheerfulness which will inspire confidence will con- 
 tribute much to the recovery. An austere and unpleasant per- 
 sonality without confidence, will, on the contrary, detract from 
 the results of the static treatment, whereas under opposite 
 conditions the relaxation induced and lessened nervous irrita- 
 bility, with restoration of normal function, will induce a prompt 
 recovery in most cases. Patients who are annoyed by the 
 vibratory influence of the wave 7 current or the noise of the dis- 
 charge at the spark-gap will be benefited by a removal of these 
 features, either by diminishing the length of the spark-gap, 
 employing a muffler which will lessen the noise, or the use of 
 static insulation. The latter is far less effective than the wave- 
 current and should rarely be employed in its stead. 
 
 HICCOUGHS. 
 
 This affection in simple cases will require no special treat- 
 ment. The distressing and dangerous cases, however, may 
 often be relieved by the employment of the wave-current over 
 the epigastrium or the vigorous application of sparks over 
 the diaphragm, both to the back and front. When employing 
 
PATHOLOGICAL MUSCULAR CONTRACTIONS. 1 27 
 
 the wave-current continue the administration for from twenty 
 to thirty minutes and repeat the administration daily, or oftener 
 if the paroxysms should recur. The result, in most cases, 
 from either the wave-current or the administration of sparks 
 will be to completely relieve the condition. Others of central 
 origin may resist the treatment. 
 
 THE OCCUPATION NEUROSES. 
 
 These affections occur as a rule in neurasthenic patients, or 
 those of strong neuropathic predilections. 
 
 The indications for treatment therefore are constitutional as 
 well as local. 
 
 The prognosis generally depends upon the common rules 
 governing chronicity. Not every case will be cured. 
 
 The modus operandi is practically the same in all cases, and 
 the different types will, therefore, be treated collectively. 
 Whether the sufferer be writer, typewriter, pianist, telegraph 
 operator, or barber, it will be the flexor group of the right 
 hand which is affected except in left-handed persons. While 
 the writer has cured patients suffering from the affection 
 without interrupting the occupation, it is not the best plan, and, 
 in cases of longer periods than a few months' standing, should 
 not be considered. In all cases employ the tonic treatment, 
 with the wave-current for its constitutional effects, for at least 
 twenty minutes, and thereby relieve the general nervous irrita- 
 bility and improve the processes of general nutrition. For this 
 purpose the spinal or abdominal electrode and a three- to six- 
 inch spark-gap are indicated. Locally a liberal application of 
 short-sparks (one-inch) to the muscles of the forearm and ball 
 of the thumb, followed by friction sparks, serves the best pur- 
 pose. Their action is to improve local metabolism and nu- 
 trition, stimulate normal reflex action, and, with rest, or very 
 moderate use of the parts, will effect a cure in most early 
 cases, and is the best measure in all cases. In stubborn 
 cases the wave-current may be employed, either by applying 
 the tinsel braid or by placing the arm in a water bath connected 
 by a metal electrode in a porcelain or glass vessel for a 
 
128 STATIC ELECTRICITY. 
 
 period of fifteen minutes. The administrations should be made 
 daily until a cure is affected, or the treatment abandoned. 
 
 CONTRACTURES. 
 
 These conditions are secondary to central or peripheral 
 stimulation constant in character, or to paralysis of opposing 
 muscles, and are curable in most cases if treated before the 
 structural changes, which eventually shorten the muscles, are 
 not too far advanced. Whenever an inflammatory process 
 continues for a length of time in the structures of a movable 
 joint in any part of the body, groups of muscles which control 
 the action of that joint become contracted, and the limb be- 
 comes fixed in extension or flexion, because long-continued 
 irritation of the nerves induces contraction of the muscular 
 filaments. If the condition has been present for only a few 
 months, the prognosis is excellent and the affection will be 
 relieved when the inflammatory joint affection is cured. (See 
 Treatment of Joints.) When treating these conditions, apply 
 sparks liberally along the course of the contracted muscle. 
 This latter means serves better than any other to overcome 
 muscular contraction. 
 
 In addition, systematically employ therapeutic exercise. In 
 cases which cannot be induced to submit to sparks, the wave- 
 current will succeed, but requires a longer time to accom- 
 plish the same result. Contractures occurring with paralysis 
 may be prevented, if treatment is initiated while the muscles 
 may still be extended by gentle manipulation. In anterior 
 poliomyelitis (q. v.), either electricity or orthopedic measures 
 will prevent contractures. The objection to the constant use 
 of fixation braces is that a degree of early restoration which is 
 often possible is thereby prevented, and the opposite group of 
 muscles atrophy, to an extent, as well, from which they may 
 never recover if restrained throughout the period of develop- 
 ment. If the orthopedic appliances are used, there should be a 
 considerable period of each day during which the muscles 
 should be exercised, and the wave-current or sparks (prefer- 
 ably the latter) may be administered at least three times weekly. 
 (See Treatment of Paralysis.) 
 
PATHOLOGICAL MUSCULAR CONTRACTIONS. I29 
 
 Contractures in hysteria, like the condition itself, yield to 
 static electricity as they do to no other method of treatment. 
 Sparks applied directly to the contracted muscles, or when not 
 tolerated by the patient, long administrations (twenty minutes) 
 of the wave-current, as strong as it can be given without caus- 
 ing painful muscular contractions, will succeed, but not so 
 promptly. Contractures associated with other affections, as 
 paralysis agitans, lateral sclerosis, cramps, etc., etc., should be 
 treated on the same general principles, and the prognosis will 
 vary with the chronicity of the affection and the organic nature 
 of the primary lesion. 
 
 ATHETOSIS. 
 
 This condition often follows hemiplegia in childhood, and 
 is characterized by varying degrees of irregular tremor of the 
 hands and feet, and inability to retain the fingers and toes in a 
 constant position. The prognosis in these unfortunate cases 
 is never good. The lesion is fixed and central, and while 
 others have reported relative success from electro-therapeutic 
 treatment, the writer has never known a case to improve. If 
 an effort is made, it should be along the same lines as in other 
 spasmodic cases, and but little encouragement should be given. 
 
 TORTICOLLIS. 
 
 Contractions of the muscles of the neck may arise from 
 myalgia or other sources of local irritation, or the affection may 
 be congenital. The former yield very promptly to sparks, the 
 brush-discharge or wave-current, if treated before a chronic 
 condition of muscular shortening is established. The con- 
 genital cases are from the nature of the affection not im- 
 proved by any but surgical measures. 
 
 SPASMODIC TORTICOLLIS. 
 
 Up to the present time no central lesion has been discovered 
 that could be associated with this painful affection, and until 
 recently the prognisis has been grave, and is now in cases 
 of more than two years' standing. If, however, these patients 
 
130 STATIC ELECTRICITY. 
 
 are treated in the early stages by the high-potential modalities, 
 few indeed will not be satisfactorily cured. 
 
 The neuropathic tendencies so often present in these patients 
 necessitate the early adoption of the constitutional, as well as 
 the local methods of treatment, as is done in epilepsy, 
 chorea, and the occupation neuroses. The wave-current alone 
 will succeed in very many of the recent cases ; but sparks will 
 be invaluable in the treatment of cases of a few months' dura- 
 tion. 
 
 TREMORS. 
 
 These signs of lessened nerve force may be due to alcoholic 
 or other excesses, overworked mental or physical conditions, 
 or organic disease of the central nervous system. 
 
 The prognosis depends on the ability of the patient to correct 
 the habit in the early stage, the chronicity, and the character 
 and stage of the organic disease. 
 
 The treatment is the removal, if possible, of the cause, and 
 the employment of constitutional and local measures indicated. 
 In most of these cases daily administration of the usual tonic 
 application of the wave-current for from twenty to thirty 
 minutes, followed by a mild general administration of short 
 sparks, closing the treatment with a rapid application of friction 
 sparks to the whole body, will be most effective. This plan of 
 treatment will meet the requirements satisfactorily in cases 
 due to functional derangement, and greatly benefit, but not 
 cure, cases of paralysis agitans, and multiple sclerosis. It will 
 also often relieve fibrillary contractions of progressive muscular 
 atrophy. 
 
 ASTHMA AND HAY FEVER. 
 
 These affections belong to the neuroses, and are more often 
 acquired than inherited, though unquestionably there is an in- 
 herited predisposition present in very many cases. 
 
 Few, however, who have it in childhood are afflicted in later 
 years ; while, on the contrary, those who acquire the disease in 
 adult life are rarely cured, except by removal to some climate 
 
PATHOLOGICAL MUSCULAR CONTRACTIONS. I31 
 
 adapted to their own cases, if such they are so fortunate as to 
 find it. 
 
 The writer, during the past few years, has been so favorably 
 impressed with the results derived from the wave-current in 
 the treatment of these cases that he has reason to hope that 
 patients may be made comfortable or cured by these means. 
 Especially is this true of asthma. A patient is often promptly 
 relieved of the paroxysms by the administration of the wave- 
 current. 
 
 Place a metal electrode having an area from twenty to 
 thirty square inches over the chest in front, gradually open the 
 spark-gap from three to ten inches, and continue the adminis- 
 tration for thirty minutes. The amount of relief afforded in 
 most cases is surprising, as well as the period for which the 
 relief continues. Enough evidence has not been collected at 
 this time to furnish any definite assurance that the results are 
 more than palliative. The relief derived, however, warrants 
 its use, and there are good reasons to expect that time will 
 demonstrate cures in many early cases. 
 
 For the treatment of hay fever, the writer would cordially 
 advise the employment of the glass electrode shown in Fig. 
 26. The application should be made at first twice daily, when 
 possible, and continue at each sitting, which may be once or 
 twice daily, until the condition is very much relieved. The 
 application should be made to the nasal mucous membrane upon 
 each side and care taken also to reach the turbinated bones. 
 If the application is made thoroughly, the local congestion will 
 be greatly relieved and the hyperaesthesia materially lessened. 
 
CHAPTER XV. 
 STATIC ELECTRICITY IN DERMATOLOGY. 
 
 Although this field is relatively new, it is already practically 
 demonstrated that the wave-current, brush-discharge, and 
 high-frequency are valuable means of relieving many stubborn 
 skin affections. 
 
 The actions of these modalities in relief of skin diseases are 
 both local and constitutional, but vary materially in their 
 respective effects. 
 
 The Wave-current induces active local secretions, stimulates 
 local metabolism, improves the nutritive processes, and at the 
 same time provokes an active elimination of effete and irritat- 
 ing accumulations. The glands become active and the circu- 
 lation and other conditions are restored to the normal when 
 only functional derangement exists. 
 
 The brush-discharge is especially valuable for its remark- 
 ably destructive effect upon germ life, due largely to the local 
 oxidizing action of the ozone set free at the surface of applica- 
 tion, but more particularly to the violet discharges so mani- 
 festly present and to which the methods of Finsen and other 
 recent writers attribute the results derived from solar light 
 and the Roentgen ray. 
 
 The high potential discharges as administered with the 
 glass electrodes are especially useful in the treatment of skin 
 affections and in its action and general effects somewhat 
 resembles the brush-discharge. It is to be preferred in the 
 treatment of conditions of the skin in which it is desirable to 
 preserve a smooth, clear, complexion, as of the face, in the 
 treatment of acne. It may be applied either directly from the 
 machine, as described in the chapter on convective discharges, 
 or in connection with the Files interrupter connecting the cord 
 from the binding post on^the positive side of the machine to 
 the electrode and grounding the negative binding post, hav- 
 
 132 
 
STATIC ELECTRICITY IN DERMATOLOGY. 
 
 133 
 
 ing placed a Files interrupter, with the rod removed, in the cir- 
 cuit of the two poles of the machine. By this means, a cur- 
 rent of very high frequency will be produced. A better method 
 is the employment of the high-potential step-up devices which 
 
 Fig 45- — Combined Tesla, Oudin, and d'Arsonval Apparatus. 
 
 are sold by most manufacturers of static machines, one type of 
 which, combining the Tesla, Oudin, and d'Arsonval currents, 
 is shown in Fig. 45. The small sparks administered with a 
 glass vacuum tube from the Tesla coil of the apparatus are 
 especially efficacious in the treatment of both types of lupus, 
 
134 STATIC ELECTRICITY. 
 
 eczema, psoriasis, ulcers, herpes — in truth, it is difficult to say 
 in what form of skin diseases this type of administration is not 
 beneficial. While the brush-discharge is also beneficial in the 
 treatment of the above conditions it has a disadvantage, stated 
 before, as producing a thickened and roughened condition 
 of the skin which contra-indicates its use upon the face for a 
 series of administrations. 
 
 The modus operandi of these modalities is, (i) local 
 •destructions of micro-organisms, (2) stimulation locally of 
 normal metabolism, (3) diminution of local oedema and con- 
 gestion, (4) relief of local pain and pruritus (5) the promotion 
 of normal secretions, as implied in the effects upon metab- 
 olism. 
 
 The effects upon the local conditions, when ulcerations are 
 present, are to promote healthy granulation with a minimum 
 of scar and to an extent unprecedented by other measures in' 
 the treatment of these conditions. The newly formed skin is 
 even and of the texture of a young child's. When applied to 
 carcinomatous ulceration it removes fetor, relieves painful sen- 
 sations, and greatly improves superficial conditions. When 
 hyperemia, swelling, or oedema is present, it is often relieved 
 to a remarkable extent by a single administration, and soon, 
 in a large variety of cases, the local lesion disappears. 
 
 The local actions and effects suggest their application to a 
 large variety of skin diseases — in few indeed do .they seem not 
 to be indicated, either alone or in connection with the X-ray 
 or light treatment. (See Chapter IV., Section III.) 
 
 The brush-discharge of negative insulation from the static 
 
 machine, employing the wooden electrodes, has, in the hands 
 
 of Dr. J. D. Gibson of Birmingham, Ala., cured in twenty 
 
 • administrations a stubborn case of lupus vulgaris covering 
 
 fully one-half of the face. 
 
 In many diseases of the skin the local manifestation is the 
 indication of a constitutional derangement, resulting from 
 organic functional inactivity. In those cases in which the 
 affection is not entirely local, excepting the specific exan- 
 themata and syphilis, the constitutional static treatment proves 
 of certain value, as would be expected. 
 
STATIC ELECTRICITY IN DERMATOLOGY. 1 35 
 
 The method of employing the brush-discharge in these cases 
 is essentially the same as in other conditions. 
 
 The time devoted to the administration, and the intensity of 
 the application, must depend largely upon the experience of the 
 operator, and will be varied in individual cases. The admin- 
 istration, however, must be thorough and necessary time not 
 cut short. 
 
 The intensity of the application may be varied by the speed 
 of the machine, the. distance from the surface at which the elec- 
 trode is moved about, the presence or absence of a direct 
 ground connection, the distance at which the ground connec- 
 tion is held from ball or point of electrode, and the material 
 and character of the electrode. If a wooden electrode is used, 
 much depends upon the quality of the wood. The grain or 
 texture should be uniform and possess poor conducting prop- 
 erties. Soft maple and whitewood are the proper substances, 
 and may be varied by wetting the end from which the applica- 
 tion is made. The form of the electrode will vary the charac- 
 ter of the discharge. From the round ball it is coarse, and 
 causes a sensation as if hot sand were thrown against the sur- 
 face. When the point electrode is employed the discharge is 
 fine, soft, and agreeable, but the desired effect is derived at the 
 expense of time. The point electrode is indispensable in ad- 
 ministrations in clefts, as between the fingers. 
 
 During cold weather the wooden electrode becomes less 
 effective from the fact that such material, when cold, is a poor 
 conductor. Warm the stick throughout the whole length 
 before using, and it will be as effective as during the summer 
 months. 
 
CHAPTER XVI. 
 PSYCHICAL AND FUNCTIONAL NEUROSES. 
 
 The nervous system, under control of the mental and reflex 
 influences, exists in such intimate relation with every physical 
 function that the health of the organism depends upon the pres- 
 ervation of the normal activity of each — mens sana in corpore 
 sano. 
 
 The psychical neuroses result from causes arising from both 
 mental and physical derangements, and to locate the correct 
 relation of cause and effect often taxes professional skill. 
 
 Environment, associations, habits, and inherited neuro- 
 pathic tendencies play no small part in determining the state 
 of the individual, and cannot be ignored in considering either 
 the prognosis or treatment. 
 
 The moral as well as the physical features require considera- 
 tion in outlining the course to be pursued in the management of 
 the neuroses. In fact, the successful physician takes cogni- 
 zance of the psychical side, no matter what the lesion with 
 which he is called upon to contend. Cheerfulness and hopeful- 
 ness greatly enhance the medical value of any remedy. Agree- 
 able surroundings and encouragement, together with a grad- 
 ual return to a proper activity in some congenial pursuit, which 
 partakes to a large extent of physical exercise, are conducive 
 to the fullest measure of success in the treatment of the psy- 
 chical neuroses. Rest enervates, and lessens thereby the ac- 
 tivity of the very processes essential to restoration when forced 
 as a therapeutic measure. Rest and massage lack initiative. 
 The normal relations of the nervous system and the muscular 
 or functionating organs are designed -for concerted action. 
 Neither passive motion nor rest affords an incentive to resto- 
 ration, and consequently does not induce the normal proc- 
 esses of nutrition. A physical agency to restore lost nerve 
 force, and organic functional activity, must be general in its ap- 
 
 136 
 
PSYCHICAL AND FUNCTIONAL NEUROSES. 1 37 
 
 plication, promoting activity in the cell structure of every part 
 of the organism. To activity add a proper nutritive pabulum, 
 congenial environment, and well-regulated exercise, and all in- 
 dications will have been served. The essential law of life is 
 activity. The body recuperates during rest most vigorously 
 when rest follows exercise. 
 
 The differentiation of the physical neuroses which are func- 
 tional and those which are organic in character has been the 
 source of some confusion, especially among general practi- 
 tioners. 
 
 The distinction, generally well marked in typical cases, often 
 affords occasion for doubt in those which are complicated, 
 or on the border line. Neurasthenia, melancholia, and mania 
 are distinctive in their characteristics, but often lead from one 
 to the other, marking the advancing stages toward a chronic 
 organic condition. Hysteria and hypochondriasis may prop- 
 erly be considered as symptoms of neurasthenia, but they pre- 
 sent distinct and characteristic features. 
 
 NEURASTHENIA. 
 
 This common affection, classed, as it properly is, with the 
 neuropathic conditions, partakes in every case of some func- 
 tional or organic derangement which either may have been 
 primarily the cause of the nervous exhaustion or has re- 
 sulted from it. Whether induced by irregular habits, busi- 
 ness requirements, or worry and trouble, added possibly to an 
 inherited neuropathic or functional predisposition, when the 
 breakdown is manifest it will often be difficult to decide which 
 is the predominating cause to be removed. 
 
 The symptoms most common are insomnia, pain in the head, 
 especially marked over the region of the medulla, anaemia, 
 indigestion, constipation, a generally sluggish or irregular 
 action of the organs of secretion and excretion, irregular action 
 of the heart and praecordial pain (false angina), to which may 
 be added the train of symptoms associated with hysteria or 
 hypochondriasis. It may be induced by impaired nerve force, 
 or associated with other derangements which have been in- 
 strumental in causing neurasthenia. 
 
I38 STATIC ELECTRICITY. 
 
 The prognosis when organic disease is not present is good. 
 The time necessary to effect a cure depends upon the dura- 
 tion of the affection, the probability of removing the cause, 
 changing the environment or other circumstances unfavorable 
 to the patient. If agreeable home surroundings cannot be 
 provided, these patients are best managed in an institution 
 provided with the means of meeting every indication. 
 
 The treatment calls for removal of the cause, correction of 
 Itygiene, etc., as suggested above when considering the general 
 management of any of the class of conditions under discussion. 
 
 The electro-static treatment undoubtedly meets more indi- 
 cations, and as efficiently as any other method, because (1) 
 it quiets nervous irritability, (2) controls local congestions, 
 active or passive, (3) promotes general functional activity, (4) 
 relieves pain, and (5) induces natural sleep, thereby restoring 
 to the sufferer the conditions which lead to the re-establish- 
 ment of the functions. Treatment of the constitutional and 
 local conditions, whether the local lesion be abdominal, pelvic, 
 precordial, spinal, or prostatic, is indicated. At the particular 
 region make the application of the electrodes, when the wave- 
 current is used, adapting the size of the metal plate to the 
 idiosyncrasies of the patient, employing an electrode large 
 enough to permit of using a spark-gap four or more inches 
 in length, for a proper constitutional effect, and at the same 
 time small enough to concentrate the effect upon the local 
 condition. 
 
 The treatment of the local affection in this manner at one 
 application results in the relief of both conditions. 
 
 Dysmenorrhea and other pelvic conditions associated with 
 local congestion of a simple inflammatory character are so 
 often associated with neurasthenia and hysteria that the first 
 indication with many of these patients is to relieve the local 
 trouble. Too often does it happen that recurrent menstrual 
 periods, accompanied by terrible suffering, tax the nervous 
 and physical energies of the patient until she becomes a victim 
 of neurasthenia. These sufferers may be treated during the 
 intermenstrual period with sedatives, anti-spasmodics, hyp- 
 notics, etc., with a possibility of lessening the severity of the 
 
PSYCHICAL AND FUNCTIONAL NEUROSES. 1 39 
 
 next attack. To relieve the condition which causes this suffer- 
 ing with the static modalities in cases in which an acute flex- 
 ion is not present, is often not a difficult matter. The same 
 general principles are to be employed as when treating a 
 sprained knee or a congested sciatic nerve. Adjust an elec- 
 trode so that the current will be applied near the congested 
 organ. This may be done either by placing the long rectal 
 electrode or the one shown in Fig. 46 in the rectum and employ- 
 ing the wave-current twenty minutes daily during the inter- 
 menstrual period. The location of the electrode may be varied 
 by placing a large abdominal electrode over the pubic region or 
 a good-sized vaginal electrode, so constructed as to press into 
 the posterior fornix and provided with a concave depression in 
 which the cervix will rest. When the current is administered 
 in the vagina or rectum, the spark-gap which measures the 
 strength of the current should be from four to eight inches 
 long. The writer has treated a case of neurasthenia which had 
 undoubtedly arisen from dysmenorrhea, in which the electrode 
 shown in Fig. 47 was placed in the rectum and held in position 
 against the lower segment of the uterus and the recto-vaginal 
 septum. After one month's treatment the patient had the first 
 painless menstruation in fifteen years. The treatment was con- 
 tinued during the next intermenstrual period with the same re- 
 sult. Since then her menstrual periods have been free from 
 suffering. The neurasthenia in this case vanished with the 
 restoration of the normal condition. 
 
 This treatment for dysmenorrhea in young girls will be suc- 
 cessful in many cases, and from the fact that the rectal elec- 
 trode may be employed, is free from all objections. The em- 
 ployment of the wave-current in pelvic conditions such as 
 chronic cellulitis, ovaritis, prolapsus of the uterus, arising from 
 atony or relaxed condition of the vagina, and general local 
 hyperesthesia are greatly relieved and often cured by the 
 local use of the wave-current or glass vacuum tubes. In some 
 of these conditions the local use of the brush and high-fre- 
 quency discharges over the hypogastric and iliac regions will 
 be employed beneficially. (See Ovaritis.) 
 
 Sexual neurasthenia in the male is one of the most stub- 
 
140 STATIC ELECTRICITY. 
 
 born types of this neurosis. Many of these cases arise from a 
 real or imaginary impotence, and are often associated with an 
 acute or chronic inflammatory condition of the prostate gland 
 or seminal vesicles or both. As in the treatment of dysmenor- 
 rhea, the effect with the wave-current, employing a rectal elec- 
 trode, is phenomenal. 
 
 In impotency which is due to psychical impressions or hy- 
 pochondriasis, the psychical effects of static electricity, of which 
 so much is said by those who know little of the other effects, 
 is here recognized by all. The local vibratory action of the 
 strong current applied in the rectum is often described as being 
 
 A 
 
 1 
 
 Fig. 46. — Set of Rectal Electrodes. A, vulcanite section for relieving anal 
 contraction. 1, short rectal; 2, constipation electrode, to be used without in- 
 sulated portion; 3, long rectal. 
 
 felt to the end of the penis. This administration should be 
 continued for at least twenty minutes, and may be followed 
 by applications of sparks to the perineum, and friction sparks 
 to the penis, if the case demands it. The tonic nutritional 
 effect of the treatment is certainly one of which the physician 
 can conscientiously make much to the patient, and either cure 
 him by suggestion, the physical effect of the current, or both. 
 In the treatment of prostatitis, acute or chronic, the use of 
 suggestive therapeutics fails, but the result from wave-current 
 administrations in these cases is triumphant. The application 
 should be made with an ordinary electrode of metal or a special 
 one about five inches in length adapted to the conformation 
 of the gland and reaching to the seminal vesicles. (See Figs. 
 46 and 47.) 
 
PSYCHICAL AND FUNCTIONAL NEUROSES. 141 
 
 The writer has designed a special electrode for the treatment 
 of this affection which is also applicable to the treatment of 
 other pelvic congestions, as well as constipation, which is 
 shown in Fig. 47. In the treatment of prostatitis, any of the 
 electrodes may be used either with or without the insulated 
 section, according to the demands of the case. In patients 
 with whom there is no indication for the treatment of an asso- 
 ciated constipation it will be desirable to use the insulated sec- 
 tion, thereby relieving the sphincter muscle from an unpleas- 
 ant contraction which would otherwise be induced. The base 
 
 Fig. 47. — Rectal Electrode. 
 
 may be set either flat upon the chair or elevated at either ex- 
 tremity, in order to bring a proper pressure or contact with the 
 diseased prostate. 
 
 The spark-gap in these cases should be regulated, as in all 
 painful and inflammatory conditions, gradually increasing it 
 as tolerance permits. The application of the current in this 
 region should allow before the close of an administration the 
 use of a spark-gap of from six to twelve inches. 
 
 The use of the rectal electrode may be varied by the employ- 
 ment of a urethral sound of as large a size as can be conven- 
 iently placed, carried to, but not into the vesical sphincter, 
 where it would produce a disagreeable contraction. The 
 spark-gap here, as in the rectum, should be regulated to the 
 sensation produced and may be from four to eight inches in 
 length. Many cases will be more benefited by the employ- 
 ment of an electrode in this position than in the rectum. In 
 others the combined use will produce the best results. 
 
 In cases in which gleet or a suspected ulcerative or specific 
 process in the deep urethra is present, the high-frequency glass 
 vacuum urethral electrode may be employed with great advan- 
 tage, to be used daily following the application of the rectal 
 electrode. 
 
 The effects upon the local conditions are to promptly re- 
 lieve the symptoms of congestion, pressure, and irritation, with 
 
142 STATIC ELECTRICITY. 
 
 prompt restoration to health. No cases which have come un- 
 der the writer's observation have afforded him greater satisfac- 
 tion than the cases of prostatitis treated by the wave-current. 
 The cases- of neurasthenia arising from this cause, as a rule, 
 need no other treatment and are promptly relieved of the ner- 
 vous conditions upon the institution of treatment. 
 
 Seminal vesiculitis will be treated coincidently when associ- 
 ated with prostatitis and relieved by the same method, care 
 being taken that the electrode is long enough to reach and 
 that it be placed in contact with the rectal wall over the 
 vesicles. The results in these cases are very satisfactory and 
 far more effective than the method by stripping. Cases of 
 three or four years' standing have been relieved with a few 
 weeks of treatment. Probably no procedure employing static 
 electricity will give greater satisfaction than the treatment of 
 subacute and acute prostatitis with seminal vesiculitis. 
 
 Sensitive conditions over the vertebral column are relieved 
 by the wave-current, brush-discharge, or sparks locally applied. 
 
 Precordial pain, when due to high arterial tension or 
 anaemia, yields promptly to the application of the wave-current. 
 (See Angina Pectoris.) 
 
 Constipation is undoubtedly a common cause of neuras- 
 thenia, as are also indigestion and some pelvic derangements. 
 Systematic applications of the wave-current followed by long 
 sparks, especially over the colon, are . energizing, but often re- 
 quire considerable time to effect a cure. Diet, mild laxa- 
 tives, liberal ingestion of water, and regulation of habit, with 
 static administrations, bring about the desired result in the 
 shortest time and most effective manner. Secretions become 
 more active, and tone is restored with a return of the normal 
 peristaltic activity. 
 
 A method of treating habitual constipation by the static 
 currents, brought to the writer's notice in a paper read before 
 the New York School of Physical Therapeutics by Dr. Sigis- 
 mund Cohn, and published in the New York Medical Journal 
 of September 6, 1902, has been demonstrated to be of so great 
 value that the following extract is quoted. 
 
 " I use static electricity, either in the form of the wave-cur- 
 
PSYCHICAL AND FUNCTIONAL NEUROSES. 143 
 
 rent or of the static-induced current; the first in the milder 
 forms of constipation, the latter in the very obstinate cases of 
 long standing. The polarity is of importance, as the posi- 
 tive pole has a stronger effect on the tissues it is in contact with 
 than the negative pole. 
 
 " In using the static wave-current the patient is in contact 
 with one pole only, while the other one may be grounded or 
 not. If we use a current without grounding, the treatment is 
 a very mild one. By grounding we make the current consider- 
 ably stronger. The contact with the patient is made either by 
 the rectum (the patient sitting on the upright rectal electrode) 
 or by the abdominal walls (tinfoil plate, 8" x 10"). The cur- 
 rent strength is regulated by the spark-gap between the slid- 
 ing poles. 
 
 " The static-induced current enables us to use very powerful 
 means without causing the patient any pain. The static-in- 
 duced current, is, in reality, a current of high tension and high 
 frequency. While the static wave-current distributes its 
 strength over the whole body, the static-induced current con- 
 centrates its whole strength beneath and between the electrodes. 
 The patient is connected with the outer surface of the Leyden 
 jars, while the inner surfaces are connected with the poles of 
 the machine. One electrode is generally on the abdomen, the 
 other one either in the rectum (direct) or on the back (percu- 
 taneous). The current strength is also regulated by the spark- 
 gap. As the patient need not be insulated, we can also use the 
 labile method. (See Plate IV.) 
 
 " The powerful action of this current, as well as that of the 
 wave-current, may be enhanced by a mode of administration 
 called the undulating or swelling current. By this we under- 
 stand a current that, starting from zero, gradually swells to a 
 maximum of strength and returns in the same way to zero. 
 By alternately increasing and decreasing this current we pro- 
 duce in the muscles alternations of wave-like contractions and 
 relaxations. The effect of this mode of administration of the 
 current is a tonic exercise of the muscles, and in using it we 
 do not risk the danger of overworking and exhausting the 
 muscles, as their maximum contractions are only of short dura- 
 
144 STATIC ELECTRICITY. 
 
 tion. The circulation of the blood and lymph will certainly be 
 accelerated by this milking-like process, and we can readily un- 
 derstand how the atonic condition of the tissues is improved. 
 On the static machine we get the swelling current by slowly 
 removing one pole from and then approaching it to the other." 
 
 The disturbances of the secretory and excretory functions, 
 inactive or excessive, as the case may be, are caused by lost 
 nervous tone, and normal activity is restored by the general 
 treatment. 
 
 Insomnia, one of the most persistent and aggravating symp- 
 toms, soon yields to the long constitutional treatment, many 
 of the patients falling asleep during the administration. The 
 general relaxation, lowered arterial tension, with lessening 
 of nervous irritability, induced as they are, afford the condi- 
 tions favorable to sleep. For best results, the treatment should 
 be given at night before retiring, if but one administration is 
 given daily. Patients in whom nervous irritability is extreme 
 should be given two half-hour sittings daily. In but rare in- 
 stances will the noise of the discharging sparks of the wave- 
 current unfavorably affect these cases. On the contrary, it is 
 soothing to the far greater proportion of patients, as soon as 
 any nervous apprehension which may be present is removed 
 by convincing them that no possible harm can come from the 
 use of such currents. Another precaution in these cases is 
 to employ an electrode of sufficient size that no unpleas- 
 ant vibration can annoy them, for which purpose a metal plate 
 6 x 10 or 12 inches, placed next to the integument upon 
 the abdominal or lumbar region, whichever is most convenient, 
 may be employed. 
 
 Insomnia will be incidentally overcome in most patients dur- 
 ing the treatment of local conditions. 
 
 Impaired secretion, so remarkably demonstrated in the ab- 
 sence of activity of the sweat glands, will be observed in these 
 cases. The writer, since employing static electricity in the 
 treatment of neurasthenia, makes the important observation 
 that in nearly all cases the secretion of the sweat glands is dor- 
 mant. Upon questioning the patients it will be found that for 
 some time, in many cases, they have noticed that they do not 
 
PSYCHICAL AND FUNCTIONAL NEUROSES. 145 
 
 perspire normally on exertion as they had before the com- 
 mencement of the neurasthenia. After the institution of treat- 
 ment, it will be found that for varying periods the secretion 
 does not appear as normally during the treatment with the 
 wave-current or sparks. In the average case, after the com- 
 mencement of treatment it will appear in from five to seven 
 days. In some cases, however, it has persisted for from one to 
 three months and finally been restored to normal. 
 
 When it does finally appear, it will occur with subsequent 
 applications. This same observation will be made in very 
 many patients taking treatment for other affections, showing 
 a tendency of this function to become inactive. It is a signifi- 
 cant fact in most cases that a remarkable improvement in the 
 constitutional condition takes place coincident with the resump- 
 tion of this function, probably from the fact that other func- 
 tions are restored to a greater degree of activity at the same 
 time. The appetite returns, the patient becomes less irritable, 
 and in most cases sleeps better during the first week. In those 
 in whom the peripheral circulation is inactive, the administra- 
 tion of sparks, especially the friction sparks applied rapidly 
 over the whole surface of the body, is productive of the de- 
 sired result. Other conditions existing with neurasthenia, and 
 the allied neuroses, call for the same general rationale. 
 
 HYSTERIA. 
 
 Hysteria is an impaired functional disease characterized by 
 lost individual control, either mental or physical, or both, and 
 marked by varying degrees of anaesthesia, hyperesthesia, 
 paralysis, contractions, or other perverted conditions. It arises 
 from inherited predispositions, physical derangements, evil as- 
 sociations, and improper moral training leading to habits of 
 indulgence often associated with a petulant, selfish disposition, 
 which under disappointment, reverses, or other disturbing in- 
 fluences cause some individuals to become helpless invalids. 
 They often do not receive needed support and proper sym- 
 pathy from their relatives and friends, who from the popular 
 notions, consider the condition one of shamming, when in reality 
 
146 STATIC ELECTRICITY. 
 
 it is not. Few patients are victims of conditions demanding 
 more skillful attention than these. The moral management is 
 of great importance and demands an exercise of tact, with 
 firmness, system, and the administration of measures of relief 
 which exert positive physical effects from which the patient 
 may derive the necessary reassurance. As in the neurasthenic 
 conditions above considered, and for the same reasons, electro- 
 static administrations are particularly indicated in hysteria. 
 The heroic application of sparks to those patients whose con- 
 dition has resulted from overindulgence and petting serve, 
 when administered under pretext of necessity, a most efficient 
 therapeutic purpose. 
 
 Areas of anaesthesia should be treated each time by the ap- 
 plication of friction sparks until sensation returns and the pa- 
 tient protests. Over paralyzed muscles and contractures apply 
 sparks, or if the patient is feeble make use of the wave-current, 
 or, over the clothing, high-frequency discharges applied with 
 glass vacuum tubes. 
 
 Treat all other conditions according to the indications, ob- 
 serving in all cases the importance of the constitutional admin- 
 istrations of the wave-current for periods of not less than 
 twenty minutes at each daily treatment. 
 
 HYPOCHONDRIASIS. 
 
 This neurosis is denned by Gowers as " a morbid state of 
 the nervous system in which there is mental depression due to 
 erroneous ideas of such bodily ailments as might conceivably be 
 present." This state is termed hypochondriasis in men only, 
 according to this writer, and when in women as forming part 
 of hysteria. Again when the character of the delusion be- 
 comes such that the impression is fixed, that the imagined con- 
 dition is actually present, it should be termed insanity. Melan- 
 cholia is present in this condition almost constantly, with an 
 inordinate brooding over an imaginary ailment. When the 
 border-line between actual insanity is crossed in a given case, 
 it is most difficult to discern, and most important on account of 
 the danger of self-destruction. 
 
 In the astiology of this condition timidity plays an impor- 
 
PSYCHICAL AND FUNCTIONAL NEUROSES. 147 
 
 tant part, either as a neuropathic predisposition to tendencies, 
 habits, or practices which vitiate and lead to a weakening of 
 the mental poise, or from the fact that the mental status in the 
 individual is abnormal from birth. Undoubtedly environment 
 and the evil associations of youth pervert and destroy the nor- 
 mal status and lead to physical depravity in many cases as well. 
 Dyspeptic troubles, which are so common in those with whom 
 the care and hustle and bustle of business make such drafts 
 upon their energies, together with the pernicious effects of 
 quick lunches, constipation, and excessive use of stimulants, 
 once established, lead to a most common variety of hypo- 
 chondriasis. This type, under systematic management, is most 
 amenable to treatment. Few indeed of the derangements of 
 digestion cannot be relieved and cured under present sys- 
 tematic methods. 
 
 In a class of individuals who know just enough of their or- 
 ganization to imagine ills and evils which cannot exist, appre- 
 hension, fear, and attention to every reflex pain or other sen- 
 sation discover ailments which are as real as if actually pres- 
 ent. Dyspepsia, constipation, and the associated annoying 
 discomforts of reflex palpitation, prsecordial pain, movements 
 of gases in the alimentary canal, and all manner of disturb- 
 ing symptoms, awaken fear of dangerous organic disease, 
 and are followed by consequent solicitude and despondency. 
 Such conditions in the writer's experience are not peculiar to 
 men, the same affection arises also from real or imaginary 
 impairment of the sexual function in the male. In such it is 
 caused, as suggested above, by masturbation, or excess of 
 venery, and is probably more common than from all other 
 sources combined. The reading of infamous literature issued 
 from all directions by a disreputable class of charlatans who 
 prey like vultures upon the uneducated and gullible youth and 
 adult by the sale of electric belts and nostrums is a fruitful 
 cause of suffering. It is hoped that the government will put 
 a stop to such vise of the mails, which is in itself worse than 
 counterfeiting, blackmail, or the getting of money by illegal 
 stock transactions, because it not only gets money by false 
 representation, but destroys and vitiates the public mind. 
 
148 STATIC ELECTRICITY. 
 
 The treatment of hypochondriasis depends upon so many 
 causes requiring, not alone physical measures, but in many 
 cases moral restraints and proper environments, that but par- 
 tial justice can be done to the subject here. Attention to the 
 digestive function when due to an actual gastritis, which should 
 be differentiated by chemical analysis of the stomach contents, 
 is indicated. Atonic or so-called nervous dyspepsia will be suc- 
 cessfully treated in most cases by applying a large (4x8 inch) 
 metal electrode over the epigastrium, and administering the 
 wave-current with a spark-gap of four to ten inches in length. 
 In gastroptosis, place the electrode over the displaced stomach 
 and employ the same current and sparks. In all other respects 
 use the same measures as indicated in the kindred cases de- 
 scribed in this chapter. 
 
 Undoubtedly institution management for these patients is 
 best calculated to meet all indications, both moral and physi- 
 cal. 
 
 MELANCHOLIA. 
 
 This condition is properly a symptom associated in varying 
 degrees with each of the neuroses included in this chapter, 
 and calls for no special indications for treatment not included 
 in the preceding considerations. 
 
 FUNCTIONAL INSANITY. 
 
 By the above term we would include a large number of cases 
 of mental derangement which arise from neurasthenia, hysteria, 
 hypochondriasis, or other causes as fright, anxiety, or trouble, 
 or occur primarily in persons who suffer from impairment of 
 general health, in which no organic lesion of the brain is pres- 
 ent. 
 
 The condition may be manifested by delusions, persistent 
 melancholy, or emotional states in connection with which the 
 patient may be thrown into fits of crying, laughing, or aimless 
 movements of the extremities. The patients are apt to be 
 sensitive to a strong light, and are annoyed by slight noises 
 which under ordinary circumstances would not be noticed. 
 
PSYCHICAL AND FUNCTIONAL NEUROSES. 149 
 
 Headache is a more or less constant symptom. The peripheral 
 circulation in a large proportion of these patients is feeble, 
 they suffer from cold hands and feet, inactive secretions, and 
 are usually of constipated habit. There is also apt to be a 
 more or less constant condition of high arterial tension. The 
 flushed face, injected conjunctivae, headache, and hypersen- 
 sitiveness, and insomnia so often present are indicative of inter- 
 current cerebral hyperaemia which is undoubtedly present in 
 most of these patients. 
 
 The indications for the employment of electro-static admin- 
 istrations in these cases are apparent and the result most grati- 
 fying. The method is practically the same as in neurasthenia, 
 observing the indications for treatment of any local condition. 
 
 The same rule should be observed in treating headache of 
 the congestive type ; i. e., during the administration of the static 
 bath, or wave-current, the point of the stand electrode should 
 be placed on a level with the knees, and at a distance that will 
 cause a moderate, not disagreeable, warmth beneath the cloth- 
 ing. This method determines in great measure a current 
 flow from the head and serves as a derivative, relieving the cer- 
 ebral hyperaemia. 
 
 The wave-current, administered for at least one-half hour 
 daily, is the best plan of treatment in these cases, but the noise, 
 as a rule soothing, in a few instances will at first aggravate the 
 patient. With these patients substitute static insulation for a 
 few days, and later they are certain to become tolerant to the 
 noise induced. To improve the peripheral circulation during 
 the first administrations of the tonic treatment, pass the brush 
 electrode rapidly over and around the patient at a distance 
 that will produce a sensible warmth, or employ the brush-dis- 
 charge from the wooden ball electrode (negative insulation), 
 and later, when the patient becomes tolerant, thoroughly apply 
 the friction sparks to the whole surface of the body. 
 
 The results from the above plan are, in most cases, gratify- 
 ing. Static administrations are calculated to benefit many 
 types of insanity, and the future will undoubtedly find the 
 machines in daily use in all the great medical institutions of 
 the country. 
 
CHAPTER XVII. 
 
 MISCELLANEOUS DISEASES. 
 
 TUBERCULOSIS. 
 
 Tuberculosis, characterized by the presence of the tubercle 
 bacillus, exists as a local affection, and may be present at the 
 same time in one or more of the structures of the body. 
 
 Pulmonary tuberculosis, the most common form of the dis- 
 ease, has in the first, and less often in the second stage, been 
 cured by measures which increase the powers of resistance 
 and restore to a degree the normal nutrition with increased 
 weight and gradual return to a state of health. The bacillus 
 cannot exist in a healthy organism, and is never actively pres- 
 ent until, for some cause, health and vitality have been im- 
 paired. 
 
 Any influence, especially in persons having an inherited pre- 
 disposition, that reduces the vitality, predisposes to the onset. 
 
 The indications are twofold : ( i ) to destroy the bacilli at the 
 site of invasion, and (2) to improve the health and powers of 
 resistance of the patient. 
 
 The prognosis will depend ( 1 ) upon the stage at which the 
 disease is recognized, (2) upon the character and extent of the 
 cause, (3) upon the institution of proper restorative measures 
 and their faithful employment. No single plan of treatment 
 is applicable to every case, and no one measure sufficient to 
 meet the indications. Of the province of electro-static ad- 
 ministrations in consumption much has been written. The 
 virtue, if any, of so-called static cataphoric administrations 
 has little foundation in fact. On the contrary, there is suffi- 
 cient evidence to prove that the static administrations act chiefly 
 to improve the functional activities of the patient and thereby 
 facilitate return to a normal condition. It is upon this as- 
 sumption, now well-founded, that the consideration which fol- 
 lows will be based as ground for the employment of the static 
 modalities in meeting the second of the above indications. 
 
 150 
 
MISCELLANEOUS DISEASES. I 5 I 
 
 The first indication, when the lesion is of the lungs, is most 
 difficult to relieve. The French, and some American writers, 
 have contended that ozone may be brought in contact with the 
 lesion and destroy the bacilli at the site of invasion. Dr. J. D. 
 Gibson, of Denver, Colo., has shown that positive improve- 
 ment is derived from inhalations in conjunction with allied 
 measures. 
 
 If ozone can be brought in contact with infected areas, its 
 effect upon the bacilli of tuberculosis is undoubtedly to destroy 
 them, as is amply illustrated in the treatment of lupus vul- 
 garis. At the present time attention is drawn to -the employ- 
 ment of the Roentgen ray in the treatment of tuberculosis, 
 both the pulmonary and other local forms of the disease. To 
 date, however, little of a positive nature is established that will 
 warrant more than the suggestion. 
 
 For the purpose of improving the general status in the man- 
 agement of every case, particular attention should be given to 
 the sluggish or deranged physical functions. Place a metal 
 electrode over the organs in question and with the wave-cur- 
 rent give half-hour administrations, bearing in mind that by 
 such means the patient will at the same time derive the desired 
 constitutional effect, and if ozone is, as it probably is, ben- 
 eficial, the patient will breathe an atmosphere impregnated 
 with it from the constantly discharging spark at the spark-gap. 
 This plan of treatment, followed daily with careful attention 
 to every function, together with care of the diet, environment, 
 regulated rest, and exercise, will contribute in a large degree 
 to the recovery of these unfortunate patients. 
 
 Another method, and one generally as effective as the em- 
 ployment of the various ozone inhalers for the administration 
 of ozone inhalations, is shown in Plate No. V. It is customary 
 when employing this method to apply the wave-current either 
 over the spine or abdomen, according to the indications of the 
 case, coincident with the ozone inhalations. The wave-cur- 
 rent is used for its general tonic effect. The strength of the 
 ozone inhalation may be regulated by varying the distance at 
 which the wooden electrode, either the ball or the point, is 
 placed from the nose of the patient. The ball electrode will 
 
152 STATIC ELECTRICITY. 
 
 give off the strongest discharge, and in order to increase the 
 richness of the discharge it is customary to ground the wooden 
 electrode as shown in the plate. 
 
 Tubercular joints and glands will not be benefited by the 
 local administration of the wave-current or sparks. There are 
 reasons to believe, on the contrary, that these conditions are 
 aggravated by the local static administrations. 
 
 If it were possible that the discharges of the brush-discharge 
 were penetrating, as some would teach, the local effects of the 
 ozone would certainly exert a curative action as it does in 
 lupus, but experience disproves the notion. 
 
 Tubercular laryngitis, we believe, will be materially bene- 
 fited by the administration of the brush-discharge, employing 
 a special electrode, which must be insulated with vulcanite 
 where it passes the fauces, or by employing the discharges 
 from a vacuum tube. 
 
 Tubercular enteritis. There is no reason to suppose that 
 any administration will favorably affect this fatal complica- 
 tion. 
 
 Lupus vulgaris yields most satisfactorily to the administra- 
 tions of the brush-discharge. ( See chapter on Dermatology. ) 
 
 CHLOROSIS AND ANEMIA. 
 
 Chlorosis and anaemia may be considered together here, 
 for both are often secondary affections, arising from men- 
 strual derangements in young women, infective or febrile dis- 
 eases, chronic suppurative diseases, nephritis, dysentery, preg- 
 nancy, and other conditions which make excessive draught 
 upon the physical resources. The proportions of the normal 
 constituents of the food become altered and the relative num- 
 ber of the red blood corpuscles is especially reduced. 
 
 The indications are (i) removal of the cause, (2) iron and 
 nutritive foods, (3) any agency that will induce functional 
 activity without producing otherwise deleterious effects. 
 
 The prognosis is dependent upon the primary cause, and 
 is especially good in all cases not complicated by serious ma- 
 lignant, suppurative, or organic affections. 
 
 The treatment of menstrual derangements characterized by 
 
MISCELLANEOUS DISEASES. I S3 
 
 the presence of passive pelvic congestion, spasmodic and other 
 nervous conditions which are amenable to the local measures 
 employing the wave-current, sparks, and brush-discharge, has 
 been described in the previous chapter, when treating of the 
 same conditions complicating hysteria. 
 
 The writer's attention was first called to the remarkable dis- 
 appearance of anaemia when treating other conditions, in a 
 clinic practice in which it was the rule to make use of no means 
 other than electricity. In these patients, as the bowels be- 
 come regular, and the other functions more active, the 
 anaemia gradually disappeared. In private practice the same 
 result is invariable where no organic, malignant, or suppu- 
 rative disease is present coincident with the restoration of the 
 normal functions. 
 
 The method of application must be governed by the con- 
 ditions present, and the electrodes placed as indicated in the 
 treatment of the peculiar constitutional and nervous affec- 
 tions. 
 
 DIABETES MELLITUS. 
 
 There are at present not sufficient data upon which to base 
 positive indications or results in a sufficient number of cases to 
 warrant more than leading suggestions. Employ the wave- 
 current, placing an electrode of a surface area of about 5x8 
 inches over the region of the pancreas, regulating the spark- 
 gap to the patient, as a rule making it four to eight inches 
 in length. Such administrations should be made at least thirty 
 minutes daily and in no wise contra-indicate the medical treat- 
 ment of the disease. 
 
 If the lesion is congestive in character and of the pancreas, 
 and the treatment instituted before structural organic changes 
 have taken place, there is the best reason to expect a restora- 
 tion of the normal conditions. 
 
 BRIGHT'S DISEASE. 
 
 The different forms of nephritis are all types of congestion, 
 varying essentially in the parts of the structure of the organ 
 
154 STATIC ELECTRICITY. 
 
 which is the site of the process. Here, as in all congestions, 
 acute or chronic, the rule for treatment obtains. 
 
 The prognosis depends upon ( i ) the chronicity of the case, 
 (2) the physical condition and habits of the patient, and (3) 
 the particular structure of the organ which is the site of the 
 lesion. 
 
 The principles of treatment in B right's disease are in accord 
 with the general rules of administration. Apply an elec- 
 trode 3x9 inches over the region of the kidneys, the long di- 
 mension transversely, taking care that the metal is shaped to 
 conform to the surface, and held in position by a pillow pressed 
 firmly between the electrode on the body of the patient and 
 the back of the chair. The wave-current should be admin- 
 istered for at least twenty minutes daily, employing a spark-gap 
 of from four to ten inches, avoiding discomfort to the patient, 
 but bearing in mind that the efficiency of the application de- 
 pends upon the relation of the current to the underlying fat 
 and muscular structures. 
 
 At the Buffalo meeting of the American Electro-Thera- 
 peutic Association, Dr. A. D. Rockwell of New York presented 
 a paper, which was published in the Journal of Advanced 
 Therapeutics for January, 1902, in which he reported most 
 gratifying results in the treatment of several cases of Bright's 
 disease by the high-tension coil and wave-current wherein he 
 expressed his preference for the latter. Under the treat- 
 ment the patient's secretions all become more active, local con- 
 gestion is undoubtedly relieved, and the general health of the 
 patient improves. It is, therefore, a rational measure used 
 either alone or in conjunction with other therapeutic means 
 which seem to be indicated. 
 
 CONGESTIONS OF THE LIVER. 
 
 Without entering into particulars as to the various conges- 
 tions of the liver, active or passive, which, for the purpose of 
 treatment, are considered in all to be practically the same, the 
 prognosis in each depends upon the possibility of removing 
 the cause, and the chronicity of the lesion. 
 
 In all visceral congestions the indications for electro-static 
 
MISCELLANEOUS DISEASES. I 55 
 
 administrations are practically the same as have been de- 
 scribed when treating of nephritis, and the results warrant its 
 general adoption. 
 
 The wave-current is the modality of great value, but in all 
 acute conditions should be supplemented by an administration 
 of the brush- or high-frequency discharges to produce a rube- 
 facient effect over the region of congestion. The operation 
 will consume considerable time, but the result will amply re- 
 ward the expenditure. 
 
 MYASTHENIA GASTRICA. 
 
 The local and tonic stimulating effects of the electro-static 
 modalities, especially of the wave-current and sparks, upon 
 myasthenia gastrica are most remarkable and particularly 
 adapted to other associated conditions. In no case will they 
 favorably affect a catarrh of the stomach, but atony and re- 
 laxed conditions respond as to no other plan of treatment. 
 
 A potent administration of the wave-current for from twenty 
 to thirty minutes, followed by a liberal administration of long 
 or short sparks — depending upon the nature of the underlying 
 structures — will meet the requirements. 
 
 EXOPHTHALMIC GOITER. 
 
 1 
 
 This disease, complex as it is in the peculiarity and remote- 
 ness of the organs involved, is favorably affected in most in- 
 stances by judicious administration of the wave-current. In 
 some patients the lowering of the arterial tension seems to un- 
 favorably affect the heart's action. In most instances, how- 
 ever, there is a marked relief of the tachycardia, diminution of 
 the size of the enlarged thyroid, and a cessation of the fur- 
 ther progress of the disease, when the treatment is system- 
 atically carried out. The application of the wave-current 
 should be local both to the thyroid and constitutional; apply- 
 ing the electrode for constitutional treatment over the epi- 
 gastrium. Secure a metal electrode over the thyroid gland 
 (for local treatment, employ as long a spark-gap as will be 
 permitted without causing unpleasant contraction of the 
 
156 STATIC ELECTRICITY. 
 
 laryngeal muscles, and continue the administration for from 
 fifteen to twenty minutes. Follow this with the tonic treat- 
 ment for a length of time depending upon indications, but 
 usually for about twenty minutes. 
 
 SIMPLE GOITER. 
 
 This form of goiter, before hyperplasia takes place, may be 
 invariably cured by a few administrations of the wave-current 
 applied to the gland, as in Graves' disease. 
 
 CONCLUSION. 
 
 In these chapters it has not been deemed necessary to refer 
 to every condition in which the high-potential modalities are 
 indicated, but by the classification adopted an effort has been 
 made to treat the subject in such a manner that, by observ- 
 ing the general principles of technique, the reader may carry 
 it into the broader field of general application. 
 
 To many who are familiar with the other electrical modali- 
 ties, some expressions may appear narrow. Such will note 
 that we were treating especially of the electro-static modes of 
 administration, and have confined the work to the considera- 
 tion of that subject. 
 
SECTION II. 
 
 RADIOGRAPHY. 
 
SECTION II. 
 USES OF THE X-RAY IN SKIAGRAPHY. 
 
 CHAPTER I. 
 INTRODUCTION. 
 
 The static machine plays such an important part in the 
 production of the Roentgen ray that a treatise on the em- 
 ployment of static electricity is incomplete which does not 
 include the subject of its various applications. 
 
 To consider the X-ray from the standpoint of but one 
 source of energy, however, would be narrow and prejudicial 
 to the proper treatment of the subject. It is the purpose of the 
 writer, therefore, to show the advantages of the several types 
 of apparatus employed. 
 
 So much diversity of opinion exists with reference to the 
 efficiency of the various kinds of static machines and coils 
 that it will not be possible in a work of the scope of this 
 volume to consider, except in a general way, the merits and 
 shortcomings of apparatus. 
 
 The writer's intention is to condemn none, but to encourage 
 such improvement in apparatus as will make the physician's 
 armamentarium replete with such appliances as will be effi- 
 cient. 
 
 Skiagraphy has already passed through two epochs of its 
 history since the discovery of the X-ray by Professor Roentgen. 
 The first epoch of discovery and publication was one of un- 
 bounded enthusiasm, during which wonderful tales were told 
 of the new force and its possibilities. The expectations of the 
 public and profession were' raised to the highest plane, only to 
 be followed, by the second epoch of disappointment and con- 
 demnation. During the first epoch, unfamiliarity with the 
 
 157 
 
158 STATIC ELECTRICITY. 
 
 characteristics and actions of the X-ray was the cause of many- 
 accidents and disappointing results from its employment. 
 
 Accidents which occurred during the first two epochs in the 
 form of severe X-ray burns discouraged many early oper- 
 ators and caused a feeling of suspicion as to the expediency of 
 its employment. Idiosyncrasy was given a very prominent 
 place which later investigation has shown to exist only in a 
 moderate degree, burns having been oftener produced from 
 overlong or too frequent exposures in the hands of those who 
 were unfamiliar with its actions. 
 
 Surgeons began to doubt its value in localizing foreign 
 bodies, as they had often failed to find the object in the spot 
 indicated on the skiagraph. Up to this time it had not been 
 appreciated that the relative position of a body with reference 
 to the anti-cathode and the sensitized plate often produced a 
 deceptive location of the shadow of the image upon the skia- 
 graph. The causes of distortion have since become better 
 understood, and by cautious methods localization is made more 
 accurate. 
 
 During the second epoch, the therapeutic uses of the X-ray 
 began to be studied by a few early observers, but received no 
 particular attention or credence until within the last three 
 years. 
 
 The third, or present epoch, is the one of technical, scientific 
 study, and a better appreciation of the limitations of an agent 
 supposed at first to possess more remarkable qualities. There 
 is also with the fuller realization of possibilities an accom- 
 plishment of results which tends to restore confidence and 
 again bring the measure into universal favor. It is the epoch 
 of realization and substantial recognition of this valuable diag- 
 nostic and therapeutic agent. 
 
 There are still many questions calling for more careful study 
 of the scientific application of the X-ray as a diagnostic means. 
 At the present time, however, its use in accurately locating 
 foreign bodies, diagnosing calculi, fractures, and various vis- 
 ceral conditions has become too certain to leave a doubt as to 
 its value. What is now required is greater skill in its ap- 
 plication, which cannot be expected of the general practitioner 
 
INTRODUCTION. 1 59 
 
 or student of medicine who has not received the proper 
 technical instruction in its different applications. The subject 
 is a progressive one, and in the near future many improve- 
 ments will be made in appliances for more definite and precise 
 localization, rapidity in making exposures, and development 
 of the sensitized plate, as well as other features which will 
 tend to perfect the methods in present use. 
 
CHAPTER II. 
 
 GENERAL CONSIDERATIONS OF THE ROENTGEN 
 
 RAY. 
 
 Since Professor Roentgen announced his discovery of the 
 X-ray, made on November 8, 1895, the vocabulary has been 
 enriched by the addition of terms applicable to the new art. 
 
 The names given to the process of making pictures of the 
 shadows of the invisible in common use are radiography from 
 the Latin radius, or ray, and grapho, to write, ray-writing, or 
 the writing of a ray, and skiagraphy from the Greek skia, a 
 shadow, and grapho, to write, shadow-writing, or the writing of 
 a shadow. 
 
 Both are in common use by good authorities. While some 
 have taken partisan- ground in favor of the former name, equally 
 good authorities have adopted the latter. The terms are both 
 philologically correct and are interchangeable. From the 
 same derivations we have the words radiograph and skiagraph 
 (also called skiagram) — applied to the print from the impres- 
 sion on the plate which has been exposed and developed. 
 Stereoskiagraphy and stereo-radiography (also known as 
 stereoscopic radiography) are expressions which refer to the 
 stereoscopic observations of the subject. Skiascopy is the name 
 applied to examination of the chest with screen or fluoroscope. 
 Radiotherapy is aptly applied to the use of the X-ray in the 
 treatment of disease. When Professor Roentgen (pronounced 
 Runtken) called the peculiar radiance the X-ray he fixed 
 upon it a name which is expressive of its to be discovered 
 features — the (X) unknown ray. Here, as with scientific dis- 
 coveries generally, the name Roentgen has become insepar- 
 ably a feature of the nomenclature, and the expression Roentgen 
 ray is interchangeable with the name adopted by the dis- 
 coverer. 
 
 The term cathode" stream refers to the discharges from the 
 
 160 
 
CONSIDERATIONS OF THE ROENTGEN RAY. IOI 
 
 concaved cathode terminal in the X-ray tube. The anode of the 
 X-ray tube is naturally the terminal to which the positive con- 
 nection is made. The anti-cathode is the surface upon which 
 the cathode discharge is focused, and may be a platinum anode 
 placed in the center of the tube of the Jackson type or the 
 glass projection of the glass side of the original Crookes tubes, 
 Fig. 7, or tubes provided with a projection and water-cooling 
 device as the jacketed cavity tube, Fig. 10, Sec. III. The 
 anti-cathode has also been called the target by various writers. 
 The vacuum of the tube has given rise to different expres- 
 sions defining that characteristic. The terms high-vacuum, 
 low-vacuum, and medium-vacuum will express this condition of 
 the tube. 
 
 Various writers have adopted the terms hard, soft, and 
 medium hard to indicate the relative vacuum of X-ray tubes. 
 Such unfortunate terms and applications will creep into the 
 nomenclature with all growing scientific subjects. 
 
 Source of the X-ray . — This peculiar radiance is produced by 
 an electrical discharge of high voltage through a sufficiently 
 exhausted Crookes tube. The rays are invisible, and the prop- 
 erty of penetration may be due to their being longitudinal 
 vibrations of great intensity. 
 
 The physical characteristics of the X-rays are as follows : 
 (i) They penetrate many substances opaque to other rays. 
 (2) They are refracted* when passing from one medium to 
 another of different density. (3) They are but slightly re- 
 flected and are absorbed by substances which they do not 
 penetrate. (4) They affect photographic dry plates as do light 
 rays. (5) They produce fluorescence of many substances, 
 notably platino-barium cyanide, willemite, tungstate of cal- 
 cium, rock salt, fluorspar, and glass. This property is notice- 
 able also in the greenish fluorescence of the glass of all tubes. 
 The penetrating qualities of the rays relative to different 
 substances depend but partially upon any law of specific grav- 
 ity, atomic weight, or density (note Figs. 1 and 2, and descrip- 
 tion). Organic substances, except bone, which is largely cal- 
 cium, are generally transparent to the rays. Wood fiber, mus- 
 
 * Recent investigations have demonstrated tliat they are refracted. 
 
1 62 
 
 STATIC ELECTRICITY. 
 
 cle, and other vegetable and animal matter are to a variable 
 extent penetrated, the density and thickness of the object les- 
 sening the distinctness of the fluorescence upon the screen or 
 
 Fig. I. — Showing the Relative Penetration by the X-Ray of Different Metals, 
 Colored Solutions, and Other Substances; Indicating that no Law of Specific 
 Gravity or Density Governs Transmission. 
 
 r, Vial of water; 2, air-slacked lime in bottle; 3, empty bottle; 4, thionin 
 staining fluid; 5, hematoxylin (stain); 6, aurantia (stain); 7. methyl blue 
 (stain); 8, indolin (stain); 9, sol. cocaine; 10, chloroform; 11. salt solution 
 12, Garlock packing, 1/16 in.; 13, oil cloth; 14, linoleum: 15, ring of vulcanite 
 16, soft rubber ring; 17, box of crayons: <7,red; 6, indigo; c, yellow; d, brown 
 <■, green; /, white; g, orange; h, black; iS, glass dropper; 19. nickel ring 
 20, stick of carbon with iron core; 2t, sheet lead (32 gauge); 22, block tin (22 
 gauge); 23, Crookes composition (22 gauge); 24, Crookes composition (32 
 gauge); 25, aluminum (22 gauge); 26, Oarlock packing. 
 
 sensitized plate. Blood and pus intercept the rays to such a 
 degree that congested regions, abscesses, pus cavities, and 
 empvema are demonstrable. Of the metals, aluminum is rela- 
 tively transparent. 
 
CONSIDERATIONS OF THE ROENTGEN RAY. 163 
 
 The photographic dry plates, films, or sensitized paper are 
 
 affected by the X-ray as by light, which manifests their chem- 
 ical action. They penetrate paper, which ordinary sunlight 
 does not, making skiagraphy an easy process. No camera or 
 screen is required. The subject or object to be skiagraphed 
 
 Fig. 2. — From a Skiagraph Made by Dr. A. C. Geyser, Showing Varying 
 Transmissions of the X-Ray of Different Substances. 
 1, Piece of tin-foil; 2, piece of wood, }i inch thick; 3, ten-cent piece; 4. 
 one-cent piece; 5, five-cent nickel piece; 6, wooden instrument handle; 7, 
 glass vial; 8, piece of rubber composition used for protection; 9, brass hypo- 
 dermic case; 10, watch; II, developed negative; 12, pocket-knife; 13. alumi- 
 num case with hypodermir needles; 14, cigar. 
 
 is placed between the enveloped plate and the tube. The radi- 
 ance is then excited for the required period of time. 
 
 Fluorescence is evidenced in a darkened room upon the 
 screen or with the fluoroscope of platino-barium cyanide or 
 tungstate of calcium. It is noteworthy that platino-barium 
 cvanide, which afforded Professor Roentgen the opportunity 
 
164 STATIC ELECTRICITY. 
 
 of making his accidental discovery, though other substances 
 have been employed for the purpose of fluoroscopic observa- 
 tion, is still preferred. The green color of a tube during radi- 
 ance is due to the fluorescence of the glass. 
 
 The quality of the radiance depends upon the relative con- 
 ditions and characteristics of the exciting apparatus and the 
 tube. 
 
 The consideration of the relative merits of apparatus — 
 static machines and coils — for exciting X-ray tubes; the rela- 
 tive power of penetration of the rays excited under different 
 conditions ; the technique necessary to obtain good results 
 under varying circumstances, are all important subjects which 
 will receive special attention in the following chapters. 
 
 Dr. Williams of Boston employs a Holtz machine having 
 but six plates, each of which is six feet in diameter. The 
 current from such an apparatus has the possibility of an im- 
 mense voltage, but the amperage is practically the same as of 
 a Holtz, having the same surface area on a larger number of 
 revolving plates, the voltage depending upon the speed and 
 diameter of the revolving plates, and the amperage upon the 
 aggregate of the surface of the revolving plates. 
 
 Dr. Williams would demonstrate that the potential (voltage) 
 is of the greatest importance. On the other hand, others have 
 done equally good work with static machines having from 
 eight to ten revolving plates, thirty inches in diameter. With 
 static machines, however, having from twelve to sixteen thirty- 
 to forty-inch revolving plates, it is possible to shorten the time 
 of exposure, indicating that the amperage thereby increased 
 plays an important part in the element of time, other things 
 being equal. In this experience the writer concurs. 
 
 The experience of excellent authorities indicates that good 
 results do not alone depend upon the amperage of the current,' 
 but upon the tube and method employed. The amperage, 
 however, does shorten the requisite length of exposure. 
 
 The eight- and ten-plate Holtz machine serves so well for 
 therapeutic purposes, as has been shown in the preceding chap- 
 ters, that it is important to know that excellent results in 
 radiography can be obtained with them in most cases, though 
 
CONSIDERATIONS OF THE ROENTGEN RAY. 165 
 
 at the expense of additional time. It may also be inferred 
 from the results and experience of Dr. Williams that the 
 diameter of the plates and consequent increased volt capacity 
 of the machine is of importance. With the coil apparatus it 
 is difficult, except with a Tesla transformer, to raise the volt- 
 age and reduce the amperage to anything that approaches the 
 extremes of proportion of that excited by a powerful static 
 machine. 
 
 It is shown by those who make use of the various coils in 
 connection with an ampere meter and controller that the rel- 
 atively greater amperage shortens the time of exposure, and 
 when used with low-vacuum tubes obtains better both defini- 
 tion and detail. This is done, however, at a greater risk to 
 the tube, always shortening its life, with the added possible 
 danger of puncturing or melting the parts, which is only ob- 
 viated by the employment of special tubes. 
 
 The time is approaching when an accurate consensus of 
 opinion will determine the regulation of amperage and voltage 
 necessary to meet special indications and for general use. 
 
 X-rays vary in penetrating power with the vacuum of the 
 tube and the character of the current employed. A high- 
 vacuum tube which requires the full capacity of a powerful 
 exciter to induce a radiance will show the greatest degree of 
 penetration, but will not give detail or contrast. A low- 
 vacuum tube, with which the bones appear dark, and the 
 shading of the tissue of the soft part is discernible, will show 
 contrast and detail if the penetration is sufficient to affect the 
 sensitized plate. Such a tube, when properly energized by 
 large ampere currents, or with a static machine having a suit- 
 able method of interruption, is valuable for special work in 
 skiagraphy. 
 
 Between the extremes will be found all degrees of varia- 
 tion in tubes, which adapt them to special cases and work to be 
 done. The vacuum of X-ray tubes is a constantly changing 
 factor, because it becomes higher with use. Besides the 
 vacuum of tubes, there are features of variation which are 
 individual in tubes of the same manufacture and which mark 
 a degree of excellence or inferiority often unaccountable — the 
 
1 66 STATIC ELECTRICITY. 
 
 thickness and quality of the glass, position, relation, and de- 
 flections of the cathode and anti-cathode account in a measure 
 for these variations. 
 
 The science is a growing one; but progress to the present 
 time has developed, by its practical utility in diagnosis and 
 therapeutics, a degree of perfection which makes it invaluable 
 to the medical profession. 
 
CHAPTER III. 
 X-RAY APPARATUS. 
 
 There are two distinct types of apparatus in common use 
 for producing the X-ray — the static machine and various modi- 
 fiications of the Ruhmkorff coil. The Tesla transformer was 
 formerly considered, but has been superseded by the other 
 types of apparatus. 
 
 Static, machines are made of three types, which have been 
 considered in Section I., all of which are more or less effective 
 for the purpose under consideration. The same test may be 
 applied for determining the capacity of the machine as was 
 given in the chapter on apparatus in Section I. Another test 
 may be made by employing the spark interrupter (see Fig. 3) 
 on the negative side of the circuit between the tube and the 
 machine, placing in the circuit, at the same time, a tube of low 
 vacuum. For the purpose of this test employ a series inter- 
 rupter having at least thirty brass balls separated about one- 
 eighth of an inch, and provided with means for increasing or 
 diminishing the number of spark-gaps in the circuit. A ma- 
 chine which will cause a series of sparks in rapid succession to 
 run across the whole line of balls and spark-gaps and a spark- 
 gap of one inch at each interrupter on the discharging end, 
 under favorable conditions, will be efficient for most uses of 
 the X-ray. Of the Holtz class, a machine to produce the above 
 effects will, under most conditions, require ten or twelve re- 
 volving plates, at least thirty inches in diameter. Any other 
 type of machine which will produce the same effect is to be 
 relied upon to serve the same purposes. Machines having less 
 capacity, in many instances, serve well for X-ray and thera- 
 peutic purposes, if the conditions do not require too great an 
 expenditure of energy, either for the purpose of exciting a 
 high-vacuum tube, or for causing a low-vacuum tube to give 
 a radiance rich in rays. 
 
 -167 
 
1 68 STATIC ELECTRICITY. 
 
 X-ray coils are of great variety, and differ in efficiency. 
 
 The important features of a coil are : ( i ) The capacity to 
 carry currents of varying amperage, adapting them to special 
 work. (A coil for general purpose work, employing ten- to 
 fifteen-ampere currents, is not an economical coil to use for 
 ordinary uses in radiotherapy and for taking skiagraphs of the 
 less dense structures of the body.) (2) The coil which re- 
 duces the amperage in a secondary to the minimum is less 
 destructive of X-ray tubes than that constructed of coarser 
 wire and less windings. Such a coil, however, is more apt to 
 
 ftlWin a aaaa aft ii M fe anei 
 
 Fig. 3- 
 
 break down, or the insulation or wire be destroyed. (3) The 
 coil should be constructed so that it is not apt to break down 
 under the conditions to which it will be subjected. For the 
 production of a high degree of radiation with high-vacuum 
 tubes, the character of insulation in the windings of coils is a 
 matter of great importance. Various means are adopted for 
 making the insulation nearly perfect. The best assurance, 
 however, that a coil will stand the test of endurance, is the 
 willingness of the manufacturer to guarantee it against break- 
 ing down. It is needless to say, in view of the experience of 
 the average physician in regard to the principles and methods 
 of employment of such apparatus, that the manufacturer runs 
 an extraordinary risk in making such a guarantee. One, 
 therefore, who so guarantees his apparatus must have con- 
 fidence in the workmanship and construction of his coil. 
 However, a guarantee is not always an assurance that a given 
 coil will energize a tube to the degree necessary to produce the 
 
X-RAY APPARATUS. 
 
 169 
 
 same effect that other coils may; nor does the spark capacity 
 signify the quality as to the amperage of the current which it 
 will produce. On general principles, then, it is wise for the 
 physician to obtain a guarantee when possible, and, at the same 
 time, to be assured that the coil he buys is capable of render- 
 ing the required service. There is much to be said in favor of 
 
 
 b'\g. 4. — Type of X-Ray Coil. 
 
 the use of large ampere currents and low-vacuum tubes in 
 connection with skiagraphy, when the apparatus is to be em- 
 ployed for radiographing structures or objects requiring detail. 
 as calculi. 
 
 It is in this particular that the coil has an advantage over 
 the static machine. The necessity for discriminating between 
 the several apparatus for special work is becoming better 
 recognized as the science is more fully understood. A coil 
 using a current of from three to five amperes of about one 
 
170 STATIC ELECTRICITY. 
 
 hundred and ten volts is capable of doing all ordinary thera- 
 peutic and X-ray work, as well as radiographing satisfactorily 
 most conditions. It has, however, been demonstrated, as 
 stated above, that a coil best suited to skiagraph the conditions 
 and structures which require detail, such as stone in the kidney 
 or gall bladder, is one which will use a current of seven to 
 fifteen amperes and about one hundred volts from the com- 
 mercial current, in connection with a low- vacuum tube. This 
 combination will produce a radiance very rich in the number 
 of rays, and while the individual rays are less penetrating 
 than the rays from a high-vacuum tube, the great volume of 
 rays compensate and do effect a passage through dense tissues 
 and affect the sensitized plate. 
 
 To operate such a coil requires a degree of familiarity with 
 the technique as well as with the operation of tubes with large 
 ampere currents, a familiarity gained only by experience — 
 not alone in using the apparatus, but in developing the X-ray 
 plates, q. v. Those in quest of a suitable coil can easily find 
 one for ordinary service, and there are now many also capable 
 of skiagraphing most difficult conditions. 
 
 The writer's experience with coils and static machines has 
 led to the conclusion that for general purposes, excepting the 
 special coils referred to, the efficient static machine is to be 
 preferred for the reasons that it does the work equally well, 
 and for the general practitioner, surgeon, or specialist serves 
 a valuable purpose for therapeutic administrations. 
 
 In every otherwise well-equipped physician's office, there 
 should be at least one static machine, having a capacity of do- 
 ing good therapeutic and skiagraphic X-ray work. If an addi- 
 tional apparatus is needed, for X-ray purposes, and the de- 
 mand for static administrations is provided for with the appa- 
 ratus on hand, a coil will occupy less space than another static 
 machine, and not be susceptible in any way to atmospheric in- 
 fluences. Under these conditions a superior coil for skia- 
 graphic purposes will work well, and may, at the same time, 
 serve for a limited degree of therapeutic work, the only dis- 
 advantage being the destructive action upon X-ray tubes. 
 
 When we compare the relative merits of coils and static 
 
X-RAY APPARATUS. 
 
 .71 
 
 machines there are several points to be taken into considera- 
 tion, as shown respectively in the parallel columns, as follows : 
 
 Advantages. 
 
 Static Machines. 
 
 1. They are invaluable for 
 therapeutic administrations. 
 
 2. They are thoroughly ef- 
 fective and capable of doing 
 as good X-ray work as coils, 
 except the coils which employ 
 powerful currents, and in 
 skilled hands are capable of 
 doing fairly rapid skiagraphy 
 and for locating calculi. 
 
 3. They are relatively noise- 
 less, easily adjusted, and not 
 apt to suffer serious damagt 
 when in operation. 
 
 4. High-vacuum tubes can 
 be excited by them for long 
 periods without serious dam- 
 age or risk to the apparatus. 
 
 5. Tubes last for a much 
 longer time without material 
 deterioration, and are not so 
 apt to be punctured. 
 
 6. They do not require an 
 electric current or operation, 
 as hand, water, or other 
 power may be utilized. 
 
 Coils. 
 
 1. They may be used for 
 some therapeutic purposes in 
 connection with glass vacuum 
 electrodes, with which in con- 
 junction with a properly 
 regulated controller they do 
 valuable service. 
 
 2. When properly con- 
 structed they are effective and 
 capable of doing better ski- 
 agraphy under difficult condi- 
 tions than other apparatus. 
 
 3. Many coils and appa- 
 ratus are portable, and may 
 be used wherever a proper 
 current is available, or by 
 taking the current from the 
 storage battery of an electric 
 automobile. 
 
 4. Coils are not affected by 
 atmospheric conditions. 
 
 5. Coils carrying large am- 
 pere currents, properly con- 
 structed, employed with low- 
 vacuum tubes, are superior to 
 other apparatus for instan- 
 taneous skiagraphy, and in 
 skiagraphing tissues easily 
 traversed by high vacuum 
 tubes. 
 
172 
 
 STATIC ELECTRICITY. 
 
 Disadvantages. 
 
 Static Machines. 
 
 Coils. 
 
 1. They are not portable. 
 
 2. They occasionally suffer 
 interference during periods 
 of humidity, which may be 
 obviated as shown in Section 
 I., Chapter III. 
 
 3. They are not as capable 
 as other apparatus in skia- 
 graphing calculi and giving 
 detail of tissues easily trav- 
 ersed by the X-ray. 
 
 1. They are not to be com- 
 pared in value to the static 
 machine for therapeutic pur- 
 poses. 
 
 2. They are more apt to 
 puncture and otherwise im- 
 pair the X-ray tubes. 
 
 3. Some coils, when sub- 
 jected to long use, are apt to 
 break down and become other- 
 wise impaired. 
 
 4. They are more noisy 
 when employed with many 
 interrupters in common use. 
 
 5. The interrupters used in 
 connection with coils are a 
 source of annoyance and more 
 or less constant expense. 
 
 Interrupters used with X-ray apparatus, especially with 
 coils, are numerous. 
 
 The static interrupters provided with all machines are so 
 arranged as to lengthen or shorten a secondary spark-gap on 
 both the negative and positive sides of the machine. They are 
 invaluable for inducing an increased bombardment of dis- 
 charge from either or both sides through the X-ray tubes, 
 thereby varying the intensity of the radiation. These may be 
 supplemented by series interrupters, arranged on either or 
 both sides of the apparatus. 
 
 The series interrupters are constructed, having a number of 
 small balls (thirty to fifty), separated about one-quarter of an 
 inch from each other and secured to some non-conducting ma- 
 terial, and provided' with a sliding rod which may be moved in 
 either direction, increasing or diminishing the number of spark- 
 gaps in the circuit. The insulating material employed in the 
 
X-RAY APPARATUS. 
 
 173 
 
 construction of these interrupters should be of some material 
 which is an absolute non-conductor. Hard rubber is apt to 
 become heated and carbonized to the extent that it ceases to be a 
 non-conductor. Mica, with a combination of shellac, or glass, 
 
 Fig. 5. — Files Interrupter in Circuit. 
 
 is the best substance of which these interrupters may be con- 
 structed. The Files interrupter, shown in Figs. 3 and 5, is 
 made of mica, and is a practical apparatus for the purpose. 
 
 The coil interrupters are the bete noir of the X-ray workers. 
 Many varieties have been made, including mechanical, elec- 
 trolytic, and mercury jet. 
 
 A practical interrupter must be both rapid and convenient 
 
174 
 
 STATIC ELECTRICITY. 
 
 of adjustment. The break-wheel interrupter, provided with a 
 blowing device for extinguishing the sparks, was one of the 
 earlier types of interrupters. Later the Wehnelt electrolytic 
 interrupter came into general use and is employed. 
 
 The Willyoung improved Wehnelt interrupter shown in 
 Fig. 6, for direct or alternating current, is provided with an 
 
 Scale 
 
 Fig. 6. 
 
 automatic feed by means of which the active electrode always 
 rests against a glass stop, descending by gravity as it is con- 
 sumed. To obviate overheating or make the heating much 
 slower, extra large jars are employed with this interrupter. 
 The electrolytic interrupters are invaluable for rapid radi- 
 ography because they permit the passage of a large volume of 
 current through the tube. 
 
 Various types of mechanical interrupters are in common use, 
 
X-RAY APPARATUS. 175 
 
 and, though permitting less rapid interruptions, serve a prac- 
 tical purpose. The objection to them, however, is that they 
 require metal terminals which, if not of platinum, are rapidly 
 destroyed, and eventually the platinum tips are also used up. 
 The mercury- jet interrupter, one of the most recent and best 
 types, has the disadvantage that the oxidation of the mercury 
 
 Fig. 7. — Crookes Tube. 
 
 necessitates frequent cleaning. A motor is necessary for 
 operating this type of interrupter. Another coil is provided 
 with parallel disks, which can be regulated in distance to the 
 current employed, giving a rapid spark interruption. The disk 
 is provided with a vessel filled with water placed over the plate 
 for cooling. The disks become oxidized, requiring frequent 
 cleaning, or an intermittent, irregular interruption occurs. 
 None of these interrupters can be considered perfect, but they 
 practically meet the requirement, and, with requisite care and 
 attention to details, answer the purpose. 
 
 Of Crookes tubes, the earliest type was described by Sir 
 William Crookes before the British Medical Association, 1879, 
 a cut of which is shown in Fig. 7. These tubes were con- 
 structed with the cathode of aluminum, having a plane, not con- 
 cave, surface, as in the tubes now in general use. With these 
 tubes, the glass side of the tube opposite the cathode was the 
 anti-cathode, from which the rays were emitted, the anodal 
 connection being placed on one side of the tube. Such tubes 
 
176 STATIC ELECTRICITY. 
 
 when emitting rays, except the tube is of very low vacuum, 
 will soon heat and puncture the glass, making them imprac- 
 ticable for therapeutic purposes or for diagnosis. 
 
 Since the vacuum of tubes becomes constantly higher, these 
 tubes were necessarily short-lived. The cathode having a 
 plane surface, the cathode rays were also diffused, not focused, 
 
 Fig. S. — Modern X-Ray Tube. 
 
 as in tubes which are now constructed having the cathode 
 concave on the side facing the anti-cathode. 
 
 To Mr. Herbert Jackson, an English physicist, president of 
 the British Roentgen Ray Society, belongs the credit of having 
 suggested the first practical method of obtaining an efficient 
 radiation from what is now known as the *' X-ray tube." He 
 had a tube constructed in which the anodal terminal was placed 
 in the center of the globe, and provided with a small platinum 
 plate, placed at an angle of about forty-five degrees with the 
 long axis of the tube. Opposite this was the cathode, which 
 was concave, and placed at the distance and angle at which 
 the cathode rays would focus upon the anti-cathode at the 
 center. In this type of tube the anti-cathode is the anode. By 
 this arrangement the volume of the rays concentrated upon the 
 anti-cathode was reflected forward in lines radiating from its 
 surface — the plane of the platinum plate dividing the tube into 
 a dark and radiating field, at the same time projecting the 
 rays at a convenient angle for practical use. (See Fig. 8.) 
 
 In the earlier type of tubes, the disposition to a constantly 
 increasing vacuum was not appreciated, and the bulbs were 
 
X-RAY APPARATUS. 177 
 
 made too small, as shown in the accompanying cut (Fig. 9). 
 Experience has developed many practical features in the con- 
 struction of X-ray tubes. The bulbs have been made larger, 
 and the tubes provided with various means of regulating the 
 vacuum. It is necessary to have the platinum anode made 
 heavy enough to guard against its destruction by melting. 
 Another method of preventing the destruction of the anti- 
 cathode by powerful coils is a water-cooling device, by which 
 a stream of water, pouring in and out, is constantly in prox- 
 imity to its metal parts. It has been impossible until recently 
 to so construct a tube of this type that the water would come 
 
 Fig- 9- — Early Type of X-Ray Tube 
 
 in contact with the metal, a glass septum having been necessary. 
 Glass, being a poor conductor, has rendered these tubes im- 
 practicable. Tubes have lately been constructed, however, in 
 which the water will come in direct contact with the metal. 
 Water cooling tubes are of particular value for use with coils. 
 For general employment with the static machine, there are 
 man}- efficient tubes on the market, notably the type of tube 
 shown in the accompanying cut, Fig. 8. There are various 
 types of imported and domestic tube3 which are practical and 
 satisfactory. The German and the English tubes, constructed 
 with an adjunct to the anti-cathode, of which a type is shown 
 in Fig. 11, are durable and practical tubes. Many devices have 
 been suggested for regulating the vacuum of the tube. Vari- 
 ous salts, rich in oxygen, as oxide of manganese, or chlorate of 
 potash, which may be decomposed upon the passage of an 
 electrical discharge, are used, thereby increasing the volume 
 of gas within the tube, thus lowering the vacuum. 
 
 A new adjustable tube shown in Fig. 10 will be found 
 invaluable to X-ray workers. 
 
1 78 
 
 STATIC ELECTRICITY. 
 
 It is found by every operator with X-ray tubes that just 
 when a tube begins to do the best work the vacuum suddenly 
 becomes too high, the current refusing to go through it, or only 
 after requiring a long and tedious coaxing. This is caused 
 by the destruction of the small amount of air which is neces- 
 sary to permit the passage of the current. With this form of 
 regulator, the vacuum may be readily lowered. By unscrew- 
 ing the metal cap, and immediately screwing it up again, an 
 
 Fig 10. — A Type of Adjustable Tube and Cut of Regulating Device. 
 
 air passage is opened and a small amount of air is added and 
 the tube is again as good as new. This may be done an in- 
 definite number of times and the quality of the tube be as often 
 restored. 
 
 Another important feature of the tube is that a very thick 
 pure platinum anti-cathode is used, allowing no possibility of 
 burning through. Pure platinum gives so much better re- 
 sults than the plated anti-cathode so commonly used in foreign 
 tubes that this is a step in the right direction. The tube shown 
 is designed for use with the static machines. It is claimed 
 by the manufacturers that for radiography this tube has no 
 equal in bringing out the detail of the soft tissues, muscles, 
 etc., for the reason, which must appeal to all operators, that a 
 tube that can be kept low has the proper qualities for giving 
 best detail on the negative. A tube can only be retained at a 
 low vacuum by replenishing the air supply. This is accom- 
 plished by their tube and at less cost for the tube in the first 
 place than any other. These tubes are constructed in accord 
 
X-RAY APPARATUS. 
 
 179 
 
 with the writer's oft-repeated plea for solid platinum anti- 
 cathodes. 
 
 The writer has found, in connection with his X-ray work, 
 that baking the tubes is a practical method. If care is taken 
 
 Fig. 11. — A German Tube. 
 
 not to permit a tube to become too high, but to lower it as soon 
 as it shows a four- to six-inch spark resistance, the tube will 
 rarely puncture. 
 
 Baking an X-ray tube, or submitting it to a high tempera- 
 ture for a necessary period of time, will lower the vacuum. 
 
 Fig. 12. — Tu'ie Clamp. 
 
 This may be effected by the glass becoming sufficiently 
 porous under high temperature to permit the passage of air 
 into the tube. The process is one which requires but little 
 practice to successfully accomplish the result. The time nec- 
 essary will depend upon the degree of temperature employed, 
 and until familiar with the action upon the tube, it is well to be- 
 gin by continuing the process in a very hot oven for not more 
 than five minutes. 
 
 The writer places the tube upon a piece of asbestos in the 
 
180 STATIC ELECTRICITY. 
 
 lower oven of a " Perfect " gas range, burning a full blue 
 flame for five or ten minutes. Under this treatment the 
 vacuum of some tubes will be lowered to such an extent that 
 a fluorescence will not be produced unless the ball inter- 
 rupter is employed. With that apparatus, however, it is pos- 
 sible to work a tube thus lowered and obtain practical results 
 
 Fig. 13.— Tube Holder. 
 
 in the treatment of superficial conditions, as acne or lupus, until 
 the vacuum is gradually raised, 
 
 Experience in baking a given tube will govern the length 
 .of time best calculated to obtain the desired vacuum. It has 
 been said by some that • tubes thus treated soon become high 
 again. This, however, is not in accordance with the writer's 
 experience. If care is taken to place the tube upon a piece of 
 
X-RAY APPARATUS. 
 
 181 
 
 asbestos, or in a pan of earth or ashes, so that the glass does not 
 touch the metal of the oven, the danger of injuring the tube by 
 this process will be avoided. Various special tubes have been 
 devised for therapeutic use, which will be described in the fol- 
 
 lowing section. 
 
 Tube stands, or holders, of many designs are employed. 
 Every manufacturer of coils and static machines provides a 
 different design. The essential features are : ( I ) A provision 
 
 Fig. 14. — Fluoroscope. 
 
 by which the tubes may be placed in any desired position, ( 2 ) 
 a substantial wooden or iron base which will not be easily over- 
 turned, (3) an upright standard, preferably of wood, with an 
 extension that may be raised or lowered and provided with 
 movable socket or thumb-screw for securing the tube-clamp. 
 The staff of the tube-clamp (see Fig. 12 ) should be at least two 
 and a half to three feet in length, and held in position by a 
 thumb-screw. The clutch, or clamp, for holding the tube 
 should always be of wood, and so constructed that it may be 
 quickly adjusted and opened wide enough (at least two inches) 
 to receive tubes of any size. A stand should also be provided 
 with a means for holding the cords connecting the tube with 
 the machine away from the standard and sides of the tube. It 
 is also desirable that above the base the upright standard should 
 be of wood. While this is not absolutely necessary, it pre- 
 vents the escape of current from the cords, a matter of im- 
 portance when operating high-vacuum tubes. (See Fig. 13.) 
 
1 82 STATIC ELECTRICITY. 
 
 A fiuoroscope is an apparatus consisting of a closed cham- 
 ber, provided with an opening surrounded with a fur border to 
 exclude the light when the face is pressed against it far the 
 purpose of observing the opposite side, which is provided with a 
 cardboard cover, coated on the inner side with crystals of 
 
 Fig. 15. — Fluoroscopic Screen. 
 
 platino-barium cyanide or tungstate of calcium, which fluor- 
 esce brightly when exposed to the X-rays. (See Fig. 14.) 
 
 A pane of lead glass placed on the inside of the fiuoroscope 
 over the screen will protect the eyes from the action of the 
 rays. 
 
 Screens of various sizes are made of the same material as 
 the fiuoroscope, the pasteboard being secured to a frame (see 
 Fig. 15). They are usually employed for examining the chest 
 in a dark room. The convenient size for practical use is 
 eighteen by twenty-two inches. These screens and fluoro- 
 scopes are expensive on account of the material and process 
 of manufacture, costing about 25 cents per square inch. 
 
CHAPTEE IV. 
 
 THE METHOD OF MAKING THE SKIAGRAPH 
 AND DEPENDENT FEATURES. 
 
 The process of making the skiagraph is simple, but requires 
 experience to perfect the details of exposure and skill in the 
 process of developing the sensitized plate. 
 
 Familiarity with the characteristics of X-ray tubes and their 
 adaptation to varying conditions is an important feature in 
 skiagraphy and requires particular attention. 
 
 The individuality of X-ray tubes: when it is appreciated 
 that tubes vary greatly in the quality of radiance emitted, the 
 selection of a tube becomes a subject of no small importance 
 to the radiographer. 
 
 Features of construction which are capable of producing 
 variations in tubes will depend upon ( I ) the kind of apparatus 
 for which they are designed, (2) the quality, thickness, and size 
 of the glass globe of the tube, (3) the quality of the metal parts 
 of the tube and their relative position, form, and size, (4) 
 vacuum of the tube. 
 
 (1) The apparatus with which a tube is to be employed will 
 determine different features in its construction. A tube which 
 is to be used with a twelve- to fifteen-inch coil, capable of carry- 
 ing a current of twelve to fifteen amperes, will require an anti- 
 cathode either manufactured of a thick block of platinum or 
 provided with a water-cooling device to protect it from melt- 
 ing during radiation. Tubes for such coils should also be 
 provided with some practical means of reducing the vacuum, 
 because they may become high during one prolonged ex- 
 posure. Those that are used in connection with the static 
 machines and the smaller types of coils will vary in these re- 
 quirements in accordance, with' the' individual' characteristics 
 of .the apparatus. Tubes used with static machines having 
 
 183 
 
1 84 STATIC ELECTRICITY. 
 
 twelve to twenty revolving plates will require heavier anti- 
 cathodes than those used with apparatus of small capacity. 
 
 (2) The glass of which X-ray tubes are constructed should 
 be free from metal, especially lead — the lead-glass bulbs trans- 
 mitting but few of the rays. When it is considered that all 
 glass but slightly transmits the Roentgen ray, it can but be 
 appreciated that the glass should be as thin as possible consist- 
 ent with the necessary strength of the tube. The glass in no 
 case should be thicker than 1-60 of an inch, and should be con- 
 structed in the form of a globe, because that form will best 
 
 <Qi 
 
 Fig. 16. — X-Ray Tube, Showing Heavy Metal Anti-Cathode. 
 
 withstand the atmospheric pressure. A practical-sized globe 
 is one six to eight inches in diameter, the vacuum of the smaller 
 ones requiring more constant attention for regulation, and the 
 gases also becoming so hot as to lower the internal resistance, 
 and, consequently, the character of the radiations. 
 
 (3) The metal parts of the X-ray tube are preferably of 
 platinum and aluminum, these metals being but slightly acted 
 upon by the electric discharges. The cathode, which is uni- 
 formly of aluminum and properly concaved, should be so placed 
 that the cathode rays will be focused upon the center of the 
 anti-cathode. The anti-cathode, which in most tubes is the 
 anodal terminal, should be of pure platinum. The tubes con- 
 structed of a single very thin piece of platinum are short-lived. 
 The anti-cathode is soon perforated, thereby permitting the 
 cathode discharge to pass through. These thin anti-cathodes 
 also become distorted into various shapes when heated, and 
 ultimately fail to properly project the rays. In a few instances 
 in the writer's experience, the cathode rays have been pro- 
 jected against the sides of tubes and have resulted in puncture. 
 
METHOD OF MAKING THE SKIAGRAPH. 1 8$ 
 
 Tubes constructed with this type of anti-cathode are of no 
 practical utility, except in connection with small-sized static 
 machines, the larger machine and small coils soon rendering 
 them useless, either by melting, puncturing, or distorting them. 
 The best general-purpose tube, though costing more, is one 
 provided with a solid platinum anti-cathode, at least 1-32 of an 
 inch in thickness. The disposition to construct tubes with 
 cheap anti-cathodes is against the interest of the radiographer. 
 When the first cost of the tube is taken into account, and the 
 fact that platinum so employed is not destroyed, it is advisable 
 that the radiographer insist upon this feature of his tube. 
 The old platinum will pay the difference of the purchase price 
 of the next tube. 
 
 With a properly placed cathode, the anti-cathode will first 
 become red at the center, because the rays are focused to that 
 point. 
 
 (4)- The vacuum of the X-ray tube is an important subject 
 for study in connection with radiography and radiotherapy. 
 
 The terms hard and soft, as applied to Crookes tubes, are ill- 
 chosen, and the writer thinks bad form when applied to the 
 degree of vacuum. Better expressions are the terms which 
 directly indicate the condition, high and low vacuum. The de- 
 gree of vacuum of an X-ray tube is best determined by the 
 spark resistance of the tube with the apparatus with which it is 
 to be employed, bearing in mind that the length of the spark 
 resistance varies to a slight degree with the amperage of the 
 current employed, and the temperature within the tube. 
 
 In other words, a tube with which the spark begins to cease 
 to discharge at the spark-gap, when the balls of the discharg- 
 ing-rods are separated for one inch with a static machine hav- 
 ing eight revolving plates, will radiate with a slightly shorter 
 spark-gap when put in the circuit of a machine having twelve 
 revolving plates. While, therefore, the spark-gap is the best 
 means of determining the degree of vacuum of the tube, it will 
 be seen to be but relatively exact. 
 
 The spark-gap, either with coils or static machines, will 
 then best serve as a means for determining the degree of 
 vacuum of tubes. Other means, however, which will indicate 
 
1 86 STATIC ELECTRICITY. 
 
 the quality of the X-rays, either a chemical device, or one which 
 will show varying degrees of penetration, will be welcomed, as 
 a more accurate guide in this important matter. Such a sys- 
 tem should conform to tubes employed with all types of appa- 
 ratus. Efforts are being made in this direction, but as yet no 
 accurate measure known- to the writer has been devised. 
 
 The resistance within the vacuum tube varies with the tem- 
 perature; in other words, when a tube has been excited until 
 the anodal plate has been heated for a time sufficient to raise 
 the temperature of the ether and gases within the tube, the 
 spark resistance of the tube becomes perceptibly lowered. 
 With small tubes in heavy coil circuits this is often marked. 
 The same thing may be accomplished during the winter months 
 by thoroughly warming the tube, which shows conclusively 
 that the lowering of the temperature of the ether and gases 
 increases the internal resistance of the tube, and vice versa. 
 This fact gave rise to the term of " working up the tube," 
 meaning inducing a high-vacuum tube to produce a practical 
 degree of radiation. It will be observed, under these conditions, 
 that when a high-vacuum tube at first excited induces a certain 
 radiation not rich in X-rays, upon the tube becoming heated 
 the volume of the radiance is greatly increased. In a tube in 
 which it is impossible to induce heat sufficient to cause the anti- 
 cathode to become red, either because the vacuum is too high or 
 too low (it will occur in either case), some other means must 
 be invoked to increase the temperature within the tube in order 
 to work it up to a practical degree of radiation. This may be 
 done by heating the exterior of the tube with an alcohol lamp, 
 or by otherwise heating the tube, or, in case of a low-vacuum 
 tube, by connecting in the circuit the series-ball interrupter, 
 thereby increasing the intensity of the bombardment of dis- 
 charges within the tube. The volume of radiation, under such 
 circumstances, depends upon the intensity of the bombardment 
 or sudden impulse of current that is thrown into the tube and 
 the relative quantity of the current ; in other words, a static cur- 
 rent from an eight-plate machine having a series-ball inter- 
 rupter, provided with a regulating controller, as shown in "Fig. 
 5, placed upon one side, preferably the negative side of the 
 
METHOD OK MAKING THE SKIAGRAPH. 187 
 
 circuit, will increase the volume of radiance in a low-vacuum 
 tube by the increase of each spark-gap of the series. The 
 capacity of the machine, however, will be marked by the num- 
 ber of spark-gaps across which the spark will pass under these 
 conditions. With a twelve-plate machine, therefore, the num- 
 ber of spark-gaps will be increased and the volume of radiance 
 proportionately, the increased amperage of the additional plates 
 of the twelve-plate machine adding to the possibility of increas- 
 ing the volume of radiance. 
 
 The relation of the amperage to the volume of radiance is 
 evidenced by the increased efficiency of a given tube when 
 excited within the circuit of a static machine of small capacity 
 and then in a coil circuit. 
 
 The intensity or penetrating quality of individual X-rays 
 will depend upon the vacuum or internal resistance of the tube. 
 The rays excited by passing a powerful current through an 
 X-ray tube of high vacuum are of greater wave length and con- 
 sequent intensity than when the same degree of intensity is 
 employed in a low-vacuum tube, using a current of greater 
 amperage or a multiple spark interrupter. At the same time, 
 the image produced upon the fluoroscope or screen may appear 
 to fluoresce the same. 
 
 When a fluoroscope is used in connection with tubes of dif- 
 ferent vacuum and under different degrees of energy, it is, 
 therefore, often difficult to determine the two features of radi- 
 ance, intensity and volume, as indicated by different X-ray 
 tubes under different degrees of electrical discharge upon the 
 screen. 
 
 The above observation is one of interest and value both to 
 the radiographer and the radiotherapist. A degree of volume 
 which will give a clear penetration on account of the great 
 number of radiations will produce a skiagraph giving details 
 of the structures less penetrable by the X-ray, while a tube 
 producing rays of great intensity will give a better definition or 
 outline of the bony structures and other objects less penetrable 
 by the X-ray. In radiotherapy, the radiance of great volume 
 is productive of the greatest local effect upon superficial tis- 
 sues and capable of affecting deep tissues as well, but in a 
 
I 88 STATIC ELECTRICITY. 
 
 different manner than the X-rays generated through a tube 
 of high vacuum, as is shown in the subsequent chapters on 
 radiotherapy. 
 
 The sensitized plates employed in connection with radiog- 
 raphy and skiagraphy are the same to the present time as 
 those employed in ordinary photography. Several manu- 
 facturers have produced plates which they have designated as 
 special X-ray plates. In the writer's experience, however, for 
 taking skiagraphs of the smaller parts of the body, the ordinary 
 cheap plates will answer the purpose as well. When making 
 a skiagraph of the trunk, however, where detail is the object, 
 an extra-sensitive plate, having a double coating, may be pre- 
 ferred. 
 
 The care of the sensitized plates used in connection with 
 the X-ray apparatus calls for particular attention. Such plates 
 must be kept at a distance from the radiating tube or be other- 
 wise protected, as they will become useless from fogging. 
 They may be kept in a metallic box in a closet, in the safe, or 
 upon the floor above the room where the X-ray is employed. 
 Plates have frequently been fogged in closets and desks twenty 
 feet away from the radiating tube. The plates should, as a 
 rule, be kept in the original package until used. This, how- 
 ever, is not imperative, but experience has taught that plates 
 kept a long time in their envelopes, as was the original custom, 
 become less sensitive than those which are recently placed in 
 the envelopes* 
 
 Preparation of X-ray plates, putting them in the envel- 
 opes ready for use, should be done in a dark room, and it is 
 the writer's custom to observe the following rules : ( i ) Take 
 the sensitized plate from the box with the film side up ; — which 
 is to be discerned by the feeling, the glass side being smoother 
 than the film. (2) Draw the. dark-colored envelope over the 
 plate, the side with the folder at one end being uppermost. 
 (3) Close the folder, keeping the plate in the same position. 
 (4)Draw over the first envelope from the folder end, the yellow 
 envelope with the folder also upward. When closed, the plain 
 side of the envelope will always be next to the sensitized side 
 of the plate. 
 
METHOD OF MAKING THE SKIAGRAPH. 1 89 
 
 If this rule is uniformly observed the radiographer will al- 
 ways know the film side of his plate, which should be turned 
 towards the tube when the exposure is being made. The 
 plate should never be brought into the room while the tube is 
 actively radiating. 
 
 Sensitized paper will often be found convenient as a sub- 
 stitute for the sensitized plate, especially so when it is neces- 
 sary to prepare a skiagraph for immediate demonstration as 
 is often demanded in court cases. The ordinary bromide 
 paper or an extra-sensitized printing out paper will answer 
 the purpose. The paper should be inclosed in an envelope 
 the same as plates, and if it is desired to have more than one 
 copy, several sheets may be put in the same envelope. The 
 paper is developed in the same manner or by the special de- 
 veloper best adapted, which can be produced from any photo- 
 graphic supply-house. The skiagraph, when paper is used, 
 will be a positive, which is another advantage in using it. 
 
 The bony parts or parts less penetrated by the rays will 
 appear white, as they do upon the sensitized plate, and not 
 dark as in the print from the plate. When using sensitized 
 paper, exposures should be made for about twice the length of 
 time employed in making the skiagraph upon the sensitized 
 plate. The accompanying cut will show the appearance of the 
 skiagraph when taken in this manner. 
 
 When the skiagraph upon sensitized paper has been de- 
 veloped, it may be immediately mounted upon the cardboard 
 backing. This advantage, and the fact that the print is a cor- 
 rect representation of the parts and not a negative, are two 
 valuable features of its employment. 
 
 The process of making a skiagraph includes several signif- 
 icant steps if the result is to be satisfactory. Before arrang- 
 ing the patient and apparatus for making the exposure, it is 
 always best to select the tube to be used and test it with a 
 fluoroscope, to be certain that the apparatus and tube are in 
 order. 
 
 I. Posture the subject in the position which will best show 
 the object sought. It will often be well to make a fluoroscopic 
 examination before placing the object in position. If one of 
 
190 
 
 STATIC ELECTRICITY. 
 
 the extremities of the body is the object, it will rarely be neces- 
 sary to place the patient in a recumbent position. In other 
 cases, however, a table should be provided, which will permit 
 
 Fig- 17- — Skiagraph Taken upon Sensitized Paper. 
 
 the patient to rest in a comfortable position during the expo- 
 sure. It is not desirable to undertake an exposure for a skia- 
 graph of the trunk with the patient in a sitting posture, except 
 
METHOD OF MAKING THE SKIAGRAPH. 191 
 
 for good reasons, as in cases of pleurisy with effusion, when it 
 is done to show the level of the fluid in the chest cavity. 
 
 When taking an abdominal skiagraph, it is always desirable 
 to place 1 the patient in a position in which the object to be 
 localized shall lie nearest the sensitized plate. 
 
 II. Place the sensitized plate beneath the object in a posi- 
 tion which shall show the part in good relation to the plate and 
 when possible, except when locating a foreign body, place the 
 corresponding part of the opposite side upon the plate for the 
 purpose of comparison. 
 
 A sheet of metal through which the rays will not be trans- 
 mitted should be placed beneath the sensitized plate to prevent 
 the possibility of the shadows of objects upon the opposite 
 side appearing on the skiagraph, as frequently happens when 
 this precaution is not taken. 
 
 III. The choice of the tube will depend upon the object to 
 be skiagraphed. When it is sought to determine the presence 
 of a foreign body which the rays will not traverse, as a leaden 
 bullet, or the condition of the bony structures, a high-vacuum 
 tube will always best meet the requirements. A low-vacuum 
 tube, however, given a longer exposure and energized to a de- 
 gree that will give a light shadow upon the fluoroscopic screen, 
 will give satisfactory results with the extremities. When, how- 
 ever, a skiagraph of the pelvis, knee, or thigh is taken with a 
 static machine, a high-vacuum tube of four- to eight-inch 
 spark resistance should always be chosen. When detail or a 
 skiagraphic image of an object easily traversed by the Roentgen 
 ray, as calculi, is sought, or even a hip joint when a proper 
 coil Unemployed, a low tube should be selected, preferably one 
 of not more than one-inch spark resistance, and the tube ener- 
 gized to the maximum capacity of the apparatus employed, 
 making use in such cases, with the static machine, of a series 
 spark-gap interrupter. 
 
 IV. The adjustment of the tube requires technical consid- 
 eration if the best results are to be obtained. 
 
 Distortion too often arises from failure to recognize the con- 
 ditions of the radiation of the X-ray. The employment of 
 the sensitized plate in connection with the process of skiag- 
 
192 
 
 STATIC ELECTRICITY. 
 
 raphy possibly leads to a confused idea, from its association 
 with photography. It must be borne in mind that the image 
 upon the sensitized plate is as if the shadow of an object in 
 the sunlight had made a fixed impression upon a plane surface, 
 not through a focusing lens, with which the image is always 
 reversed. In the latter case the print from the negative pro- 
 duces a second impression upon the sensitized paper with the 
 objects in their normal relation. The reverse is true of the 
 skiagraph : the shadow casts an image upon the sensitized plate 
 of the parts in their normal relation, and the print made upon 
 the sensitized paper reverses the relation of the object, the 
 
 Fig. 18. — Showing Radio-active Field and Occasion for Distortion. 
 
 right hand or right side of the body always appearing as the left 
 upon the printed skiagraph. 
 
 The sun casts a shadow obliquely or directly upon a back- 
 ground, according as it is placed, relatively before the back- 
 ground. It is the same with the skiagraph : the position of 
 the anti-cathode — the body from which the rays are projected- — 
 determines the position of the shadow upon the sensitized plate 
 which will be directly opposite or obliquely placed, according 
 to their relative positions. The rays projected upon a plane 
 surface will in all cases produce a relative degree of distortion, 
 from the fact that the outer raya, making the margin of the 
 skiagraph, are more oblique than the central rays, proj-ected 
 perpendicularly upon the sensitized plate. 
 
METHOD OF MAKING THE SKIAGRAPH. 193 
 
 This may be illustrated by the accompanying drawing in 
 which the distance and obliquity of the radiations are shown, 
 a curved line and a plane surface (see Fig. 18). This defect, 
 however, is not sufficient to seriously interfere with the study 
 of the skiagraph when the anti-cathode is placed over the cen- 
 ter of the object exposed to the rays. This preliminary con- 
 sideration will suggest the occasion of distortion and possibly 
 assist in the appreciation of the following rules for locating 
 the tube with reference to the objects to be skiagraphed. 
 
 (1) Place the tube in position. In case the size of the ob- 
 ject and the relations of a foreign body are to be considered, 
 regulate the distance so that the size of the object will be 
 normal. The nearer an object is placed to the tube, the larger 
 it will appear upon the screen or sensitized plate. 
 
 Experience has established the proper distance as eighteen 
 to twenty-four inches from the anti-cathode. 
 
 (2) Place the tube at an angle at which the plane of the anti- 
 cathode will be parallel to the plane of the table, or the sen- 
 sitized plate otherwise placed, thus projecting the rays emitted 
 from the center of the anti-cathode, where the cathodic rays 
 are focused, and from which the most direct and the greatest 
 volume of radiation is projected perpendicular to the plane of 
 the anti-cathode. 
 
 (3) Observe that the anti-cathode is over the center of 
 the object to be skiagraphed, in order that the perpendicular 
 rays will be projected upon the object and those of relative 
 obliquity upon either side, thereby avoiding distortion. 
 
 This rule is of special significance in localizing foreign bodies, 
 and special care should be taken by a prior fluoroscopic exam- 
 ination for the purpose of determining the relative position 
 of the foreign body or fracture before the skiagraph is made. 
 When, however, skiagraphing two bodies for making relative 
 observations, the anti-cathode parallel to the plane of the sensi- 
 tized plate should be located over the center of the plate or at 
 a point which will project the rays at the same angle upon the 
 opposite parts. (See Plate No. VI.) 
 
 V. The exposure may next be made. The object, tube, 
 and sensitized plate having been put in the proper relative 
 
194 STATIC ELECTRICITY. 
 
 position for taking a skiagraph, the tube should, under most 
 circumstances, be energized to the maximum capacity of the 
 apparatus, and the length of exposures made relatively short. 
 
 VI. The length of the exposure will be relative to the 
 quality of the tube, the density of the object, and the char- 
 acter of the apparatus employed, and in these conditions much 
 latitude and diversity will exist. 
 
 Experience will be necessary on the part of the operator 
 in the employment of his tubes and apparatus. Good judg- 
 ment as to the relative penetration of tissues is necessary in 
 order to definitely determine the length of time necessary to 
 obtain the best results. The following tables will serve, how- 
 ever, as a guide in arriving at a definite technique. 
 
 Taking the hand as the minimum exposure, the two columns 
 given will show approximately the range of time with different 
 apparatus. 
 
 Hand I sec. to 2 min. 
 
 v Elbow 2 " " 4 
 
 1 ShoulcU r 20 " " io 
 
 ; Chest IO " " 8 
 
 ' Skull 15 " "15 
 
 Foot 2 " " 3 
 
 Leg 4 " " 5 
 
 Knee 1 min. " 10 
 
 Hip Joint 7i " "20 
 
 Pelvis li " "20 
 
 Stone in the Kidney 2 " "20 
 
 These figures are based upon results obtained from employ- 
 ing a static machine, having eight revolving plates for the 
 longer periods of exposure, and a coil of twelve- to fifteen-inch 
 spark resistance, capable of employing a current of ten to 
 fifteen amperes, through the primary for the shorter. Be- 
 tween these limits, there is every degree of difference in the 
 time required to obtain the desired results, and experience with 
 the apparatus and tubes employed will perfect the operator in 
 getting about the right exposure. 
 
 When it is decided to get outline of bone, it will be best to 
 make the exposures relatively long. It is only in taking a 
 
METHOD OF MAKING THE SKIAGRAPH. 195 
 
 skiagraph of the soft structures which are easily traversed by 
 the rays that an overexposure, except extreme, will prove a 
 failure. 
 
 Much is said, at the present time, on the subject of instan- 
 taneous skiagraphy. To effect this, it is necessary to place 
 the tube closer to the object and employ powerful coils, and for 
 practical purposes, except in case of stone and examination of 
 the chest in which respiration interferes with the skiagraph, 
 there is little advantage to be derived from so-called instan- 
 taneous skiagraphy. For all practical purposes, the skiagraph 
 taken with the static machine, which will give a clear outline 
 upon the fluoroscope, is satisfactory. 
 
 The time required with static machines having twelve to 
 sixteen revolving plates is about the same as with most coils 
 in general use, and the results are all that can be desired, ex- 
 cept, perhaps, in the special cases referred to above. 
 
 The development of a skiagraph should, as a rule, be done 
 by the physician who made it or under his personal observation. 
 An exception may, perhaps, be made in cases where it is 
 sought to define the bony structures, because they require less 
 attention to detail. 
 
 The length of exposure and other conditions under which 
 the skiagraph is made, as well as the quality of the tube em- 
 ployed, will determine in many respects the length of time 
 which will be required to obtain definition. This, however, 
 will not be accomplished by any fixed rule, but will require 
 experience and careful observation on the part of the operator. 
 
 A plate which has been exposed to the radiance of a high- 
 vacuum tube when taking an object of relatively slight den- 
 sity will appear very rapidly, and the process may be carried 
 so far as to overdevelop the negative unless a retarder for 
 slowing the process or a weaker solution of the developer is 
 employed. 
 
 When a skiagraph has been taken under proper conditions 
 for a calculus in the kidney or elsewhere, much care will be 
 required, and a long period of development, with careful obser- 
 vation of land-marks during the process of development — re- 
 quiring knowledge, experience, and care which will not be 
 
196 STATIC ELECTRICITY. 
 
 given by other than an interested party, and can rarely be 
 trusted to a photographer unless he has been specially trained 
 by the physician who is familiar with the degree to which the 
 process of development should be carried. It will rarely be 
 the same in two cases, depending, as it does, upon so many 
 conditions, as the quality of tube, character of apparatus, time 
 of exposure, and varying physical characteristics of the dif- 
 ferent subjects skiagraphed. 
 
 A dark room for the purpose of careful development of a 
 skiagraph, as in other photography, is a necessity. A large 
 closet provided with facilities for washing the plate may an- 
 swer the purpose, but will require care in excluding all light 
 around the doorway. It is better that a room to be used for 
 this purpose should be especially constructed and provided 
 with two doors and a passage-way for entering the dark room, 
 the outer door to be closed before the inner one is opened. 
 This will permit ingress and egress during the process of 
 development without admitting light into the room. Such a 
 room should be ventilated by some means which will not per- 
 mit the reflection or direct admission of light into the room. 
 
 The light to be employed during development should be a 
 ruby light covered with orange-colored paper or glass, as the 
 two colors exclude the rays most apt to affect the sensitized 
 plate. A ruby lamp provided with glass windows will serve 
 for this purpose, but is apt to smoke and cause disagreeable 
 fumes in the dark room. If a lamp is to be used, it is better 
 that it be situated on the outside of the dark room in front of 
 a colored glass window provided in the partition which will 
 admit the light at a convenient angle to the developing tray, 
 or still better is an electric incandescent light in the dark room 
 because there are no disagreeable fumes or odors emitted, and. 
 it is always convenient. A ruby bulb should be employed, 
 over which may be placed a box made of the yellow paper 
 which is provided for the outer envelope used over the X-ray 
 plate. In lieu of the colored bulb two thicknesses of the yellow 
 envelope tied over an incandescent bulb will serve a practical 
 purpose. It will always be best not to employ even these lights 
 too intense in the dark room. 
 
METHOD OF MAKING THE SKIAGRAPH. 197 
 
 The trays used in development for a complete equipment 
 should include the sizes of the different plates to be used. 
 While a large-sized developing tray may be used for small 
 plates, placing more than one in the tray at the same time, to 
 advantage; it will necessitate the employment of a larger 
 quantity of developer each time, and as it is not always best to 
 use a developer for more than one plate, it necessitates an un- 
 necessary waste of material when but one plate is developed. 
 The material of which trays are made is hard rubber, espe- 
 cially prepared composition, glass, or a porcelain-lined tin 
 vessel, Fig. 19. The latter, which may be procured at depart- 
 ment stores, will answer the purpose, except for plates eleven 
 by fourteen inches, or larger. Two trays will be required un- 
 
 19. — Developing Tray. 
 
 less a fixing bath of wood or other material is provided in the 
 dark room, the second one to be used for the fixing bath. 
 
 The developing solution may be made of various combi- 
 nations and relative proportions of chemical substances which 
 will wash away the unexposed portions of the silver compound 
 upon the sensitized plate. The manufacturers of plates used 
 for skiagraphic purposes advise various combinations in 
 powders or tablets which are adapted for the purpose. These 
 will generally prove satisfactory when used in the proportions 
 as directed upon the package. They cost more, however, in 
 these packages, and when it is known what the combinations 
 are — usually some commercial substance as metol and hydro- 
 conone — it is cheaper to buy the materials in bulk and divide 
 them in the proper proportions. 
 
 Operators who do much skiagraphy prefer to make their 
 solutions and keep them in stoppered bottles, measuring out 
 sufficient solution for the treatment of each skiagraph. These 
 solutions may be made at a comparatively small outlay and are 
 alwavs convenient. 
 
I98 STATIC ELECTRICITY. 
 
 To develop a sensitized plate, enter the dark room, and 
 having selected the tray and prepared the solution, remove 
 the sensitized plate from the envelope, taking care not to allow 
 too bright a light from the lamp or incandescent bulb to strike 
 upon the film when removed. Take care that the film side of 
 the plate is uppermost, and tipping the tray at an angle of 
 forty-five degrees place the plate on the bottom. With a 
 sudden movement, holding the tray so that the fluid will flow 
 evenly over the plate in the bottom, lower the tray to the level 
 of the table. If the film has not been completely covered by 
 this movement, with a piece of absorbent cotton see that the 
 whole surface of the plate is moistened, otherwise it will have 
 a spotted appearance when developed. Whenever bubbles 
 form on the surface of the plate and persistently remain in 
 one spot, a tuft of soft cotton should be applied or blisters will 
 appear on the plate when developed. Having thoroughly 
 moistened the surface of the plate, continue a rocking motion 
 from side to side, for the purpose of getting uniform action 
 upon the bromide of silver which has been affected by the rays 
 or affected in varying degrees by the exposure. The first 
 appearance of the object will be as a white surface, the form 
 of the limb or substance which has been exposed. As the 
 rocking process is continued this surface gradually becomes 
 darker, and if persisted in long enough will entirely disappear. 
 
 The outlined surface of the image will appear in most 
 cases within the first minutes of development, and if the solu- 
 tions are too strong or the exposure has been for a short period 
 it will rapidly disappear. Under these conditions, the solution 
 should be diluted by the addition of water, or, as some prefer, 
 the employment of a retarder, or the plate should be promptly 
 removed. 
 
 The retarder usually employed is a ten per cent, solution 
 of bromide of potash. The quantity added will depend upon 
 the volume of the fluid in the tray and the rapidity with which 
 the image is changing and is added with a dropper. 
 
 The extent to which development will be carried and the 
 time necessary to bring out the detail will depend upon the ob- 
 ject sought. When developing a skiagraph which has been 
 
METHOD OF MAKING THE SKIAGRAPH. 199 
 
 taken to show the bony structures, with a high-vacuum tube, 
 definition and not detail will be desired. In these cases, the 
 plate should be submitted to a rapid process and carried to the 
 point that the bony structures begin to disappear as the oper- 
 ator looks upon the plate lying in the tray, i. e., until the whole 
 surface of the plate looks dark, only the outlines of the bone 
 being discernible. 
 
 When developing a plate for the purpose of bringing out 
 the detail, as in cases where it is sought to show the presence 
 of objects which the rays traverse to a greater extent than bone, 
 a weaker developer should be employed and if the image dis- 
 appears rapidly the retarder should be added and the process 
 prolonged, or the object will have disappeared from the plate. 
 In these cases, it will be difficult to determine when the de- 
 velopment has been carried to the proper degree and which 
 can only be judged by experience. 
 
 The operator should learn to fix upon some bony prominence 
 and determine at what degree of development the structures 
 sought, as calculi, are best indicated upon the sensitized plate, 
 by the relative appearance, and so decide to what degree the 
 process of development should be carried. This can be 
 learned only by experience, and the success in making skia- 
 graphs of this character will depend largely upon the good 
 judgment, patience, and attention to technique of the operator. 
 Washing the surface of the plate before placing it in the fixer 
 will be the next step in the process. This may be done by 
 allowing a stream from a faucet running at moderate pressure 
 over the surface of the plate, or by immersing it in a water 
 bath. Then place the plate, film uppermost, in the fixing solu- 
 tion. " 
 
 To fix the plate in the solution of hyposulphite of soda will 
 require but a short time, depending upon the strength of the 
 solution. The salts which have not been affected by the light 
 will then be dissolved from the plate, leaving only that portion 
 of the coating which has been hardened by the action of the 
 developer. The plate may lie in this solution for an indefinite 
 time without injury. When the white appearance on the glass 
 side of the skiagraph, however, has entirely disappeared, it may 
 
200 
 
 STATIC ELECTRICITY. 
 
 be removed from the fixing solution and washed preparatory 
 to drying the film. When there is an abundance of time and 
 the plate will not be required for several hours, it is well to 
 allow it to remain in the solution of clean water for twelve 
 hours, or it may be accomplished in less time by allowing a 
 
 Fiy 
 
 stream of water to flow gently over the film surface until it 
 appears to be clean. The plate will not be sensitive to light 
 immediately after it has been placed in the fixing solution, and 
 mav be removed or examined at any time after having been 
 placed for a few minutes in the hypo. bath. 
 
 To quickly dry a developed plate pour alcohol over the 
 film side, and then set it in position where an electric fan will 
 blow against the surface. A plate may be thoroughly dried in 
 this manner in a short time, preparatory to taking it from the 
 premises. 
 
 A skiagraph is best studied in a subdued light, holding it 
 at an angle in which it appears to the best advantage. A 
 
METHOD OF MAKING THE SKIAGRAPH. 201 
 
 ground glass held between the skiagraph and the light, so ar- 
 ranged that the light does not enter the apartment from any 
 other source, will show it well. Another method is to examine 
 the plate in a dark room, employing a box especially con- 
 structed, provided with a ground-glass side and an electric 
 lamp in the interior which will enable the observer to detect 
 all of the lights and shadows upon the sensitized plate. (See 
 Fig. 20.) 
 
 Printing from the sensitized plate upon paper for the pur- 
 pose of mounting is a simple process, requiring but little prac- 
 tice to accomplish it in a satisfactory manner. It should be 
 borne in mind that when printed the skiagraph is a positive, 
 not a negative, that the shadow picture upon the sensitized 
 plate is in exactly the same relation as the parts were presented 
 when the exposure was made, not as when a focusing lens is 
 employed, when the image is reversed. A print of a skia- 
 graph, as in photography, reverses the relation of the parts, 
 the right hand appearing on the skiagraph as the left, and the 
 liver as though it were on the left side. 
 
 Care then should be taken not to use the term negative when 
 referring to the developed plate, but to refer to it as the skia- 
 graphy plate. For printing various makes of sensitized paper 
 may be employed, as the bromide, solio, or blue print. If it is 
 desired to show particularly the detail of the picture, it will al- 
 ways be best to use a glossy paper instead of the mat or soft 
 toned paper. When printing a skiagraph of the bony parts 
 it will make little difference which sort of paper is used. 
 
 A self-toning paper which is practical and will not fade is to 
 be preferred by the physician, who will find it inconvenient to 
 be obliged to have at hand toning solutions as well as delay 
 for washing after toning the picture. 
 
 Printing frames may be procured in the various sizes. 
 They consist of a wooden frame having a glass front, and pro- 
 vided with a movable back and a spring for holding it in posi- 
 tion. (See Fig. 21.) 
 
 The skiagraphic plate is placed with the film outward and 
 the printing paper is placed over it in the back and then tightly 
 closed to hold the paper in apposition during the printing 
 
202 
 
 STATIC ELECTRICITY. 
 
 process. The exposure is then made either in direct sunlight, 
 subdued light, or the light of an electric lamp, according to 
 the character and sensitiveness of the paper employed. 
 
 Developing. — After the exposure has been made, some 
 paper, as bromide, requires developing. Place it in a develop- 
 ing solution and develop the same as the sensitized plate. 
 
 Fixing will also be necessary and various formulas will be 
 employed according to the requirements of each special paper, 
 directions for which will be furnished by the manufacturer. 
 Some experience will be required in order to carry out this 
 process in the most rapid and successful manner, but by fol- 
 
 Fig. 21. — Printing Frame. 
 
 lowing the directions furnished with the particular paper which 
 is adapted for use, it will not generally be difficult. 
 
 It is best always to employ the same plates, papers, and de- 
 velopers with which the operator will soon become familiar. 
 
 Stereoscopic radiography constitutes a method for show- 
 ing a superposition of images from two skiagraphs of various 
 planes and the distances which separate them. It is accom- 
 plished by taking two skiagraphs at different angles of ex- 
 posure, substantially as follows : The object is placed in posi- 
 tion upon the table before making the first skiagraph. A 
 tube-holder, provided with a means for marking by a gauge the 
 exact relative position of the tube to the object, is placed in 
 position. The exact center of the object is discovered by 
 measurement and the employment of a plumb line. The tube 
 is so placed that the center of the anti-cathode is in position 
 
METHOD OF MAKING THE SKIAGRAPH. 203 
 
 with its plane absolutely parallel with the plane of the object 
 placed upon the sensitized plate. The position of the anti- 
 cathode over the object is then made one and one-half inches 
 from the line suspended over the median line of the subject 
 (representing, approximately, one-half of the distance between 
 the eye of an observer). The exposure is then made and the 
 plate removed. Great care must now be taken that the second 
 plate is placed in identically the same relation to the object as 
 the preceding plate, which may be accomplished by securing 
 the patient in a position from which he cannot be moved and 
 then placing the second plate by marking, or a purposely pre- 
 pared gauge in exactly the position of the preceding sensitized 
 plate. The tube-holder is now moved so that the center of the 
 anti-cathode is one and one-half inches to the opposite side 
 of the median line of the object, and the second exposure is 
 then made. 
 
 These plates should be treated in every way in the same man- 
 ner, the exposures being for the same period of time and the 
 development carried to the same extent. For observing the 
 pictures, a special apparatus has been designed. The one 
 shown in the cut was designed by Dr. L. A. Weigel of Roches- 
 ter, N. Y., and described by him in the New York Medical 
 Journal of November 16, 1901. It is an instrument of more 
 than ordinary merit and value. (See Fig. 22.) 
 
 Its use is described by Dr. Weigel as follows : 
 
 " The correct interpretation of X-ray negatives frequently 
 presents considerable difficulty, because all parts of an object 
 lying in different planes are projected into one, and there is 
 practically no way of showing the superposition of the various 
 planes and the distance which separates them. This defect of 
 the ordinary skiagraph is readily overcome by making two 
 stereoscopic negatives, which, when placed in the stereoscope, 
 virtually reconstitute the object in space. Every detail of the 
 negative is seen in its proper place, the surfaces appear in their 
 natural form, and the various planes are correctly separated 
 from each other. 
 
 " The stereoscope shown is adapted for studying the original 
 negative, although it may also be used for examining full- 
 
204 
 
 STATIC ELECTRICITY. 
 
 sized prints. It is constructed on the principle of the reflect- 
 ing stereoscope invented by Professor Wheatstone in 1838. 
 In this apparatus two plane pictures, representing slightly dif- 
 ferent views of an object, are superimposed and appear to the 
 eye as giving the same relief as the object itself. 
 
 "As seen in the illustration (Fig. 22), it consists of a bed- 
 piece upon which, at its center, two mirrors, inclined to each 
 other at an angle of 90 degrees, are mounted on a slide having 
 a forward and backward movement, to facilitate adjustment. 
 At the angle formed by the mirrors a screen, with openings for 
 the eyes, is placed. 
 
 " Two grooved frames for holding the negatives face the 
 mirrors and are adjustable by a single sliding motion in two 
 directions — one at right angles to the base, and the other 
 parallel to it. In the base of the frames there is also a mechan- 
 
 Fig. 22. — X-Ray Stereoscope. 
 
 ism controlled by a milled-head screw, for vertical adjustment. 
 By means of these various movements the image of the two 
 negatives reflected in the mirrors may be quicklv adjusted 
 until they are accurately superimposed, and stereoscopic relief 
 is obtained. 
 
 " Transillumination of the negatives is necessarv, and this is 
 
METHOD OF MAKING THE SKIAGRAPH. 205 
 
 best secured by artificial light. The most convenient and 
 satisfactory source of illumination is from an electric light. In 
 my apparatus a sixteen-candle-power lamp is placed behind 
 each negative. Flexible conducting cords from these lamps 
 are wired in parallel to a single key-socket, attached to the 
 under side of the bed. An electric-light cord of convenient 
 length, and having an extension-plug at each end, is used to 
 connect the apparatus, and the other is attached to the source 
 of illumination selected. For concentrating the light on the 
 negative an ordinary metal shade, or reflector, surrounds the 
 electric-light bulb, which should be preferably of ground glass. 
 An even diffusion of the light is still further secured by having 
 one side of the negative frames covered with a sheet of ground 
 celluloid, which is lighter and less fragile than ground glass. 
 The lamp brackets are adjustable vertically, and, as they are 
 attached to an independent base, the distance between the light 
 and the negative may easily be regulated, according to the 
 varying density of the plates. Where an electric-light plant 
 is not available, Welsbach gas lamps, or acetylene bicycle 
 lamps, may be substituted for the illumination. 
 
 " The negative-holders are square and large enough to take 
 in plates of all sizes up to and including eleven by fourteen 
 inches, and may be placed in the frames either vertically or 
 horizontally. For the smaller-sized plates it is advisable to 
 use masks of black press board, or other material, to cut off 
 all extraneous light. The left-hand frame in the illustration 
 shows a mask for an eight-by-ten plate in position." 
 
 When this method is employed, the structures are shown in 
 perspective. The superposition of the various planes and dis- 
 tances between the structures are seen as in their natural posi- 
 tion. A fractured bone will appear, showing perspectively the 
 relative distance and position of the broken fragments. Look- 
 ing into the chest, the appearance is as looking into a skeleton. 
 Another singular feature of this method of examination is 
 that, if the plates are reversed, it will appear as if looking 
 from the opposite side. Foreshortening, in case exposures are 
 made with the joints in a flexed position, is distinctly dis- 
 cernible. 
 
206 STATIC ELECTRICITY. 
 
 The practicability of the method, however, except for demon- 
 strating the possibilities has not been proved, and it is doubt- 
 ful if it will ever become a recognized procedure on account of 
 failure to show any special advantage that is to be derived 
 from its employment. 
 
CHAPTER V. 
 PRACTICAL SKIAGRAPHY. 
 
 A proper conception of the power and character of X- 
 radidhce is essential to its intelligent use in diagnosis. It 
 must be understood that a skiagraph is a relative expression 
 of the penetration of the parts of the object by the X-ray. It 
 shows upon a plane surface the relative shadows of tissues of 
 different densities which had intervened between the tube and 
 the sensitized plate, varying with the character of the rays, 
 time of exposure, method of development, etc. In other 
 words, a spherical body is represented as a flat object, except 
 possibly of a varying thickness and density, as that of a bone, 
 which will show darker shadows at points of greater compact- 
 ness or thickness. Foreign bodies, muscle, fat, and skin will 
 appear in varying shadows in proportion to their penetrability. 
 It must be borne in mind, therefore, that to radiograph small 
 organs or tumors which are easily traversed, when bone or 
 muscle intervene, is practically impossible. 
 
 The relative penetrability of structural and pathological con- 
 ditions is from greater to lesser in the order named as follows : 
 Pone, muscle, blood, cartilage, pus, fat, and integument. 
 
 Structures the seat of active suggestion, as the lungs in 
 pulmonary tuberculosis and pneumonia, aneurism of the large 
 vessels, or pus cavities, present well-marked shadows. 
 
 For purpose of diagnosis the X-ray is valuable in many 
 conditions, — in fractures and dislocations, foreign bodies 
 lodged in the tissues which are of substances impenetrable to 
 the ray, calculi in the kidneys, bladder, ureter, or gall-bladder, — • 
 also in examinations for differential diagnosis, or for the pur- 
 pose of determining the prognosis in affections of the bones, 
 joints, or the diagnosis of aneurisms, and for examination of 
 the viscera. 
 
 In diagnosing fractures and dislocations a fluoroscopic ex- 
 
 207 
 
208 
 
 STATIC ELECTRICITY. 
 
 amination should first be made for the purpose of deter- 
 mining at what position the skiagraph will best show the 
 conditions present, and then two skiagraphs should be made, 
 the exposures of which should be at right angles to each 
 other, and in such a manner as to give the best expression 
 of the deformity, as determined by the fluoroscopic examina- 
 tion. 
 
 The localization of foreign bodies which have been swal- 
 lowed or lodged in the tissues often requires a degree of dex- 
 terity, skill, and a knowledge of the technique only obtained 
 by special training and experience. It is this particular de- 
 
 Fig. 23 
 
 partmeut of the work which has so often brought radiography 
 into disrepute with the surgeons. 
 
 The quality of tube best suited for this work will, in most 
 instances, be one of fairly high vacuum, because objects to be 
 located are generally of metal, and detail is then of little im- 
 portance. If, however, it is sought to locate an object easily 
 traversed by the rays, it will then be necessary to employ a 
 tube of low vacuum. The time of the exposures will be made 
 relative to the part in which the foreign body is to be located. 
 
 In the case of a needle or a bullet in the hand or thin portion 
 of the foot, it may be necessary to take but one skiagraph to 
 locate the object. 
 
 In the thick portions of the body, as the trunk or limbs, it 
 
PRACTICAL SKIAGRAPHY. 
 
 209 
 
 will be necessary to make two exposures, which should be 
 made at right angles to each other in order that the object 
 may be located in both depth and lateral positions. In order 
 to make certain that these exposures are made at right angles, 
 it is desirable to adopt some method easily accomplished and 
 accurate. Besides taking the skiagraphs at right angles, it is 
 also necessary to have some mark upon the limb or body to 
 indicate the exact relation which the parts bore to the sensi- 
 tized plate when the exposure was made. 
 
 The writer has adopted the following modus operandi, which 
 he finds both simple and practical. A gauge ( see Fig. 23) 
 
 quare and Spirit-Level 
 
 is made of a strip of board one-half inch in thickness, three 
 inches wide, twenty inches long, having another piece of the 
 same thickness, three inches square, nailed at right angles. 
 An opening in them ma}' be made in each, through which a 
 strap will pass in such manner that the gauge be secured to the 
 limb or body of the patient as shown in Fig. 26. A square, 
 such as artists use, to one side of which is screwed an adjust- 
 able spirit-level, shown in Fig. 24, is used in placing the gauge 
 in two planes, which shall be at right angles to each other. 
 Instead of the spirit-level a plumb line, suspended as shown in 
 Fig. 26, will serve the same purpose. In addition to these 
 devices, it will be necessary to have some provision by which 
 the relative position of the limb to the plate can be determined 
 at the time of an operation. This may be done in the follow- 
 ing manner : two screens made of two sizes of wire, as shown 
 
2IO 
 
 STATIC ELECTRICITY. 
 
 in Fig. 25, should be strapped to the limb at the same angle 
 and relative position as the gauge when the skiagraph is taken. 
 These should be securely strapped to the surface next to the 
 patient's skin, to be left in position until the time" of the opera- 
 tion, when upon removal the imprint upon the skin, which will 
 remain for some time after removal, will indicate the square 
 marked by the screen corresponding to the same square in the 
 skiagraph in which the foreign body will be located. The 
 operator will by this means be able to determine the relative 
 transverse and vertical positions of the foreign body. The 
 modus operandi is illustrated in Figs. 26 and 27. 
 
 The presence or absence of calculi in the gall-bladder, kid- 
 ney, or ureter may in many cases be determined by the skia- 
 
 Q 
 
 ~~^ 
 
 -^-~* f LIT - 
 
 
 
 Fig 
 
 -Localizing Screen. 
 
 graph. It will be impossible to determine their presence with 
 a fluoroscope because the image upon the screen does not give 
 the same degree of detail as the impression made upon the 
 sensitized plate. There is no other procedure in radiography 
 which calls for an equal amount of skill and familiarity with the 
 apparatus and details of the manipulation. It will then be im- 
 possible to locate a stone in very muscular and obese objects. 
 
PRACTICAL SKIAGRAPHY. 
 
 •I I 
 
 Small calculi and those of the salts of the phosphates will be 
 difficult to determine. 
 
 The apparatus best suited to this class of skiagraphy is a 
 powerful coil capable of passing a ten- to fifteen-ampere cur- 
 rent through the primary. These coils again require special 
 tubes, having heavy anti-cathodes of platinum or provided with 
 a water-cooling device to prevent the melting and destruction 
 of the anti-cathode. The tube at the time of the exposure 
 
 F'ig. 26. — Method of Locating Foreign Bodies. First Exposure. 
 
 should be of low vacuum, otherwise the impression of the ob- 
 jects sought would not appear on the sensitized plate, the rays 
 having traversed its substance. 
 
 Another matter of importance is the necessity of the ab- 
 solutely fixed position of the object during exposure. The 
 patient will of necessity be compelled to abstain from breathing 
 during the intervals of radiation. This is best managed by 
 strapping him to the table after the sensitized plate has been 
 
:i2 
 
 STATIC ELECTRICITY. 
 
 placed in position and then instructing him to breathe at inter- 
 vals, as signaled, always taking the same depth of inspiration, 
 and exhaling it softly. At the instant of the patient's taking 
 an inspiration, the current is to be cut off. By this plan, the 
 movements of the diaphragm will not interfere with the rela- 
 tive position of the calculus. With the apparatus above' de- 
 scribed, the exposures need not exceed three to five minutes. 
 The development of the negative in these cases requires a 
 degree of skill and familiarity with the work which will deter- 
 
 27. — Locating Foreign Bodies. Second Exposuie. 
 
 mine the success or failure of the diagnosis. It should be the 
 habit of the radiographer to have some landmark, as a rib, the 
 body of a vertebra, or the crest of the ilium, to guide him in 
 the process of development in carrying it far enough and not 
 too far to bring out the proper detail. 
 
 Experience will be necessary to become proficient in a 
 process so technical. It will not be possible in a dark room 
 
Q 
 
PRACTICAL SKIAGRAPHY. 213 
 
 to read the skiagraph. The negative should never be rapidly 
 developed when it is sought to obtain detail in the skiagraph, 
 as in cases of stone. It will, therefore, be necessary either to 
 use a slow developer or have a retarder, as a solution of 
 bromide, ready to add to the solution. If the image comes up 
 too rapidly, either dilute the solution or add a retarder, as 
 suggested. 
 
 Another important consideration is the character of the 
 contents of the alimentary canal ajt the time the skiagraph is 
 made. The patient should be prepared as for an abdominal 
 operation, with the intestines as nearly evacuated as possible. 
 
 When taking a skiagraph for stone with a static machine or 
 a small coil, it will be necessary to make these exposures for 
 from ten to thirty minutes, and often without favorable re- 
 sults. In these cases, a second skiagraph should not be taken 
 without an interval of at least five days intervening between 
 the exposures, in order to avoid the possibility of dermatitis. 
 
 The skiagraph pending a surgical operation for stone is a 
 matter of somuch importance, and the possibility of imper- 
 fections in the plate so possible, that at least two skiagraphs 
 should be taken in all cases to confirm the presence of a sus- 
 pected calculus. 
 
 Biliary calculi were for a considerable time skiagraphed 
 with so much difficulty that the possibility was questioned. 
 Drs. Beck and Boggs and others have since succeeded in 
 making it no longer a question of doubt. Undoubtedly for the 
 greatest measure of success in these cases, technical skill is re- 
 quired both for controlling the respirations of the patient and 
 the management of the powerful coils above described. The 
 accompanying skiagraph shown in Plate VII., taken by Dr. 
 Boggs, is an excellent example of the success of the pro- 
 cedure. 
 
 Stone in the kidney has been demonstrated so many times 
 and by so many excellent authorities that it has become a 
 recognized means of diagnosis, and is looked upon as essential 
 to the operation for removal. The reading of a skiagraph in 
 these cases requires some familiarity and experience in order 
 to detect its presence in cases in which the definition is not 
 
214 STATIC ELECTRICITY. 
 
 distinct. It will always be better to study the developed plate 
 in a subdued light before a light-colored background, prefer- 
 ably ground glass, than the print for the purpose of discover- 
 ing the presence of the calculi, bearing in mind that a light 
 spot on the film indicates the presence of the foreign body 
 (the reverse from the printed copy). In these cases it should 
 also be remembered, as in all others, that the sensitized plate 
 gives the positive impression and that the print is a negative, 
 otherwise a mistake would result and a stone be thought to be 
 in the wrong kidney. Likewise in the skiagraph shown of 
 stone in the gall-bladder, the object appears to be upon the left 
 side of the body, because the print of the skiagraph is a nega- 
 tive. 
 
 Stone in trie bladder will call for the same precaution in the 
 matter of respiration, though not of as much importance as in 
 the biliary cases. The abdominal breathing, however, causes 
 sufficient movement, especially in males, to interfere with the 
 success of the process. 
 
 Stone in the bladder, to be best shown upon the plate, de- 
 mands posturing the body at forty-five degres to the table 
 or chair in order that the rays may be projected perpendicu- 
 larly through the pelvis to the sensitized plate. In other re- 
 spects, the technique is practically the same as in the exposures 
 for calculi already given. 
 
 The diagnosis of tumors — of sarcoma, tubercular joint con- 
 ditions, and osteophytic growths — is one of much importance. 
 The history of the case will assist in making the differential 
 diagnosis and the presence of the tumor of the bone will con- 
 firm it, at the same time determining its extent. No particular 
 technique is essential other than in the diagnosis of fractures. 
 A medium-vacuum tube or a low tube energized to a degree 
 to give a distinct outline will be found most satisfactory, except 
 in cases of the hip joint, when a high tube will be required. 
 In the differential diagnosis and for purpose of prognosis, 
 in cases of joint lesion and tubercular, rheumatoid, and osteo- 
 arthritis the skiagraph will be found valuable. (See Rheu- 
 matoid Arthritis.) Plate VIII. shows a tubercular condition 
 of the bones of the hand. 
 
Plate VIII. — Diagnosis of Bone Tumors. Tuberculosis of ihe Finger, l>\ Dr. Geyser. 
 
PRACTICAL SKIAGRAPHY. 2 I 5 
 
 The diagnosis of aneurism is one of the recognized valu- 
 able procedures accomplished with the X-ray. The blood 
 being less easily traversed by the ray than the other tissues, 
 except bone and muscle, makes it possible to obtain a distinct 
 shadow of an aneurismal tumor. So also inflammatory areas 
 will show a darker shadow than under normal conditions. 
 
 Pus cavities likewise are more opaque than the normal con- 
 ditions. Examination of the viscera by the X-ray, especially 
 of the lungs, heart, and liver, and under certain conditions of 
 the spleen and stomach, is a subject calling for careful consid- 
 eration. The condition of the lungs in which the X-ray has 
 proved a valuable measure is the diagnosis of incipient phthisis, 
 for which the fluoroscopic screen is most satisfactory. In 
 these cases, the apices, the usual seat of the incipient invasion, 
 appear hazy, whereas the portion of the lung unaffected ap- 
 pears clear, as in the normal chest. 
 
 The method adopted by Dr. Stubbert of holding a metal rod 
 transversely across the chest, dividing the image for the pur- 
 pose of comparison, will facilitate the examination. By in- 
 spection of the upper portion of the images thus made it will 
 be easy to determine the relative penetration of the rays upon 
 the screen and a diagnosis will be rendered more certain. 
 
 Cavities may often be shown in the lungs with a calcified or 
 fibrous ring surrounding them. 
 
 Pleurisy with effusion may be easily diagnosed with the 
 patient in the sitting posture, the level of the fluid being dis- 
 tinctly shown upon the fluoroscopic screen. 
 
 Empyema may likewise be diagnosed and the experienced 
 eye will detect the differential diagnosis from pleurisy by the 
 fluid, the shadow being distinctly darker. The diagnosis of 
 localized chronic pneumonia, large pus cavities, and atelectasis 
 may be confirmed by the X-ray. 
 
 Displacement and hypertrophy of the heart may be demon- 
 strated with the X-ray. On account of the fact, however, that 
 the heart is constantly in motion, it will be impossible to get 
 a distinct outline, except the exposure be made instantaneous, 
 and even then it will be impossible, except by chance, to ob- 
 tain a definite image. The general outline and position, how- 
 
2l6 STATIC ELECTRICITY. 
 
 ever, may be satisfactorily denoted upon the skiagraph, except 
 in very muscular subjects. 
 
 An enlarged liver, on account of its vascular structure, will 
 be readily shown on the skiagraph. A dilated or displaced 
 stomach may sometimes be diagnosed by giving the patient 
 very large doses of subnitrate of bismuth. In this case, how- 
 ever, it will be necessary to evacuate the alimentary canal, and 
 success can only be obtained in cases in which the muscular 
 development is slight. 
 
 The general principles, including the technique of the above 
 procedures, will suggest other additional uses for diagnostic 
 purposes. 
 
SECTION III. 
 RADIOTHERAPY 
 
SECTION III. 
 RADIOTHERAPY. 
 
 CHAPTEK I. 
 INTRODUCTION. 
 
 Prohably no subject in recent years has taken stronger 
 hold upon the medical mind than the prospects of the X-ray 
 in the treatment of diseases of many types which have hereto- 
 fore resisted all measures. It seems that a new area is dawn- 
 ing, and that the future has greater possibilities in store for 
 the alleviation of human suffering. 
 
 Those who, since the discovery of the Roentgen ray, had 
 employed it therapeutically, until the past two years, were few, 
 and the satisfactory results were confined to superficial neo- 
 plasms. 
 
 The field at present, however, offers so much, and the pos- 
 sibilities of effecting favorable results in the treatment of malig- 
 nant diseases by its aid are so encouraging, that many physi- 
 cians who have heretofore been entirely unfamiliar with the 
 employment of electricity or of the Roentgen ray are now dis- 
 posed to investigate the, subject. 
 
 For the reason that mistakes are easily made timely caution 
 should be given, and an honest effort put forth by members 
 of the profession to become enlightened both as to the best 
 methods of operation, and the dangers to be encountered, be- 
 fore attempting to employ the X-ray. 
 
 While it is not absolutely necessary that those employing 
 the Roentgen ray should be familiar with the technicalities of 
 electrical science, it is most desirable that the physician who 
 intends to employ it should know the general features of the 
 subject, as well as the possibilities and construction of the ap- 
 paratus, and the action of the agent he employs. It is also a 
 
 217 
 
2l8 STATIC ELECTRICITY. 
 
 matter of great importance, in order that the best results may 
 be obtained, that the operator understand the use of other elec- 
 trical modalities which are employed therapeutically with ad- 
 vantage in connection with the X-rays. 
 
 While the dangers arising from the use of the X-ray in the 
 treatment of diseases are relatively small, it is certain that 
 there are dangers when proper precautions are not taken. On 
 the other hand, to obtain favorable results in many grave cases 
 of deep-seated tumors requires that the rays be employed to the 
 utmost degree of toleration, taxing both the skill and tact of 
 the operator to determine the limitations and the dangers to be 
 encountered. 
 
 The individual idiosyncrasies, while to a certain extent 
 marked, are not fraught with sufficient danger, except in deep- 
 seated cases, to preclude effective employment. There is, how- 
 ever, a slight predisposition on the part of a few patients who 
 are affected by an early dermatitis. These, under ordinary 
 precautions, need never exceed the second degree. There are, 
 indeed, few superficial cases in which the want of toleration is 
 sufficient to prevent an effective employment of the ray. It 
 is, therefore, a matter of great importance, both in the interest 
 of science and humanity that those who presume to employ 
 the X-ray should become familiar with the methods. It is not 
 assumed, at this time, that the modus operandi at present 
 in vogue will not be improved upon, but it is to be hoped that 
 the present methods will prove a safe guide to those who study 
 the new science. 
 
 Conservatism on the part of those who are obtaining suc- 
 cessful results is most desirable, lest others who do not employ 
 the Roentgen ray may attribute to them an excess of en- 
 thusiasm. It is wise, therefore, when possible, that the diag- 
 nosis of malignant cases be confirmed by microscopic examina- 
 tion before treatment is instituted. If this plan be generally 
 adopted the accumulated evidence in time to come may be a 
 guarantee of the effectiveness of the X-ray in therapeutics. 
 
 The diseases to which attention has already ben called, as 
 being influenced by the rays, belong generally to the types of 
 heretofore intractable conditions. Probably its employment in 
 
INTRODUCTION. 219 
 
 the treatment of the forms of sarcoma and carcinoma, associ- 
 ated with surgery, offers one of the greatest triumphs of 
 the new method. Already other remedies had been found 
 for the successful treatment of the forms of lupus, but the 
 malignant diseases had generally defied the surgeon's knife 
 unaided, until the discovery of the wonderful properties of 
 the Roentgen ray affords assistance which will add to instead 
 of take from the glories of surgery. 
 
 Failure to observe a cautious and correct technique has 
 already thrown much discredit upon the institution of the new 
 measure, and will until the dangers are understood and physi- 
 cians become familiar with the numerous aspects of the sub- 
 ject. 
 
CHAPTER II. 
 
 PHYSIOLOGICAL EFFECTS OF THE ROENTGEN 
 
 RAY. 
 
 Little has been written upon this subject, and at best only 
 approximate conclusions can be contributed at this time. 
 
 It has been generally conceded that the X-rays are a form of 
 energetic vibration marked by an intensity which exceeds -the 
 rate of vibration at the violet end of the spectrum. We know 
 them by the physical characteristics by which their presence is 
 manifested — -not seen. A study of the manifestations, or the 
 physical characteristics, of the Roentgen ray affords the only 
 basis for an understanding of its actions, except so far as it is 
 possible to investigate clinically their effects upon the body 
 under varying conditions. 
 
 That the vibrations are electrical discharges there is no 
 reason to believe. The light emanating from the electric arc 
 is the product of electrical discharges between the two poles of 
 a circuit of relatively low voltage and large amperage in the 
 earth's atmosphere, and the X-ray is the resultant of the two 
 polarities of very great potential and small quantity produced 
 in a tube of high vacuum. Both result from the mingling of 
 the discharges of opposite polarities under favoring conditions, 
 and as such are not electrical but consequent products. 
 
 Some have attributed the effects upon animal tissues to the 
 high-potential discharges at the terminals of the tube. Noth- 
 ing is more improbable to those familiar with high-potential 
 discharges. 
 
 The study of the actions of the X-ray is the study of the 
 effects of form of vibration — agitation of the ether of the 
 highest recognized intensity. It is an invisible force, and, 
 like other invisible forms of vibration, can only be compre- 
 hended by the results arising from its actions. 
 
 The physical characteristics are as follows : 
 
PHYSIOLOGICAL EFFECTS OF ROENTGEN RAY. 221 
 
 I. They penetrate many substances which absorb the visible 
 rays of the spectrum. 
 
 II. They are refracted * when passing from one medium to 
 another of different density. 
 
 III. They are but slightly reflected, and are absorbed by 
 substances which they do not penetrate, and cause others to 
 fluoresce. 
 
 IV. What the peculiar effect of the rays may be upon the 
 protoplasmic structures of the body as they pass through the 
 tissues can only be determined from the conditions arising, 
 which are as follows : 
 
 ( i ) As one stands before the radiating tube with the rays 
 penetrating the body, there is little perceptible sensation. It 
 may have been noticed, however, if the hand be held before the , 
 tube for several minutes that a sensation of gentle contraction 
 of the skin is perceptible. The statement of this fact is not un- 
 commonly made by patients under treatment by the X-ray. 
 
 (2) It is also observed that the surface of an ulcerating, 
 cancerous growth appears as if glazed or as covered with a 
 thin coating of collodion after an exposure of several minutes. 
 
 (3) The substance of a growth, when standing prominently 
 above the surrounding surfaces, is also perceptibly contracted. 
 
 (4) Following a series of exposures it has been observed 
 by all familiar with the subject that the skin becomes atrophied, 
 and the hair follicles and sweat glands become inactive — hair 
 falling out and secretion of sweat ceasing. 
 
 (5) Pain is in most cases relieved to a remarkable extent 
 after a few exposures in various inflammatory and malignant 
 conditions. 
 
 (6) Congestion is evidently diminished, and is indicated by 
 the relief of conditions which could be explained under no 
 other hypothesis, occurring, as it does, when inflammatory con- 
 ditions are exposed to the influence of the rays. 
 
 (7) Long or repeated short exposures produce dermatitis 
 and necrosis, deep or superficial, according to the length of 
 exposure. 
 
 * Recent convincing reports affirm that the X-Rays are refracted, contrary to 
 Roentgen's first statement. 
 
222 STATIC ELECTRICITY. 
 
 The above propositions, jointly and severally, point strongly 
 to one effect in particular, which accounts for all — the contrac- 
 tion of cell protoplasm. The sense of contraction of the normal 
 skin, the glazing and contraction of an ulcerating surface, the 
 atrophy of the skin, and the relief of pain and congestion are 
 all indicative of tissue contraction. Indeed, it is the most plau- 
 sible explanation of the impaired nutrition, for necrotic and 
 sloughing tissue, normal or diseased, betokens a diminished 
 blood supply — local anaemia ; due to the consequence of the 
 contraction of the muscular coats of the vascular system. 
 Whether the action is the influence upon the end plates of the 
 neurons or upon the individual cells it would be -difficult to 
 assert. 
 
 The writer in a former contribution presented a statement 
 of the results of the action based upon clinical observation : 
 " That the effects of the X-ray upon the normal tissue are ( i ) 
 to induce normal activities, due to the vibratory effect of the 
 rays, or of the ether in the presence of the rays. (2) That 
 these effects with short exposures at proper distances with 
 high vacuum tubes induce activity of normal tissue cells, 
 which, in some cases, supplant abnormal tissue elements with- 
 out evidences of disintegration. (3) That exposures destroy 
 only the abnormal tissues unless they be too prolonged. (4) 
 That abnormal tissue thus exposed breaks down and disappears 
 through the natural channels of absorption or by sloughing." 
 It has been shown in the writer's experience that tissues of 
 low vitality are always the first to break down. 
 
 It is probable that the vitality of all tissue is lowered by 
 cutting off the blood supply. Naturally, under such circum- 
 stances, tissues of low vitality are the first to break down. It 
 is also well established that the tissues of debilitated patients 
 do not resist the destructive action of the rays as do those of 
 normal individuals, which confirms the theory. 
 
 It has also been demonstrated that malignant tumors in the 
 aged or infirm are more likely to soften and break down than 
 in normal individuals, which confirms the view that when for 
 any reason the tissue resistance is lowered the tissues break 
 down. The violent toxaemia occurring under such conditions 
 
PHYSIOLOGICAL EFFECTS OF ROENTGEN RAY. 223 
 
 is not due to extension of the malignant process, but to the 
 auto-infection arising from absorption of toxins present in the 
 broken-down structures. 
 
 This effect upon circulation and nutrition when employed 
 to the extent of destroying malignant growths is at best a 
 dangerous one, and demands careful attention to the manage- 
 ment of details and a knowledge of the consequences. 
 
 The cumulative action is a striking feature of the effects of 
 the rays and demonstrates the more or less persistent con- 
 dition of contraction which follows a series of exposures, and 
 explains the diminished metabolism after long exposures or 
 series of exposures. 
 
 It would seem, therefore, that the logical explanation of the 
 action of the X-ray when nearby, prolonged, or frequent ad- 
 ministrations are given is, that the exposed structures contract 
 at the expense of nutrition and produce, when carried to a 
 certain degree, necrosis of the parts. This theory accords with 
 the therapeutic results obtained from nearby and prolonged 
 exposures. 
 
 The stimulating or tonic effect of the Roentgen ray, in- 
 duced by short exposures or with a high-vacuum tube at dis- 
 tances of sixteen to twenty inches from the anti-cathode, is 
 probably due to the disposition of the vibratory influences of 
 the rays to first overcome local stasis, restoring tone to the 
 muscular coats of the arterioles, and at the same time inducing 
 a more active local metabolism. 
 
 A knowledge of the action of all stimulants teaches that their 
 employment must be judicious or the opposite effects will re- 
 sult. So with the X-ray, to obtain the tonic action, exposures 
 must be infrequent (not oftener than twice weekly), with pene- 
 trating rays emanating from a tube usually at a distance of 
 from twelve to twenty inches. The length of exposure under 
 these circumstances may be for the usual period of ten min- 
 utes. 
 
 Pathological changes which follow the administrations of 
 the X-ray confirm in most instances the actions as given. 
 
 Germ life has not been demonstrated to be susceptible to 
 the direct -act ion* of the rays, as has been shown by many ob- 
 
224 STATIC ELECTRICITY. 
 
 servers. What does seem to be the case, however, is that the 
 pabulum is rendered unsuitable for their existence, and they 
 perish. 
 
 The structural changes taking place in the tissues are con- 
 sistent with the theory of the diminished supply of nutrition. 
 Fatty degeneration, atrophic changes, degeneration of the 
 nuclei of the cells of the sarcoma, and necrosis may all occur 
 from such a cause. 
 
 Future developments and observations will still farther elu- 
 cidate this interesting question. 
 
CHAPTER III. 
 
 THE GENERAL PRINCIPLES OF RADIO- 
 THERAPY. 
 
 The therapeutic uses of the X-ray, in order to have associ- 
 ated the minimum of danger consistent with the greatest 
 amount of benefit to be derived, require a technical knowledge 
 of the actions and the limitations to which it may be em- 
 ployed. 
 
 Many physicians who make use of the X-ray have thought 
 it necessary- to make contracts with their patients, exempting 
 them from all responsibility in case of serious X-ray burns. 
 To the writer this seems an indication of unfamiliarity with 
 the subject, because, when properly used, the patients seldom 
 suffer more than a first degree of dermatitis. In rare cases, 
 however, a dermatitis of second degree may be produced, 
 which will disappear under simple treatment. 
 
 If the patient at the commencement of treatment is given 
 to understand that a dermatitis is certain to be induced, and 
 that it may be of the second degree, and of the danger of autp- 
 infection, no responsibility will rest with the physician, and he 
 who invariably makes the statement to his patients will require 
 no better evidence than their testimony to substantiate his 
 position. 
 
 In order, however, to avoid litigation it should be the rule of 
 physicians to inform patients that dermatitis of the second de- 
 gree may arise, explaining to them the character of the condi- 
 tion. Very few patients will be deterred by such small risks 
 from taking the treatment to relieve them of the severe condi- 
 tions generally present. In the treatment of acne and other 
 superficial conditions, or when the X-rays are used for their 
 tonic effects at the proper distance, it will not be necessary to 
 
 225 
 
226 STATIC ELECTRICITY. 
 
 make any explanation, because in such cases the exposures will 
 never induce, under judicious management, any dermatitis 
 whatever. 
 
 The physician, however, must understand the limitations and 
 the extent to which he can carry the X-ray exposure, that he 
 may not go beyond the point of producing a greater degree of 
 destructive action than a second-degree dermatitis. Some in 
 the past have made exposures daily, and for periods ranging 
 from ten to fifteen minutes, making a series of exposures, 
 which in most cases would have given disastrous results. At 
 the present time, however, the experience of a large number 
 of observers has established rules of administration which place 
 the measure within the range of safety. 
 
 In every case the operator should have in mind two things : 
 (i) The actions of the X-ray, and (2) the extent to which the 
 exposures can be carried with safety. 
 
 The length of exposure may depend upon the character 
 of the lesion, the quality of the tube, the character of the 
 energizer. and the distance at which the tube is placed from 
 the patient. 
 
 The distance at which the tube is placed may, on the other 
 hand, regulate the other difficulties of condition, and the time 
 be made a constant factor ; in other words, a low-vacuum tube 
 may be placed nearer to the parts to be rayed and the time re- 
 main the same, or a high-vacuum tube may be placed at a 
 greater distance for the same period, or a tube of medium or 
 low vacuum energized by a large ampere current or a static 
 machine provided with a spark interrupter placed at a shorter 
 distance than in case of a high-vacuum tube. Some have made 
 the rule an inch a minute ; in other words, a tube in which the 
 anti-cathode is placed one inch from the surface to be exposed 
 for one minute. This rule, however, would not be consistent 
 with the different power or penetration or the varying capacity 
 of different tubes variously excited. It will be readily seen by 
 the student that many factors enter into the question of dis- 
 tance and length of exposure. 
 
 Experience both with reference to different subjects and 
 different apparatus will be required to enable the operator to 
 
GENERAL PRINCIPLES OF RADIOTHERAPY. 227 
 
 make precise and definite rules of action whereby he will be 
 enabled to judge of the relative penetration or volume of the 
 radiance employed, to govern the regulation of distance and 
 time. 
 
 The frequency of exposure calls for careful consideration 
 and is employed in relation to distance and time. In the 
 majority of cases, the best results will be obtained and the 
 greatest degree of safety assured by making the exposures at 
 intervals of two days. 
 
 The cumulative action of the X-ray is such that in cer- 
 tain cases it will be found that even with every other day ex- 
 posures a second-degree dermatitis will be produced. Had 
 exposures in such cases been made daily, it is doubtful if it 
 would not have resulted in a serious X-ray burn involving the 
 deeper structures. To the present time, no cases have been 
 recorded in which unfavorable results have occurred from the 
 superficial action of the X-rays where the rule has been to 
 employ the ray for ten minutes with the static machine and 
 for five to seven minutes with the coil actively energized, 
 making exposures on alternate days, with the patient at an 
 average of, ten inches for the anti-cathode, and raying has 
 been discontinued at the appearance of a dermatitis. 
 
 The writer would therefore suggest from his own experience 
 that a safe rule of action is to make exposures of ten minutes 
 each when employing the static machine, and five to seven 
 minutes when employing a coil actively energized, at a dis- 
 tance of ten to twelve inches from the anti-cathode, when 
 using a tube having from two- to four-inch spark resistance, 
 and from four to eight inches with tubes having from one-half 
 to two-inch spark resistance. These administrations should 
 be made, beginning with the first days of treatment, invari- 
 ably on alternate days. It has been advised by some authori- 
 ties that exposures may be made twice weekly, making the 
 periods of exposure fifteen minutes each, with as good results. 
 This, however, does not accord with the writer's experience. 
 With a patient in whom a degree of hardihood is found to 
 be present, it may be wise to make exposures on two or three 
 consecutive days after the case has been rested for months. 
 
228 STATIC ELECTRICITY. 
 
 In cases in which the fact of such hardihood is not established, 
 it will never be wise to pursue a course of daily exposures. 
 
 The above rules apply, in a general way, to the therapeutic 
 employment of the X-ray, and in whatever cases it is em- 
 ployed for the removal of malignant growths or neoplasms, 
 they will be found to be safe. 
 
 The choice of special tubes. and the technique of exposure in 
 special cases will be considered when taking up the treatment 
 of the various conditions in the subsequent chapters. 
 
 Screening of the parts not requiring X-ray treatment is a 
 subject upon which operators are somewhat divided, some 
 preferring to ray widely. The following rules, however, may 
 be generally accepted : 
 
 ( 1 ) When raying the trunk of the body, there should be no 
 indications to expose the face or extremities, which will be 
 wisely screened. 
 
 (2) When raying the face or extremities, on the other hand, 
 the trunk should, as a rule, be screened. 
 
 (3) In treating epithelial growths of the face, the surround- 
 ing parts, including hair and mustache,- when the contiguous 
 parts are not involved, should be properly screened. In all 
 cases, the screen surrounding an epithelial growth should be 
 so shaped that a margin of one-quarter to one-half inch in 
 width is uncovered surrounding the ulcerated surface, in order 
 that no indurated tissues may escape exposure. 
 
 (4) When treating any extensive affection of the face, as 
 acne, particular pains should be taken to completely cover the 
 hair to the margin as well as the eyes and eyebrows, thereby 
 avoiding an accidental alopecia. (See Plate XIII.) 
 
 (5) When raying the cases of primary or recurrent cancer 
 of the female breast, it is unwise to screen the part extensively. 
 The writer believes that in these cases only the arm and the 
 face should be screened, and that two exposures should be 
 made at each sitting, the first directly over the lesion and the 
 other from the side, in the latter the perpendicular rays from 
 the anti-cathode being directed to the axillary space. 
 
 The material of screens employed by the writer in his clinic 
 and practice is a composition of rubber with metallic sub- 
 
GENERAL PRINCIPLES OF RADIOTHERAPY. 
 
 229 
 
 stances, which effectually absorb enough of the rays for 
 safety. About the face, tinfoil or soft metal composition 
 thirty-two gauge in thickness proves effective. 
 
 The writer employs three shields of the rubber composition 
 
 Fig. I. — Large X-Ray Shield. 
 
 which are found convenient for use in a variety of conditions. 
 (See Figs. 1, 2, and 3.) 
 
 Tanning is a term applied, as the word implies, to produc- 
 ing a dark or bronzed appearance of the skin which is sup- 
 posed to be associated with a hardened condition not so liable 
 to dermatitis. The writer's experience in bringing about such 
 a condition has not proved eminently successful-, for when the 
 raying is pushed far enough to be effective in the treatment of 
 
230 
 
 STATIC ELECTRICITY. 
 
 malignant disease, a dermatitis will sooner or later occur, after 
 which, instead of the part becoming less susceptible to a re- 
 current dermatitis, it is apt to recur after fewer exposures 
 than the number which first produced the condition. 
 
 Idiosyncrasy to the action of the X-ray is not as common 
 as has been generally supposed. The period of time in which 
 a dermatitis will appear, however, varies considerably with 
 different patients. But rarely, with the plan of raying 
 described above, does it occur within three weeks and some- 
 
 Fig, z. — X-Ray Shield. 
 
 times it may be deferred to six weeks. In one case (a blond) 
 treated by the writer, exposed upon alternate days, dermatitis 
 did not appear until after the sixth week, when instead of the 
 usual first blush of superficial dermatitis the patient suddenly 
 acquired a painful second-degree dermatitis, indicating 
 strongly the cumulative effect of X-ray exposures. It is also 
 noteworthy that in patients in whom vitality is lowered for 
 any reason, dermatitis appears earlier, and is apt to be most 
 severe. It has been supposed by some that blonds were espe- 
 cially susceptible, responding earlier to the irritating effects 
 of the X-ray. This has not been borne out in the writer's 
 
GENERAL PRINCIPLES OF RADIOTHERAPY. 
 
 231 
 
 experience, of which the case above referred to was an ex- 
 ample. Various rules for the first exposures of patients have 
 been made, some advising that the exposures at first be made 
 at intervals of one week, after which the treatment should be 
 taken up according to the regular plan of exposures. If an 
 idiosyncrasy of so marked susceptibility, calling for such re- 
 markable precaution, has been discovered by others, their ex- 
 perience differs materially from that of the writer. 
 
 Various accessories will be judiciously employed in con- 
 nection with the X-ray in the treatment of superficial affec- 
 tions. 
 
 The brush-discharge administered with the wooden elec- 
 
 Fig. 3. — X-Ray Shield for Arm. 
 
 trode will prove invaluable in the treatment of lupus vulgaris, 
 extensive epitheliomas, rodent ulcers, psoriasis, indolent ul- 
 •cers, eczema, and sycosis. 
 
 The ultra-violet rays have already been demonstrated to 
 be useful in the treatment of cases of lupus, especially of 
 marginal growths, as the lobe of the ear, which would be 
 sacrificed if the X-ray were energetically employed, and in few 
 cases could be cured without the employment of additional 
 measures. It also seems, from the experience of recent writ- 
 ers, that light is of value, used on alternate days in connection 
 with the X-ray in the treatment of malignant disease. The 
 
232 STATIC ELECTRICITY. 
 
 results already accumulated are too meager to establish a 
 definite course of action for their employment in these cases. 
 That the accessory measures have a beneficial effect upon 
 malignant growths as well as upon the forms of lupus has 
 been demonstrated to the writer's satisfaction. The evidence 
 seems to be conclusive that all of the light rays of the spec- 
 trum violet and ultra-violet rays may be employed judiciously 
 and with advantage in conjunction with the X-rays in the 
 treatment of all cases of malignant disease. 
 
 The high-frequency administrations employing the glass 
 electrodes with the coil or static machine, either in connection 
 with or without a resonator or high-frequency step-up appa- 
 ratus, are undoubtedly beneficial in some skin affections, as 
 acne and lupus vulgaris. 
 
 Dermatitis, when it does occur, as it is certain to in all 
 cases except when special precautions are taken, as in the 
 treatment of acne, and the conditions in which it is used for its 
 tonic effect, may appear in one of three types, which are simi- 
 lar to the dermatitis arising from other irritating causes. The 
 condition has been well described by Beck, as follows : " The 
 first is characterized by hyperaemia, infiltration, increased tem- 
 perature, exfoliation in small scales, associated with a torment- 
 ing itching. It seems that there is a regressive metamorphosis 
 (atrophy) of the differentiated elements of the skin, viz., 
 glands, hair, and hails. The main feature of the second degree 
 consists in the formation of blisters — the inflammatory signs are 
 well pronounced, the tension considerable, and the pain in- 
 tense accordingly. After the blisters are removed the corium 
 is exposed as a red and sore surface — bullous form of 
 Roentgen ray dermatitis. The third and gravest degree is 
 characterized by the escharotic destruction of the irradiated 
 tissues. They show the sign of dry gangrene, and appear 
 brownish black. If they exfoliate by a slow suppurative 
 process, or, if they are removed, as they should be, by surgical 
 interference, a granulating ulcer remains, the cicatrization of 
 which may take months — the necrotic form of dermatitis." 
 
 The indications when dermatitis occurs are in most cases 
 to stop raying the tissues as soon as the first blush of redness 
 
GENERAL PRINCIPLES OF RADIOTHERAPY. 233 
 
 appears and to suspend treatment until it has disappeared. 
 In the meantime, the case should be treated as an ordinary 
 dermatitis with cooling applications. The writer has found 
 the itching to be usually allayed by applications of carbolized 
 vaseline. Later the irritated surfaces will be smoothed by the 
 application of the officinal zinc ointment. Exposures of the sur- 
 face for from twenty to thirty minutes daily to sunlight, or 
 better, to the rays of a powerful arc light, projected from 
 a parabolic mirror. 
 
 The deep X-ray burns may be considered in this connec- 
 tion, though they have occurred oftener with skiagraphy from 
 carelessness than as a resulting condition of radiotherapy. 
 The condition rarely occurs now since the action of the X-ray 
 is so well understood, and only in cases when exposures have 
 been made for periods of from thirty to sixty minutes, or for 
 relatively long periods on successive days. It is characterized 
 by the superficial third-degree dermatitis of the necrotic form 
 and at the same time involves deeper tissues, often extending 
 to the bone. In most cases in which the accident has oc- 
 curred no screens have been employed, and consequently the 
 tissues starting from the region which has received the direct 
 rays at the shortest distance are, devitalized in varying degrees 
 back to the normal tissue. For this reason, a line of de- 
 marcation between the necrosed tissue and that which has 
 just escaped necrosis is not formed for a long time and the re- 
 parative process is long delayed. Probably few conditions are 
 more aggravating or recover more slowly than deep X-ray 
 burns. 
 
 The indications are to assist nature in getting rid of the 
 necrosed tissue, at the same time to sustain the vitality of the 
 patient in every possible manner until nature has time to repair 
 the damages done. It is far easier to prevent a deep X-ray 
 burn than to cure one. It is rarely necessary to make ex- 
 posures for purpose of diagnosis with the X-ray for long 
 periods, for at the present time improved facilities enable the 
 skiagrapher to shorten the period. When, however, ex- 
 posures are made, as may be necessary with some apparatus, 
 for periods of thirty minutes, care should be taken that a 
 
234 STATIC ELECTRICITY. 
 
 second exposure should not be made within five days. An- 
 other matter to be taken into account is the physical condi- 
 tion of the patient, remembering that aged people and those 
 whose vitality is reduced by sickness are more- susceptible to 
 the injurious effect than persons in good health, 
 
 It is also well known that low-vacuum tubes energized by 
 either coil or static machine are more apt to cause these con- 
 ditions than tubes of high vacuum. 
 
 Indications for the therapeutic employment of the X-ray 
 may be divided into three distinct classes: (i) cases in which 
 it is employed for its stimulating or tonic effect; (2) cases 
 in which it is sought to destroy malignant growths without 
 breaking down adjacent normal tissue, and (3) where it is 
 employed for its effects upon regions of local congestion. 
 
 The cases included in the first classification are such as pul- 
 monary tuberculosis, indolent ulcers, and alopecia areata. 
 These features will be considered in the treatment of the sub- 
 ject under the management of the various classes of cases. 
 
CHAPTEE IV. 
 
 TREATMENT OF THE FORMS OF SARCOMA 
 AND CARCINOMA. 
 
 The diverse views of various writers and authorities upon 
 the methods of application of X-ray treatment to malignant 
 disdase arise probably from failure to recognize their peculiar 
 actions upon normal and abnormal tissue, some having em- 
 ployed them without due caution and foresight. Others do 
 not take into account the fact that the larger number of cases 
 submitted to the present time have been hopeless, inoperable 
 cases. 
 
 Experience taught those who made use of the X-ray im- 
 mediately after its discovery that its action was dangerous to 
 normal tissue. 
 
 What produced the destructive effect seems to be demon- 
 strated by its action upon various conditions. It is evident, 
 as previously shown, that protoplasm contracts when exposed 
 to the X-ray — whether from the stimulating action due to 
 the intense vibration or some other specific action of the rays, 
 is not known. The contraction of the muscular structures 
 of the circulatory apparatus at first lessens by giving tone and 
 later completely occludes the lumen of the vessels to a degree 
 in proportion to the extent of exposure, which varies with the 
 condition of the ray, the character of the structures exposed, 
 and the capacity of the blood-vessels. If the epithelial coats 
 of the capillaries were not susceptible, having no muscular 
 coats but the lumen of the smaller blood-vessels, were entirely 
 occluded by the contraction of their muscular coats, the capil- 
 lary circulation would also be interfered with. 
 
 The larger vessels are not occluded to the same extent, rela- 
 tively, as the smaller, and the arteries deeply placed are affected 
 relatively to the depth and intensity of the radiance. It seems 
 also that in the intervals between exposures there is always a 
 disposition for all of the structures to resume normal condi- 
 
 235 
 
236 STATIC ELECTRICITY. 
 
 tions. Hence, in the longer intervals between periods of ex- 
 posure, the arterioles gradually relax and resume their func- 
 tion and the tissues which have not perished are restored. 
 Under the process of tissue change, induced by the X-ray, the 
 cancerous tissue element will have perished while the normal 
 structures recover. 
 
 The relative degrees of destruction of the abnormal tissue, 
 and possibly of the normal tissue as well, or complete destruc- 
 tion of the abnormal and partial or complete restoration of the 
 normal, will depend upon many elements which are variable : 
 (1) the penetration of the rays of different tubes variously 
 excited; (2) the relative vitality of the tissues; (3) the physi- 
 cal status of the patient; (4) the depth or thickness of inter- 
 vening structures, (5) and the length, frequency, and distance 
 of exposure. To obtain relatively satisfactory results will call 
 for a degree of judgment, technical knowledge, and skill in 
 the manipulation of apparatus which experience will improve, 
 but never make perfect. With these facts facing the physi- 
 cian, he cannot fail to realize the responsibility of the under- 
 taking in the treatment of these critical conditions. 
 
 The effect of breaking down a sarcoma or carcinoma, 
 ■deeply seated or superficial, is to induce a degree of auto- 
 infection which may imperil the life of the patient. When 
 ■drainage is possible, except into the alimentary tract, in which 
 absorption will invariably take place, the prognosis ma}' be 
 fairly good. Experience has taught that a malignant growth 
 breaking down within or discharging into the alimentary canal 
 is certain to be followed with dire results. 
 
 A tumor in the abdominal cavity may break down and dis- 
 charge its contents into the peritoneal cavity and thus be 
 followed by a fatal peritonitis. 
 
 It then becomes incumbent upon the attendant to weigh 
 well every feature of effect and possibility of the results when 
 treating an abdominal cancer. Wherever a malignant tumor, 
 except one of small size, appears, the indications, if operable, 
 are for its removal, after a period of raying consistent with 
 the indications of the case, usually for periods of from four 
 to six weeks. 
 
TREATMENT OF SARCOMA AND CARCINOMA. 237 
 
 Preoperative raying is a subject deserving most thoughtful 
 consideration. Experience teaches those who have observed 
 the action of the X-ray upon a case of recurrent cancer of the 
 female breast, that the processes are abated, the tumor be- 
 coming movable over the underlying structures, the pain is 
 diminished, and, at the same time, undoubted removal of some 
 of the foci of infection and in some cases apparently all such 
 foci takes place. 
 
 The indications for the application of the X-ray prior to 
 operative procedure in all cases of malignant disease are: (1) 
 to remove the surrounding infiltration, permitting the tumor 
 to move freely over the underlying structures, and at the same 
 time lessening the activity of the malignant process; (2) the 
 destruction of surrounding focj of infection; (3) to prevent in- 
 fection and consequent recurrence in the line of the cicatrix, 
 where from past experience it is shown to almost invariably 
 occur. 
 
 The disadvantages which may arise from raying before 
 the operation are, (1) a possibility of lowering the vitality 
 of the skin which may defer the prompt union by first inten- 
 tion, and (2) the possibility that a delay, owing to the rapid 
 growth, even when rayed, may militate against the ultimate 
 recovery of the case. 
 
 The removal of the infiltration surrounding the congested 
 area is acknowledged, even by those who do not recognize the 
 importance of preoperative raying, and requires no defense. 
 The statement that foci of infection are destroyed is undoubt- 
 edly correct, because epithelioma and other growths of known 
 cancerous nature are removed by the systematic employment 
 of the X-ray, even beneath the integument, and because of the 
 remarkable improvement in most cases. The importance of 
 raying to prevent recurrence in the line of the incision is too 
 apparent to require discussion. 
 
 The disadvantage of delaying union, due to the lowering 
 of vitality, while possible in some instances, is not of uniform 
 occurrence, and even if it should occur, does not necessarily 
 contraindicate the procedure. With reference to the possible 
 danger arising from deferring the operation, it is needless to 
 
238 STATIC ELECTRICITY. 
 
 say to those familiar with the employment of the X-ray that 
 the danger is an exceptional one, because the malignant 
 growth is in most cases at once adversely affected by the ex- 
 posures of the ray. 
 
 It seems from these observations that there can be no in- 
 dication or argument against the wisdom of the employment 
 of the X-ray for a period preceding the operation in most 
 cases. 
 
 The removal of the glands in the region of a malignant 
 growth which have not become involved, is contraindicated 
 for two reasons : ( 1 ) that the glands have functions to per- 
 form; (2) that their presence is a bar to immediate metastasis 
 in case of recurrence. Under judicious observation, following 
 the operation in cases in which the glands have not been re- 
 moved, they will serve constantly as objects for investigation, 
 their enlargement indicating recurrence at the original site 
 earlier than might otherwise be determined. 
 
 The X-ray, in many such cases, when applied early, will re- 
 store the parts to normal, for an enlarged gland in proxim- 
 ity to a malignant process is not necessarily an infected one, 
 and when under X-ray treatment, such a gland has been re- 
 peatedly known to become normal and remain so for long 
 periods or indefinitely. 
 
 The reaction which occurs at varying periods during the 
 course of X-ray exposures is marked by different degrees of 
 intensity, varying with the conditions rayed. It undoubtedly 
 arises from auto-infection due to the breaking down and re- 
 absorption of toxins. This reaction is associated with de- 
 grees of fever and depression ranging from a slight malaise, 
 which often is not detected, to a profound depression some- 
 times accompanied by high temperature and great prostration. 
 The condition, however, is not a dangerous one nor one to be 
 feared, except when raying internal cancers, which are not 
 provided with external drainage, or in cases calling for pro- 
 tracted treatment. Symptoms may appear, as they have in 
 one case in the writer's experience, on the day following the 
 first exposure or be deferred for several days. In cases which 
 are rayed for considerable periods the condition will as a 
 
TREATMENT OF SARCOMA AND CARCINOMA. 239 
 
 rule occur at some time during the course of treatment. In 
 most cases, however, the reaction comes on gradually, persists 
 during the sloughing periods, and subsides during periods of 
 rest. 
 
 Auto-infection from the absorption of broken-down tissue 
 should not be confused with metastasis, because in no in- 
 stance, in the writer's experience at least, has metastasis been 
 occasioned by the process of auto-infection, which, as con- 
 sidered above, will persist with varying degrees of intensity 
 during the period of disintegration of the malignant mass. 
 
 Metastasis has been attributed to the Roentgen ray by 
 numerous observers, generally those who are opposed to its 
 employment. There are many reasons, we believe, and ex- 
 perience teaches, that these occurrences are coincident, and do 
 not result from the actions of the ray. The vibratory influ- 
 ences of the X-ray, to which alone such effects could be attrib- 
 uted, are not of the gross character which affects masses of 
 tissue in a manner which could produce metastasis. It must 
 also be remembered that the cases that have been submitted 
 to the X-ray treatment have been inoperable, many of them in 
 advanced stages of the disease. Under such circumstances, 
 metastasis should not be looked upon as an unusual occur- 
 rence. Furthermore, the larger number, if not all, of these 
 cases of metastasis have occurred in recurrent, inoperable 
 cancer of the breast in which the glands had invariably been 
 removed. It is a well-attested fact that the glands check 
 the extension of infection, and that when metastasis does 
 occur in these cases, as it is likely to, it is in remote regions 
 which might have been spared had the glands not been re- 
 moved. It is, therefore, impossible from the present history 
 of the use of the X-ray in malignant disease to draw any posi- 
 tive conclusion which will show, without question, that metas- 
 tasis is induced where it would not have occurred if the X-ray 
 had not been employed. 
 
 Those most familiar with the treatment and course of malig- 
 nant disease with the X-ray will cordially concur in these 
 statements. 
 
 The effects of the Roentgen ray .on carcinoma and sarcoma 
 
240 STATIC ELECTRICITY. 
 
 are in so many respects the same that they will be considered 
 together. The disintegration of malignant growths is always 
 relative to the vitality of the tumor in question. No two cases 
 of sarcoma or carcinoma of any of the types are influenced in 
 exactly the same manner by the same character of exposure. 
 It is a question of nutrition, which will vary with the health 
 and vigor of the patient and the proximity of the growth to 
 large sources of blood supply. In debilitated patients, for- 
 tunately, the tumors break down from less vigorous treat- 
 ment than in the robust; otherwise, the normal tissue would 
 be sacrificed by the influence of the X-ray. It has been shown 
 from past experience that sarcoma responds more promptly to 
 X-ray treatment and promises a better prognosis than car- 
 cinoma, other things being equal, which is probably due to the 
 lower vitality of the structure of the former; otherwise it is 
 difficult to determine any special variation of the effects other 
 than that dependent upon the general nutrition of the patient 
 and the location of the lesion. 
 
 It will not, therefore, be the purpose of the writer to con- 
 sider malignant disease from the standpoint of particular types 
 of cancer, but with reference to the general character of the 
 structure and the location of the lesion. Two classifications 
 of structure only will be considered relatively, i. e., bone and 
 soft tissues. 
 
 Malignant disease of the bone promises little encourage- 
 ment from the X-ray treatment alone. To the present time, 
 we believe, there are no cases on record where a sarcoma or 
 carcinoma of the bone has been cured by the action of the 
 X-ray. There are many cases, however, in which the effort 
 has been made to save bony structures, and the life of the pa- 
 tient has been prolonged and- the conditions somewhat im- 
 proved for varying periods of time, but in no case is there a 
 record of cure. It seems to be demonstrated that the action 
 of disintegration in the vascular structure of the bone is less 
 influenced by the action of the X-ray than in that of the soft 
 parts, but that the growth is retarded, with a disposition to 
 break down and discharge, as is evidenced in the cases which 
 have been observed. It is found impossible in these cases to 
 
TREATMENT OF SARCOMA AND CARCINOMA. 24I 
 
 sufficiently disintegrate the hard substance and remove a se- 
 questrum of bone, as under ordinary conditions of bone ne- 
 crosis. The indication, therefore, in all cases of malignant 
 disease involving the bone is its surgical removal. In these 
 cases, then, the same rule should be applied as in the treatment 
 of all malignant disease. The region should be rayed with a 
 high-vacuum tube for a period of from four to six weeks be- 
 fore the operation, and the diseased bone removed. Following 
 the operation, it should be again rayed and watched, and 
 the same cautious care should be observed as is exercised in 
 the treatment of all cases of malignant disease. 
 
 Cancer of the soft structures will include all other cases 
 except those involving bone, and call for no special considera- 
 tion. 
 
 The local classification will be made with reference to the 
 region affected, as follows, (1) face, (2) throat, tongue, and 
 fauces, (3) breast, (4) internal, (5) uterine, (6) vesical, and 
 (7) rectal. Epitheliomas will be considered in the subsequent 
 chapter under Diseases of the Skin. 
 
 Cancer of the face may arise pathologically in the deeper 
 structures including the bones or extend from an epithelial 
 growth upon the surface, and later involve deeper structures. 
 There are no special indications for the treatment of cases 
 not included in the genera! consideration of the subject. As 
 has been said, when the bone is involved the indications will 
 invariably be with a view to an ultimate surgical operation and 
 subsequent raying. When the orbit is involved in the process, 
 it should be rayed with the same exposure as the other struc- 
 tures, and experience has taught that the eye in most cases is 
 not unfavorably susceptible to its influences. 
 
 In the case shown in Figs. 4, 5, and 6 the eye was subjected 
 to X-ray exposures during ten months of consecutive treat- 
 ment, and suffered no harm until the disease had involved the 
 organ from behind the orbit. 
 
 An interesting case of sarcoma of the face which was re- 
 ferred to the writer by Dr. W. B. Coley was a subject of great 
 interest to the writer, and demonstrates so many valuable 
 lessons that it will be considered at length. The patient, Dr. 
 
242 STATIC ELECTRICITY. 
 
 L., dentist, aged thirty-six, was in perfect health until July, 
 1900. The first symptom was an excessive flow of tears from 
 the left eye, and then inability to breathe through the left side 
 of the nose, and loosening of a second molar tooth on the same 
 side. Soon a small elevation appeared on the contiguous sur- 
 face of the gum and hard palate not unlike a " gum-boil." 
 Not yielding to treatment, it was diagnosed by several sur- 
 geons to be a sarcoma, and removal of the greater part of the 
 superior maxilla was advised. The operation was performed 
 by Dr. W. T. Bull on September 21, 1900. The recovery 
 was prompt, with very little deformity and no impairment of 
 speech, and the scar was hardly noticeable. There was recur- 
 rence, and a secondary operation was performed again by Dr. 
 Bull on February 4, 1901, The serum treatment advised by 
 Dr. Coley was proposed, and the patient put under Dr. Coley's 
 care. This treatment was administered systematically with 
 the usual reactions until June 1. The interior of the mass 
 was then curetted and the serum treatment continued. The 
 growth was kept in abeyance until August, 1901, about one 
 year after the first appearance of the growth. After August 
 the growth progressed rapidly, involving the tissues along the 
 scar, extending through the left cheek, left part of nose, and 
 displacing the left eye considerably. Until this time there had 
 been but little pain in connection with the pressure, but the 
 pressure on the eye then caused considerable discomfort, ac- 
 companied by headache. At the suggestion of Dr. Coley an 
 attack of erysipelas was induced early in the month of No- 
 vember. 1 901. It lasted with remissions for about three weeks. 
 The results were very striking. The tumor flattened con- 
 siderably. The masses of malignant tissue of the nose and the 
 eye were almost restored to a normal condition. There was, 
 however, considerable sloughing, accompanied by foul odor. 
 The end of this induced erysipelas marked the end of im- 
 provement. The tumor returned to its former size, and then 
 involved the adjacent parts, crossing over the median line, and 
 causing increased thickness on the right side of the face under 
 the eye. Other inoculations of erysipelas were made, but 
 failed to, have any effect, the patient evidently having become 
 
TREATMENT OF SARCOMA AND CARCINOMA. 
 
 243 
 
 immune. At this time the general health was weakened, pain 
 was almost continual, accompanied by severe headaches and 
 sleepless nights. The opening on the left side of the nose in 
 
 Fig. 4. 
 
 the line of scar was accompanied by more or less sloughing. 
 At the suggestion of Dr. Coley the patient was then referred 
 to the writer; and on January 15 the first X-ray exposure 
 was made. On the following day the photograph shown in 
 Fig. 4 was taken. It will be observed that there was a tumor 
 five inches long and four inches wide, which also had a 
 
244 STATIC ELECTRICITY. 
 
 depth of four inches, as estimated by the patient, from the 
 nearer to the outer surface at the longest diameter. The nose 
 and angle of the orbit were the sites of small tumors and 
 large superficial veins ran across to the opposite side of the 
 nose. A tumor of considerable size will also be observed in 
 the cut on the outer canthus of the eye. The first two ex- 
 posures were each of twenty minutes' duration and admin- 
 istered on alternate days. The large engorged veins which 
 ran across the front of the tumor became dry, and were re- 
 moved like pieces of burnt wood, leaving depressions but not 
 bleeding holes. The slough and discharge, which were con- 
 siderable and offensive at the commencement of the treatment, 
 disappeared. The exposures were made, after the first two 
 prolonged ones, for ten minutes each on alternate days, and 
 high-vacuum tubes were employed. After three or four ex- 
 posures a marked change for the better was noticeable. The 
 discharge and slough had diminished, and the displacement 
 of the eye had become less marked. The pain was much less, 
 being absent sometimes for days, and the patient's general 
 condition had greatly improved. The size of the tumor was 
 rapidly reduced, as shown by a photograph taken one month 
 after the first exposure (see Fig. 5). During the subsequent 
 progress of the treatment, many features interesting to the 
 study of radiotherapy developed. The tumor upon the orbit, 
 as it appeared in the first photograph, absolutely disappeared 
 during the first month of the treatment. From time to time, 
 during the course of treatment, the patient had marked re- 
 actions associated with the sloughing away of the large tumor 
 of the face from beneath the surface and later from sloughing 
 elsewhere. During these periods symptoms of auto-infection 
 were present, and marked by various degrees of fever and 
 depression. The improvement of the local conditions 
 progressed rapidly. There was during the first months of 
 treatment frequent disposition of the disease to extend to the 
 maxilla of the opposite side, which was evidenced by loosen- 
 ing of the incisors, swelling of the gum, and tenderness during 
 rrastication. Whenever these symptoms occurred after several 
 days of vigorous raying with high tubes, the tenderness and 
 
TREATMENT OF SARCOMA AND' CARCINOMA. 
 
 2 45 
 
 swelling would subside to return later. From time to time 
 this condition was checked and held in abeyance until a period 
 of about seven months after treatment had been instituted. 
 
 Fig. 5. 
 
 The progressive disappearance of the tumor and constant im- 
 provement of the facial deformity were marked until about five 
 months after treatment was begun, when the tumor had ab- 
 solutely disappeared never to recur during the life of the pa- 
 tient, as shown in Fig. 6. The orbit occupied relatively its 
 
246 
 
 STATIC ELECTRICITY. 
 
 Fig. 6. 
 
TREATMENT OF SARCOMA AND CARCINOMA. 247 
 
 normal position, except that there was a slight protrusion 
 forward. Immediately following this improvement, however, 
 there was evidence of the progress of the disease in the 
 pharynx and post-orbital region with severe pain and press- 
 ure, of which the patient complained most bitterly during the 
 last months of his suffering. The disease extended inward 
 through the bones, in which it had gained a foothold before 
 the first exposures of the X-ray were administered. The 
 process extended inward and involved the structures at the 
 base of the brain, finally terminating in the death of the pa- 
 tient in the month of November, 1902. Before death the orbit 
 had become again involved with a growth which protruded 
 from beneath the lid and surrounded the margin of the iris. 
 It should be said, however, that during the latter months of 
 the patient's life he was unable to submit to X-ray treatment 
 for periods of weeks consecutively on account of the painful 
 dermatitis, he having become more susceptible to the X-ray 
 during the progress of the treatment. The involvement of 
 the opposite side during this period also became more marked, 
 but at no time prior to his death was there any recurrence of 
 the tumor in the soft parts upon the opposite side. Metas- 
 tasis did not occur in the history of the case. 
 
 This case demonstrates many valuable principles of the 
 effects of the X-ray upon living tissues. (1) That tumors 
 which involve the bony structures will not yield satisfactorily 
 to exposures of the X-ray; (2) that large tumors will disap- 
 pear by sloughing within the mucous cavities when rayed over 
 the integument; (3) that the process of sloughing is invariably 
 associated with rise of temperature and depression due to auto- 
 infection, which does not, however, lead to metastasis ; (4) that 
 marked progress toward improvement takes place during 
 periods of depression; (5) that with physical improvement in 
 the general condition of a patient there is apt to be a more 
 vigorous extension of the processes of the disease — possibly 
 a coincidence; (6) that for most marked results, X-rays hav- 
 ing great power of penetration are indispensable in the treat- 
 ment of such cases; (7) that with great caution and raying 
 every second day for ten minutes, dermatitis of the second 
 
248 
 
 STATIC ELECTRICITY. 
 
 degree is very apt to follow, as it did in this case four times 
 during the course of the treatment; (8) that necrosis of nor- 
 
 Fig. 7. 
 
 mal tissue does not occur under the last-named conditions if 
 raying is discontinued; (9) that patients become less tolerant 
 to the rays during prolonged courses of treatment ; ( 10) that 
 
TKEATMENT OF SARCOMA AND CARCINOMA. 
 
 249 
 
 long periods of time are essential in some cases to effect a 
 cure or determine a failure. 
 
 Another case is shown in Figs. 7 and 8, which is evidence of 
 the remarkable effect upon the superficial structures in cancers 
 
 Fig. 
 
 of the face. The patient, Mr. T., was referred to my clinic by 
 Dr. Sharp with diagnosis of adeno-carcinoma, involving the 
 turbinated bones and other structures in the posterior nares. 
 The first photograph was taken on the day following the first 
 exposure, and the other at the expiration of five weeks with the 
 
2$0 STATIC ELECTRICITY. 
 
 result as shown. The prognosis in this case, however, which 
 is still under treatment, is unfavorable, as in all cases in which 
 the bones are involved. 
 
 Cancer of the larynx, according to the records of treat- 
 ment rand results to the present time, has been favorable so 
 far as partial or temporary improvement is concerned, but in 
 most cases the final results have not been so favorable as 
 would be hoped. The difficulties to overcome in making 
 exposures to the larynx are due to the intervening cartilages 
 and possibly other features in the structure of the larynx, 
 which necessitates a degree of exposure which, when made 
 over the larynx, seriously affects the skin before sufficient 
 improvement can take place in the involved organ. Marked 
 improvement, however, takes place in these cases, life is pro- 
 longed, and success has been reported at least in one case.* 
 
 It is necessary in these cases to employ all the means at 
 command to meet the difficulties. For this reason, exposures 
 should be made both over the throat externally and by a 
 •special X-ray tube directed into the larynx. The method of 
 ■exposure externally may be made as follows : 
 
 Secure a metal shield to the margin of the lower jaw, tied 
 back of the bead to cover the face, and the composition chest 
 shield for protecting the trunk. In these cases, exposure 
 should be made with high-vacuum tubes placed with anti- 
 cathode ten inches from surface for ten minutes on alternate 
 days, and pushed to the extent of producing dermatitis, be- 
 cause it is necessary, in order to affect the deep structures, to 
 employ the rays as intensely as the tissues will permit. 
 
 An accessory measure, and one which will add to the pos- 
 sibilities of recovery, is to employ the X-ray through the 
 mouth. A modification of the Cossor, an English tube, has 
 been designed by the writer, and is found to be convenient. 
 Surrounding the prolongation of the tube (see Fig. 9) is a shell 
 of glass open at the extremity, which insulates it by an air-gap 
 between the tube and the shell. By this means it is possible, 
 with the additional insulation of a piece of rubber tubing, to 
 
 * " A Case of Cancer of the Larynx Cured by the X-Ray," by Dr. W. Schep- 
 pegrell, in the Journal of Advanced Therapeutics for December, 1902. 
 
TREATMENT OF SARCOMA AND CARCINOMA. 25 1 
 
 place the tube well into the mouth, whereas without the glass 
 insulation the induction will carry the discharges through a 
 very thick insulation of rubber tubing, making it impossible 
 to employ the tube in this position. The exposures may be 
 made with this tube when the static machine is employed for 
 periods of ten minutes. The distance should be measured by 
 the space between the anti-cathode as in all cases. It must be 
 borne in mind when employing these tubes, which are made 
 of lead glass, that only a beam of X-rays, measured by the area 
 
 mm 
 
 Fig. 9. — Modified Cossor Tube. 
 
 of a transverse section of the extension, is projected in the di- 
 rection of the prolongation. It is, therefore, essential that the 
 operator shall know the exact position of the tumor, and place 
 the tube at the angle which will direct the rays to it. It is not 
 prudent to use the medium-vacuum tube in this position as an 
 accessory oftener than twice weekly for ten minutes at ten 
 inches, for though it is demonstrated that the mucous mem- 
 brane is no more susceptible to the influences of the Roentgen 
 ray than the skin, the location makes caution imperative. 
 
 Patients should be impressed at the commencement of treat- 
 ment for laryngeal cancer that the treatment is certain to be a 
 prolonged one, because the action of the X-rays upon cancer in 
 this position is in most cases, especially true of carcinoma, 
 in effect very slow. At this time, the record of improvements 
 
252 STATIC ELECTRICITY. 
 
 in the cases treated is sufficient to urge the employment of 
 the method, but not sufficient to show any positive results. 
 It will, therefore, be best in all cases to give a guarded prog- 
 nosis. One case which the writer had under observation for 
 nearly one year made progressive improvement, but very 
 slight, for months, when an intercurrent sickness kept the 
 patient from treatment for a period of six or eight weeks; 
 after which time the improvement was less marked, and, 
 finally, recurrent attacks of dermatitis delayed the treatment 
 again, and the case became gradually worse. During the 
 early treatment of this patient the special tube described above 
 was not in use, and, with one used during the later months, 
 so much trouble was experienced from the discharges to the 
 teeth of the patien-t that he became timid. This led to the adop- 
 tion of the tube provided with an insulated shell referred to. 
 The patient, however, abandoned the treatment after six 
 months, was treated by mechanical vibration for about six 
 months, and subsequently died from an intercurrent disease 
 without further progress of the throat affection. The sus- 
 ceptibility to dermatitis, which had become so painfully 
 marked in this case, demonstrates again the unpleasant feature 
 of long-continued employment of the X-ray. The interference 
 occasioned in the progress of the treatment which, in many 
 cases, is for long periods, so far militates against the success 
 that the patient may eventually abandon the treatment, and a 
 fatal result subsequently follow. 
 
 It is the writer's conviction that even in these cases when 
 it is possible that an operation following a period of raying 
 promises so much in the ultimate success of the case that it 
 should always be given serious consideration. 
 
 Cancer of the tongue, we believe, is one of the conditions 
 in which the X-ray is especially indicated. It has been shown 
 by one writer that those cases do the best in which no opera- 
 tion has been performed. In these cases, however, it is prob- 
 able that the operation had not been preceded by a course of 
 preoperative exposures to the X-ray. The technique to be 
 employed when the growth is near the tip of the organ is to 
 protrude the tongue for purpose of exposure through an 
 
TREATMENT OF SARCOMA AND CARCINOMA. 253 
 
 opening in a screen placed upon the face. Another method, 
 which may be employed with a tumor on any part of the 
 tongue, is to make use of the X-ray tube designed for internal 
 treatment of cancer of the throat described above (Fig 9). 
 If the tumor is small, exposures made over the organ in this 
 way would effectually cover the portion exposed; otherwise, 
 the portions of the mouth to which the rays are not directed 
 may be protected by fitting tin over the vault and sides of the 
 fauces. 
 
 Cancer in other parts of the mouth, as the pharynx or post- 
 nasal regions, may be treated with a jacketed cavity tube pro- 
 vided with a shield of tin, which shall cover either the water 
 bath or the inner glass of the tube, except where the rays are 
 to be emitted. In this way, the rays may be directed to any 
 part. The prognosis in these cases, however, will depend 
 upon the limited area involved. It is probable that in no 
 case where bony tissues have been invaded, except they are first 
 removed, can anything but an unfavorable prognosis be given. 
 Here, as in other cases, surgery and the X-;ray must work 
 hand in hand. 
 
 Cancer of the female breast, the most common of all types 
 of malignant disease, offers to-day under the judicious em- 
 ployment of the Roentgen ray and surgery the greatest meas- 
 ure of success to the combined method. 
 
 Many surgeons are still loath to employ the X-ray before 
 operation, and generally insist upon the removal of the por- 
 tions of the pectoral muscle and all glands within the axillary 
 region. This, we believe, is a radical mistake, and one which 
 in future practice will be abandoned. First, because the ser- 
 vices of the glands in case of recurrence are invaluable for the 
 prevention of metastasis. It is well known that when in the 
 past history of this operation the glands and all structures in 
 the region of the tumor were removed as in desperation, al- 
 most certain recurrence took place, and the mortality of the 
 disease was remarkable. 
 
 The treatment of these unfortunate women by combining 
 the X-ray with the surgeon's knife in the management of all 
 cases, making use of pre-operative and post-operative raying, 
 
254 STATIC ELECTRICITY. 
 
 promises an ultimate lessening of the terrible mortality re- 
 corded in the past history of these cases. In no instance, 
 we believe, should an effort be made beyond a period of six 
 weeks to remove a cancer of the breast without surgical inter- 
 ference. On the other hand, prior to every operation, as has 
 been previously shown, every case should be exposed to the 
 ray for at least four weeks on alternate days, arid immediately 
 after union following the operation again for a period of at 
 least six weeks. In cases in which union is delayed for any 
 reason X-ray exposures will in many cases hasten it. 
 
 The established practice of operating upon these cases and 
 removing the gland and portions of the pectoral muscle has 
 been almost uniformly followed by recurrence within a short 
 time after the operation. In few cases, indeed, has recur- 
 rence been delayed longer than three years. 
 
 Recurrent cancer of the breast is the condition to-day 
 which most commonly faces the radiotherapist, either be- 
 cause the case is already an inoperable one or the prognosis 
 is so unfavorable that the surgeon is disposed to refer the 
 patients for X-ray treatment. The record of improvement 
 and final recovery in these cases is not all that could be hoped. 
 Temporary improvement is invariable, but at the time that the 
 patients come under observation in most cases the disease has 
 probably involved unsuspected regions, and during the im- 
 provement of the local condition the evidences of metastasis 
 assert themselves, and the case is then beyond hope of re- 
 covery. In these patients it is reasonable to believe that had 
 the lymphatic glands been left at the early operation they 
 would have given warning of the recurrence before an exten- 
 sion into other regions had taken place, and at the same time 
 might have checked such extension. 
 
 To the writer this seems a most important matter, and it is 
 encouraging that a careful investigation is being made in ac- 
 cordance with these ideas. 
 
 The method of making exposures in the treatment of can- 
 cer of the breast is one which calls for thoughtful consid- 
 eration. 
 
 In the early days of the employment of the X-ray the fear 
 

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 15 
 
TREATMENT OF SARCOMA AND CARCINOMA. 255 
 
 of producing extensive dermatitis induced the employment of 
 screens to an extent which often covered tissues already in- 
 fected. It has since, however, become the practice to make 
 wide and extensive exposures in these cases. 
 
 The writer has adopted an invariable plan of raying from 
 two positions at each treatment. The first exposure, as shown 
 in Plate IX., is made over the site of the operation with the 
 plane of the anode opposite and parallel with the scar — only 
 screening the face, the arm of the patient, and the abdominal 
 region, permitting the oblique rays to come in contact with 
 the breast of the opposite side. 
 
 Exposures so made will never produce dermatitis, except 
 at the parts directly in front of the anode and nearest to the 
 tube at the time of exposure. The second exposure is made 
 with the tube placed at the back and the side of the patient 
 with the anode directly towards the axillary space, the arm 
 being raised, extended, and supported, and at the same time 
 screened. This modus operandi includes nearly all of the tis- 
 sues of the chest of the patient upon the affected side in the 
 field of radiation, and especially those most likely to become 
 affected. 
 
 As in other cases of malignant disease, the best results are 
 obtained in the writer's experience from exposures made for 
 ten minutes on alternate days, discontinuing the treatment 
 upon the first appearance of a dermatitis and then resting the 
 case until the skin has become normal. This procedure is 
 followed by the best results for two reasons. The results of 
 the ray carrying the effect to the extent of almost breaking 
 down the normal tissue destroy the abnormal tissue cells and 
 short periods of rest enable the tissues to recover, when nor- 
 mal tissue replaces the broken-down structures. 
 
 The following case, referred to the writer by Dr. Griffith 
 Davis, will illustrate come important features of the treatment 
 of cancer of the breast. Mrs. H., aged forty-six, came with 
 a tumor in the left breast, about two inches in diameter, freely 
 movable, and characterized by the usual early symptoms of 
 carcinoma, sharp pain, commencing retraction of the nipple, 
 and the glands slightly enlarged in the axilla. 
 
256 STATIC ELECTRICITY. 
 
 The patient wishing to avoid an operation, a series of X-ray 
 exposures were made. The raying was kept up regularly, ex- 
 cept when resting the case during periods of dermatitis, for 
 more than four months. During this time the tumor was re- 
 duced in size about one-third. The retraction of the nipple 
 disappeared and the glands in the axilla, with one exception, 
 became normal. At this time the patient developed a fre- 
 quent pulse and other symptoms which induced her to yield 
 to advice and submit to an operation. The breast was re- 
 moved by my associate, Dr. Herman Grad, and the glands with 
 the exception of one were left in position. The pectoral mus- 
 cle was undisturbed and the patient made a rapid recovery. 
 Subsequent to the operation, X-ray exposures were made on 
 alternate days for four weeks, since which time the raying has 
 been somewhat irregular, but the patient is still under con- 
 stant observation fourteen months since the operation, with 
 no indication of recurrence or affection of any of the glands. 
 
 The recurrent cases treated by the writer all made satisfac- 
 tory progress at first, but in three instances metastasis later 
 occurred; all were advanced cases and inoperable. All, ex- 
 cept the one described above, have been cases of recurrent 
 carcinoma, in which the glands have been removed, and the 
 results, except in the three referred to, have been satisfac- 
 tory. 
 
 The internal cancers, including those within the trunk 
 proper, are usually in positions which afford no opportunity 
 for drainage, and are therefore fraught with danger to the 
 patient and a source of great anxiety to the physician who 
 appreciates the dangers involved. 
 
 Few cases of success in the management of this class of 
 cases have been reported to the present time. At best, the 
 prognosis is unfavorable in all cases, but the X-ray offers 
 such a measure of relief from suffering and the only possible 
 hope in so many cases that its judicious employment should 
 be encouraged. 
 
 The exposures should be made with relatively little screen- 
 ing of the trunk, and preferably a high-vacuum tube should 
 be employed, because the skin is less apt to be affected when 
 
TREATMENT OF SARCOMA AND CARCINOMA. 257 
 
 the same degree of effect is produced upon the internal struc- 
 tures as would be produced by a low-vacuum tube pushed to a 
 sufficient degree of penetration to affect the involved structures 
 to the same extent. Exposures should be made in all cases 
 not oftener than on alternate days, watching carefully the 
 patient's physical condition, and standing ready to lessen the 
 frequency or diminish the intensity of the treatment upon the 
 indications of the dreaded auto-infection, which may at first be 
 slight, marked by progressive decline in the patient's general 
 health, with lost appetite, slight fever, and varying degrees 
 of prostration. In these cases, the lowered condition of the 
 patient should not be mistaken for a possible extension of the 
 diseased process, because the patient's health would not be 
 likely to be impaired in so short a time by an extension of 
 the disease beyond what had preceded the period of X-ray 
 exposures. 
 
 To discriminate, however, is a matter of the utmost im- 
 portance, because, should the employment of the X-ray be 
 pushed to the point of breaking down of the malignant mass, 
 a mild degree of auto-intoxication would merge into a condi- 
 tion of severe prostration likely to be followed by unfavorable 
 results. 
 
 Bearing in mind that the action of the ray is to break down 
 malignant tissue, it is of the utmost importance that the ex- 
 posures be made with great caution and that in each case the 
 size and location of the tumor be considered. While, under 
 ordinary conditions, when an abscess breaks into the intestinal 
 tract not sufficient infection takes place to endanger the health 
 of the patient; with the broken-down cancerous structure, 
 however, it is different — evidently from the toxins which are 
 the products of the destructive action upon the malignant 
 growth. These poisons require most careful consideration, 
 and their rapid absorption must be prevented or the life of 
 the patient may be shortened by the process of treatment. 
 
 It will be wise, therefore, noting the condition of the pa- 
 tient, not to be governed alone by the degree of dermatitis in 
 determining the limitation of the exposure. As soon as the 
 first lowering of the physical status of the patient appears, 
 
258 STATIC ELECTRICITY. 
 
 the frequency of the exposures should be shortened or the 
 tube placed at a greater distance from the surface, and the 
 case carefully watched and given occasional periods of rest 
 from the treatment. On the other hand, it can be easily un- 
 derstood that too great conservatism in the process of raying 
 may eliminate the possibility of curing a patient, because if 
 the periods of rest are too long or the treatments not suffi- 
 ciently energetic, the disease may be held in statu quo for a 
 time, but not cured, and ultimately the lowered condition of the 
 patient be followed by general decline and death. Cases 
 which have made satisfactory improvement have, in a few 
 instances, been those in which the raying was carried to a 
 dangerous limit. 
 
 One case reported to the writer by a confrere had been 
 rayed for a cancer of the caecum until a dangerous degree of 
 auto-infection was induced. The patient lay for many days at 
 the point of death, but finally rallied and is clinically cured. It 
 will therefore always be a hard question to determine, how 
 far this process should be carried in order to effect an ulti- 
 mate cure. The individuality of the case has much to do 
 in governing the procedures, and experience only can teach 
 this valuable lesson, and at best many accidents will occur 
 in skilled hands, which might have been otherwise, had a 
 slight change been made in the conduct of the case. 
 
 It is impossible to give any definite rules of action. Good 
 judgment, foresight, and experience will increase the number 
 of successes in this otherwise hopeless class of cases. It may 
 be said, however, that the patient's life, which may be short- 
 ened, under these conditions, will fortunately be somewhat 
 relieved of suffering in the employment of another effort for 
 recovery. 
 
 The physician who would protect his own good name when 
 treating cases of internal cancer must be open and candid at the 
 outset in explaining the possibility of accidents and should 
 always give a most guarded prognosis, as favorable results 
 can be obtained m but a small percentage of cases of internal 
 cancer. 
 
 CSncer in the pelvis offers more favorable results than the 
 
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TREATMENT OF SARCOMA AND CARCINOMA. 259 
 
 preceding class of cases, because of the obvious advantages of 
 drainage. 
 
 Cancer of the uterus is a condition which the advent of the 
 X-ray in therapeutics offers a most hopeful prognosis. The 
 results already promise great alleviation and clinical improve- 
 ment in all cases, and we believe, properly associated with the 
 surgical procedures, it will be possible to cure very many of 
 these cases. It should not be sought in any instance to pre- 
 serve any portion of the organ in question, placed as it is 
 
 Fig. 10. — Jacketed Cavity Tube. 
 
 adjacent to other structures which may become so easily in- 
 volved by a possible recurrence. 
 
 In the treatment of these patients, preoperative raying is 
 a matter of the greatest importance, as will be shown. This 
 procedure should be carried out thoroughly for from four to 
 six weeks, the exposures to be made either from below 
 through an aluminum speculum, as shown in Plate X., or em- 
 ploying the jacketed cavity tube, Fig. 10; or a Pennington 
 shield, Fig. 1 1 ; or a modified Cossor tube, Fig, 9 ; or by raying 
 immediately over the coccyx. Another exposure should be 
 made with a high-vacuum tube placed over the abdomen at a 
 
260 
 
 STATIC ELECTRICITY. 
 
 distance of eight or ten inches with the plane of the anti- 
 cathode perpendicular to the axis of the superior strait, that the 
 larger volume of rays may be projected downward through 
 the pelvis. (See Plate XL) 
 
 The method of screening during this procedure is simple 
 and effective. Place a large screen of rubber composition 
 ( Fig. i ) , or a tin one, having a hole about five inches in 
 diameter in the center, in a position that will permit the rays 
 to pass as suggested. It will be generally unnecessary to em- 
 ploy any other screen in these cases if the one employed is 
 
 Fig. II. — The Pennington Shield. 
 
 eighteen to twenty-four inches in dimension, if the head be 
 slightly elevated, as the position of the anti-cathode will direct 
 the rays from the upper portion of the abdomen, and the 
 thighs will not be near enough to be unfavorably affected. 
 
 When raying at the perineum the same rubber shield may 
 be employed, securing it to the thighs by cords, and fitting 
 within the opening smaller shields to cover the parts not 
 necessary to expose, as shown in Plate X. 
 
 If the jacketed tube, Fig. 10, is employed the inner tube 
 
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TREATMENT OF SARCOMA AND CARCINOMA. 261 
 
 within the water bath may be covered except for one inch or 
 one inch and a half from' the extremity with a metal shield to 
 prevent the escape of the rays except to the involved struc- 
 tures. The tube should be constructed of the thinnest glass 
 at the anti-cathodal extremity, and the jacket should also be 
 a very thin glass shell. 
 
 The writer has modified this tube in two particulars. The 
 projecting portion of the tube is made of lead glass, except the 
 last inch and a half at the extremity, and the jacket is fitted 
 to the body of the tube by a ground-glass connection to avoid 
 leakage and hold the jacket in position; the tape or rubber 
 having so often become loose, and, at the same time, it did not 
 hold the jacket away from the inner tube. When this tube is 
 used it should be borne in mind that the X-rays evolved are 
 induced in close proximity to the tissues, which necessitates 
 shorter exposure. Five minutes is the generally accepted 
 length of time admissible. It may, however, be shown to be 
 of advantage to make longer exposures in the future, no 
 recorded accidents having occurred from the five minutes' rule. 
 With this type of tube it is impossible to energize it sufficiently 
 to give any but low-vacuum effects without puncturing the 
 anti-cathodal extremity of the tube, which is covered with 
 the water-jacket to prevent the melting and puncturing of the 
 glass. The jacket should, therefore, be kept filled during 
 operation. The tube may either be placed in position and 
 held by the usual stand tube-holder or held in the hands of 
 the operator during the administration. 
 
 A modification of the Cossor tube used by the writer has 
 the disadvantage of projecting only a small beam of X-radi- 
 ance, and should be used for at least ten minutes, the operator 
 moving it about in order to direct the rays in different direc- 
 tions, and thereby insure exposure to the involved structures. 
 
 The writer has found in these cases, when raying through 
 the mouth, that the insulating shell has the advantage of pre- 
 venting the induction and causing the uncomfortable sensa- 
 tions to the patient when it comes in contact with the teeth. 
 
 The Friedlander shield is similar to the Pennington, and 
 composed of a material opaque to the X-ray. Tt is light in 
 
262 STATIC ELECTRICITY. 
 
 weight and completely envelops the tube. It is constructed 
 (Fig. 12) so that openings of different sizes enable the op- 
 erator to focus the rays upon any desired spot or area. An 
 advantage of this shield is that it is so constructed that sparks 
 cannot jump across to the patient. The extension of hard 
 rubber allows close contact to the part treated without un- 
 pleasant sensations to the patient. 
 
 An objection to both the Friedlander and Pennington 
 shields, as now made, is that they are so constructed that the 
 most direct and greatest volume of rays perpendicular to the 
 
 Fig. 12. — The Friedlander Shield. 
 
 anode are absorbed by the shield. This can be easily altered 
 by placing the extension at the proper angle. 
 
 The two-cavity shields described above possess little ad- 
 vantage over the rubber composition shield and aluminum 
 speculum (see Plate XL), but may be preferred by some 
 operators. 
 
 Systematic post-operative raying should be instituted as soon 
 after the operation as the conditions will permit. If the union 
 by first intention is delayed, it will be found that a few ex- 
 posures of the X-ray will in most cases hasten the reparative 
 process. The exposures should be made as prior to the opera- 
 tion. Twice weekly for prophylactic purposes will not be 
 generally sufficient. The case should be watched for many 
 months after the operation, and at the slightest indication of 
 recurrence active raying should be instituted. The method is 
 
TREATMENT OF SARCOMA AND CARCINOMA. 263 
 
 on trial, and certainly offers additional encouragement for 
 success in the treatment of this class of cases, in which the 
 prognosis has been uniformly bad. The following case will 
 illustrate the methods and results of treatment. 
 
 Mrs. B., aged fifty-five, came to me on August 6 with 
 the history of having had pain for a year or more. At the 
 time, she was feeble, and unable to come from her home in 
 Brooklyn without an attendant. There was an offensive dis- 
 charge from the uterus, and the organ was enlarged to nearly 
 twice the normal size, but fairly movable. The diagnosis of 
 malignant disease was made, and treatment with the X-ray 
 instituted. Two exposures were made at each administration 
 on alternate days — one through a speculum, and the other 
 over the abdomen, as above described. 
 
 At the end of one week improvement was well marked. 
 The discharge ceased to be offensive, and the patient's general 
 health was materially improved. This treatment was kept up 
 for six weeks, during which time she recovered her health, 
 gained weight, and the discharge, which had entirely ceased 
 for two weeks, had again appeared. 
 
 The uterus at this time was reduced to about one-half the 
 size at the beginning of treatment. It was evident that the 
 structures were breaking down under the influence of the 
 ray, and that auto-infection would , soon occur. An opera- 
 tion was accordingly advised, to which the patient submitted. 
 It was performed by the writer's associate, Dr. Herman Grad, 
 and the parts removed. It was found to be adherent to a loop 
 of intestine; the rectum and bladder and the tissues were so 
 friable that when separating the adhesion from the bladder 
 the operator's fingers passed into the uterus. The operator 
 accordingly found it necessary to remove the parts piecemeal 
 removing the cervical portion through the vagina. The vagi- 
 nal wound healed promptly, the floor of the pelvis being 
 completely closed within two weeks. The abdominal wound, 
 however, healed less promptly, but with entire satisfaction. 
 The patient is in perfect condition nine months after the 
 operation, having been kept under constant observation. 
 Clinically, the patient is cured; time only will determine the 
 
264 STATIC ELECTRICITY. 
 
 permanency of the result. The accompanying drawing was 
 made under the supervision of Dr. F. M. Jeffries from a mi- 
 croscopic specimen of the diseased organ. His report of the 
 case follows. (See Plate XII.) 
 
 "Examination of the uterine tissue marked (Mrs. B.) re- 
 veals the following conditions : 
 
 " Uterus about the size of a nullipara. Cervix is missing 
 and stump very ragged. Cavity slightly dilated, and presents 
 numerous small projections. Entire organ is soft and spongy. 
 Microscopically there is an extensive invasion of a mixed- 
 celled sarcoma. The superficial structures both on the stump 
 and within the uterine cavity have undergone -extensive co- 
 agulation necrosis. The sarcoma cells have invaded the deeper 
 portions of the muscular walls, and it is observed that the 
 nuclei have undergone some sort of retrograde change, in that 
 the chromatin filaments have broken up into minute granules, 
 distributed evenly throughout the substance of the nuclei. 
 From its nature I would assume that it is of a very malignant 
 type." 
 
 Cancer of the rectum calls for the same general considera- 
 tion as the preceding, except that the location renders an 
 operative procedure much less satisfactory. The method of 
 mercuric cataphoresis, instituted by Dr. G. Betton Massey of 
 Philadelphia, offers more in these cases, when employed in 
 conjunction with the X-ray, than the knife. The applications 
 may be made high up in the cavity or in the region of the anus, 
 and will be followed by sloughing away of all of the cancerous 
 tissue without other unfavorable symptoms. 
 
 In these cases, a small jacketed cavity tube may be utilized 
 for carrying the rays high up into the rectum. When 
 the X-ray is employed in conjunction with surgery or the 
 method of mercuric cataphoresis the prognosis will be fairly 
 good. 
 
 Cases of cancer of the bladder may be treated as cancer 
 of the uterus, raying above the uterus as well as employing 
 the jacketed tube in the vagina. A small jacketed tube has 
 been designed by Dr. Margaret A. Cleaves, which may be 
 passed through the urethra and the exposures made directly 
 
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TREATMENT OF SARCOMA AND CARCINOMA. 265 
 
 to the inner coats of the bladder of the female. Not enough 
 of these cases have been reported or treated to the present 
 time to afford any basis for prognosis. The prognosis is 
 generally bad, but will always be relative to the extent of the 
 lesion and method of treatment. 
 
CHAPTER V. 
 
 THE X-RAY AND ACCESSORY MEASURES IN 
 AFFECTIONS OF THE SKIN. 
 
 The peculiar actions of the X-ray upon the skin are as 
 follows : 
 
 I. Characteristic contractions on protoplasmic structures 
 are produced, as shown in the chapter on Physiological Ac- 
 tions. The arterioles contracting deprive the skin of the usual 
 blood supply 
 
 II. The hair follicles and sweat glands, partaking of the 
 same action, become functionally inactive, and, at the same 
 time, are impaired by the cutting off of the nutrition furnished 
 by the normal blood supply. 
 
 III. When the exposures are continued for successive 
 short periods, or when a prolonged exposure is made, the 
 glands and hair follicles become atrophied. This condition 
 of suspended activity when followed by discontinuance of the 
 exposures recovers in most cases after varying periods. The 
 hands of physicians, however, who have exposed themselves 
 frequently and for long periods to the X-ray, become painfully 
 affected from the inactivity of the sweat glands thus induced, 
 and the small hairs upon the hands fail to return, indicating 
 a complete destruction of the hair follicles. 
 
 That nature is disposed to restore all such functions after 
 periods of rest is shown in, th£ restoration of the normal 
 growth of hair and recovery of the functions of the sweat 
 glands in most cases, which have been affected during a 
 course of treatment for epithelioma or rodent ulcer. That 
 the continuance of the use of the X-ray will ultimately destroy 
 the possibility of the restoration of the functions of both hair 
 follicles and sweat glands cannot be doubted. It seems, how- 
 ever, to be established that partial or complete restoration of 
 those two sets of organs is most likely to take place in the 
 
 266 
 
THE X-RAY IN AFFECTIONS OF THE SKIN. 267 
 
 sweat glands, and that the hair follicles are first actually de- 
 stroyed by X-ray exposures. 
 
 IV. The atrophy which takes place in the other struc- 
 tures of the skin is well marked from the thinning of the 
 corium, leaving a peculiarly soft and delicate condition of the 
 skin without scarring or other noticeable defect. 
 
 The writer has observed this condition particularly in a case 
 of lupus erythematosus, which has been given six periods of 
 raying during the past year, each time with the production of 
 a slight dermatitis. The skin of this patient is absolutely free 
 from hairs, is soft and peculiarly thin. It preserves, how- 
 ever, in other respects a normal appearance, not being unduly 
 pale, as might be supposed from the contraction of the cap- 
 illaries whigh takes place, which is probably because the 
 brush-discharge has been used during the treatment of the 
 case, and to some extent preserved the superficial circulation 
 of the skin. 
 
 V. Microscopically the above conditions are in all respects 
 verified. 
 
 In the treatment of skin affections it is unnecessary to em- 
 ploy an X-radiance of the same intensity as in the treatment 
 of deep, malignant growths for obvious reasons. The employ- 
 ment of low-vacuum tubes, which give a dark shadow of the 
 bones upon the fluoroscope, placed at a distance of six to eight 
 inches from the anti-cathode, will generally prove satisfactory. 
 It is not necessary, however, to obtain good results with the 
 local conditions, that low tubes be employed, because high 
 tubes will accomplish the same purpose. Penetration not be- 
 ing a requisite in these cases, the high-vacuum tubes unneces- 
 sarily affect deeper structures, and are on general principles 
 contraindicated when effects upon only the superficial .struc- 
 tures are necessary. 
 
 Acne of either the pustular or simple type is more 
 promptly cured by the X-ray than by any other method. 
 Success does not demand the employment of the X-ray to the 
 extent of producing a severe dermatitis. 
 
 Screening in the treatment of acne is a matter of par- 
 ticular importance, because to sacrifice the eyebrows, eye- 
 
268 STATIC ELECTRICITY. 
 
 lashes, and hair in an effort to remove a facial blemish would 
 detract from instead of improving the cosmetic effects. (See 
 Plate XII.) When the infection involves only the forehead 
 and front of the face, one exposure at a sitting will be sufficient. 
 In most cases, however, it is best to make two exposures, if 
 for no other reason than that the prominence of the nose, with 
 repeated exposures close enough to affect the sides of the face, 
 brings that organ so near the X-ray tube that it is liable to 
 suffer from marked dermatitis before the parts demanding 
 treatment derive the necessary effect. If, however, exposures 
 are made from the front, the nose should be screened. With 
 female patients who have an abundant growth of hair upon 
 the face the hair which soon replaces it after the X-ray ex- 
 posures are discontinued will be coarser and it is also apt to 
 be of darker color. Therefore screen the upper lip and sides 
 of the face when superfluous hairs are found to be present. 
 
 To screen the eyes and eyebrows, cut a piece of soft metal 
 to fit above the nose and large enough to cover the parts, and 
 secure it with a piece of tape. A soft metal shield should be 
 placed above the forehead and over the ears, and, at the same 
 time, a shield of the soft rubber composition should be so 
 placed as to protect the chest and shoulders of the patient. 
 
 The exposures should be made with the tube placed in such 
 a position that the plane of the anti-cathode will be relatively 
 parallel to the surface exposed, and at a distance of six to eight 
 inches when employing a low-vacuum tube, or ten to twenty 
 inches if a high-vacuum tube is used. The exposure should 
 be for ten minutes on alternate days for the first five ex- 
 posures, after which exposures may be continued twice weekly 
 until a slight blush appears, indicating a commencing der- 
 matitis, or, if no blush occurs, until the affection disappears. 
 It may, however, be necessary in exceptional cases to make 
 the exposures on alternate days again for a second and longer 
 period in order to obtain satisfactory results. 
 
 After the first dermatitis does appear, it may not be neces- 
 sary to make any subsequent exposures. If, however, the 
 affection is not cured, successive periods of exposure should 
 be made until a satisfactory result is finally effected. 
 
THE X-RAY IN AFFECTIONS OF THE SKIN. 269 
 
 In the intervals between the series of exposures the high- 
 frequency glass electrode should be applied to the surface 
 for its stimulating effect, thereby restoring the normal circula- 
 tion to the superficial structures of the skin. There is no rea- 
 son to believe that this plan of treatment should be followed by 
 any unfavorable effects. 
 
 The vacuum-tube application is to be preferred in these 
 cases to the brush-discharge, as the latter will produce a 
 roughened and thickened condition of the surface if used for 
 a long time. 
 
 The promptness with which the pustules cease to form 
 during a course of X-ray treatment is a source of satisfaction 
 and reassures the patient as to the ultimate success of the 
 treatment. 
 
 The following cases will illustrate the results of treatment 
 in which the above method was employed. 
 
 Miss C, a case of acne of three years' standing, in which 
 all other methods of treatment had failed, characterized by 
 the presence of deep pustules covering the sides of the face, 
 chin, and forehead. She was treated for six weeks daily with 
 the brush-discharge, with the result of lessening in a small 
 degree the tendency of new pustules to form, but the method 
 promised so little that the X-ray was substituted. After the 
 first five exposures, which were given on alternate days, no 
 new pustules formed, and at the end of three weeks a slight 
 dermatitis appeared, and the treatment was suspended for ten 
 days, after which the treatment was resumed twice weekly, and 
 at the end of two weeks disconinued, the disfigurement 
 having entirely disappeared. There has been no recurrence 
 of the trouble two years after discontinuance of the treat- 
 ment. 
 
 Mr. F., a case of the same type as the preceding, cover- 
 ing the back of the neck and shoulders, in which the affection 
 had been present for two years, and had stubbornly resisted 
 other treatment. The X-ray exposures were made for six 
 times on alternate days, after which twice weekly. Dermatitis 
 did not appear in this case to the end of six weeks, when every 
 indication of the disease had disappeared. It is now eighteen 
 
270 STATIC ELECTRICITY. 
 
 months since the treatment has be.en discontinued, and there 
 has been no indication Of its recurrence. 
 
 Case 3, Miss S., a case of simple acne covering both cheeks 
 and forehead, was exposed to the X-ray and the brush-dis- 
 charge administered on alternate days for three weeks ; at the 
 end of this time a slight dermatitis appeared, and the raying 
 was discontinued, but the brush-discharge was employed as 
 before. At the end of four weeks there were no pimples pres- 
 ent, but the skin had a roughened and scaly appearance. The 
 brush-discharge was then discontinued, and the face rayed 
 twice weekly, when, after two weeks' treatment, all indications 
 of the trouble had disappeared. 
 
 This case demonstrated to the writer's satisfaction that these 
 cases are best treated without the employment of the brush- 
 discharge. It has, however, been since demonstrated in the 
 treatment of other affections that the glass vacuum tube elec- 
 trodes are beneficial in stimulating the normal circulation, 
 and thereby offsetting the tendency of the X-ray to produce an 
 unnatural paleness to the surface. 
 
 The removal of superfluous hairs by the X-ray, as shown 
 in the effects upon the hair follicles resulting when treating 
 other pathological conditions, is naturally successfully accom- 
 plished but must be repeated many times to be finally suc- 
 cessful, and on the whole is not to be recommended.- The 
 process, if to be employed, must be pursued .in much the same 
 method as in the treatment of acne, making the exposures 
 practically the same, and at the same intervals, always discon- 
 tinuing the exposures for a time when a slight dermatitis 
 appears, or when the hairs have dropped out, as they will in 
 most cases after from four to eight weeks of exposures. The 
 treatment should be then suspended until the hairs begin to 
 reappear, as they will in from two to three months, when the 
 treatment should be resumed and carried out as previously. 
 If this plan is persevered in after a series of intervals, the hairs 
 will finally cease to recur. 
 
 This method of treatment has the disadvantage over epila- 
 tion of affecting the secretion of the sweat glands as well, but 
 in most cases, after the final'' discontinuance of the treatment, 
 
the x-ray in affections of the skin. 271 
 
 the sweat glands will recover their normal function, and the 
 object sought be practically attained. 
 
 Sycosis can be promptly cured by the employment of the 
 X-ray in connection with the use of the brush-discharge, the 
 X-ray to be used more energetically than in the treatment of 
 acne, it being desirable to induce an active first-degree der- 
 matitis. The brush-discharge may be applied daily to the 
 affected spots during the period of raying, continuing the appli- 
 cation each time until the skin is distinctly red. Satisfactory 
 results are obtained in most cases within a month. 
 
 Ulcers of all types will in most cases be promptly healed 
 by the application of the brush-discharge. The applications 
 should be made not alone to the ulcerated surface, but also to 
 the entire indurated area surrounding the ulcer, which 
 thereby overcome the local stasis and hasten recovery. The 
 promptness with which these cases are healed under this plan 
 of treatment will give satisfaction to those who have employed 
 other measures in the past. Undoubtedly the employment 
 of the X-ray twice weekly will assist in the treatment of these 
 cases. It should never be sought, however, to obtain any- 
 thing more than the stimulating effects of the X-ray. 
 
 Lupus. vulgaris had until the adoption of the light treat- 
 ment by Finsen generally resisted all former methods. It has 
 been demonstrated within the last three years, however, that 
 the X-ray associated with the brush-discharge, and in rare 
 cases the accessory employment of the light rays, succeeds 
 promptly' in the treatment of all cases. Most cases can be 
 cured with the X-ray without the addition of other measures. 
 Again, enough cases have already been cured' by the employ- 
 ment of the brush-discharge, without the aid of other meas- 
 ures, to establish its recognition as a valuable measure in the 
 treatment of all cases. 
 
 The violet and ultra-violet rays will succeed in these cases, 
 but require powerful currents or prolonged periods of ex- 
 posure, and are, therefore, more expensive than the X-ray 
 and brush-discharge. They are indispensable, however, in 
 saving indurated areas of the affection on marginal surfaces, 
 as the eyelid, lip, or lobe of the ear, when, if the X-ray were 
 
27: 
 
 STATIC ELECTRICITY. 
 
 employed, the part would break down and be sacrificed. The 
 violet light will undoubtedly cure most cases of lupus vul- 
 garis without the assistance of other means, but has the dis- 
 advantage of being a slow, tedious, and expensive process. It 
 is best, then, when possible, to employ the X-ray in connec- 
 tion with the brush-discharge, except in cases associated with 
 marginal indurated areas. 
 
 The brush-discharge in these cases in the writer's experi- 
 ence fails to successfully cope with the condition of deep in- 
 duration. 
 
 The X-ray when employed in the treatment of lupus vul- 
 
 Fig"- 1 3- — Lupus Vulgaris. 
 
 •garis should be used on alternate days with exposures of from 
 ten to fifteen minutes, usually employing a low-vacuum tube; 
 that is, a tube with which the fingers cast a dark shadow upon 
 the fluoroscope. The tube should be placed at a distance of 
 
THE X-RAY IN AFFECTIONS OF THE SKIN. 
 
 '-71 
 
 six to eight inches from the ulcerated surface. The surface 
 should be screened close to the margin of the affection and ex- 
 posures made until the affected surface shows a distinct break- 
 ing down, when the X-ray should be discontinued and the 
 brush-discharge employed daily until the effects of the previ- 
 ous employment of the X-ray shall have subsided. 
 
 The brush-discharge should be vigorously applied, mov- 
 ing it constantlv about over the affected surface until the 
 
 Fig. 14. — Result of Treatment with the Brush-Discharge. 
 
 healthy margin of the normal skin becomes distinctly red 
 from the administration. If after two weeks of this treatment 
 the surface still shows a marked degree of infection, the ray 
 should be again employed as before, and followed by the 
 brush-discharge. This plan, if pursued, will result, we be- 
 lieve, in curing the affection in the shortest possible time. If 
 the affected area is small, and it is desired to remove it with 
 
274 
 
 STATIC ELECTRICITY. 
 
 the least amount of scarring, the brush-discharge will effect- 
 ually remove the trouble. In the picture shown in Fig. 13 
 the patient was treated on alternate days for six weeks with the 
 brush-discharge with the result of absolutely relieving the 
 trouble, as is shown in Fig. 14. In this case the skin is per- 
 fectly normal, and absolutely no scar remains over the region 
 affected. The scar just beneath resulted from curettement 
 and the employment of carbolic acid in a former treatment of 
 the case. -This same patient was treated on alternate days 
 for the affection, as shown in Fig. 15, with the brush-dis- 
 
 Fig. 15. — Lupus Vulgaris. 
 
 charge. The treatment was persisted in for five months with 
 a marked improvement in all respects, except that the lobe of 
 the ear remained thick and indurated, and tender to pressure. 
 At the end of five months, four exposures were made to the 
 
THE X-RAY IN AFFECTIONS OF THE SKIN. 
 
 275 
 
 surface with the X-ray, as above, including the lobe of the ear, 
 when a distinct reaction was produced, and the danger of de- 
 stroying the affected portion of the ear was apparent. The 
 ear was accordingly covered, and the remainder of the face 
 subjected to three more exposures. In the meantime, the em- 
 ployment of the ultra-violet light daily from a condensing 
 focus lens using from twenty-five to forty amperes for the arc 
 
 Fig. 16. — Showing Marked Improvement. 
 
 light was instituted. All induration has disappeared, the dis- 
 coloration alone remaining (see Fig. 16). In this patient, the 
 surfaces have never become ulcerated during the course of 
 treatment. Otherwise, it would probably have been cured 
 by the brush-discharge, because the antizymotic action would 
 then have affected more deeply the diseased structures. The 
 results in the treatment of this case, which had resisted all 
 
2 76 
 
 STATIC ELECTRICITY. 
 
 measures since infancy, illustrate well the various features of 
 the technique applicable to the treatment of lupus vulgaris. 
 
 Lupus erythematosus, of the two types of lupus, is less 
 prompt to respond to the mixed X-ray, brush-discharge, and 
 light treatment, but invariably yields. The management and 
 prognosis as to ultimate recovery both are about the same 
 as in the treatment of lupus vulgaris. It has been demon- 
 strated in lupus erythematosus that the violet light will sue- 
 
 Fig. 17. — Lupus Erythematosus. 
 
 ceed in curing most, if not all cases ; but it is also demonstrated 
 that the combined employment of the X-ray and brush-dis- 
 charge will effect the same results generally in a shorter period 
 of time. On the other hand, when the affection involves 
 marginal structures, which is less frequent than in lupus vul- 
 garis, or when affecting the parts where it is desirable to pre- 
 serve the hair, the violet light may be judiciously emploved. 
 The case shown in Fig. 17 had been under treatment for 
 
THE X-RAY IN AFFECTIONS OF THE SKIN. 2~J 
 
 seventeen years in the clinics of the best specialists in New 
 York, and steadily grown worse. When he first presented 
 himself for treatment, the face was covered, as shown, with 
 thick, indurated blotches. There were also three spots in the 
 hair over the occipital region, and the margins of the ear 
 were in an ulcerating condition, and had been already par- 
 tially destroyed. The treatment by the brush-discharge was 
 begun and kept up for five months, at the end of which 
 time the X-ray was employed, and was at intervals during 
 a period of nine months. In this time the patient had rapidly 
 
 Fig. IS. — Result of Treatment. 
 
 improved, as shown in Fig. 18. During the application of the 
 brush-discharge there was marked improvement. The ears, 
 which were ulcerating and stiffened, became normal, and the 
 thinner portions of the affection disappeared. It was not, 
 however, until the X-ray was employed that the thicker in- 
 
278 
 
 STATIC ELECTRICITY. 
 
 durated portions began to yield, showing the necessity of its 
 employment. In the skin of the eyebrow of the left eye, in 
 which the affection had already destroyed most of the hair 
 follicles, it was deemed advisable to use the focused violet ray, 
 and the results have been very satisfactory. 
 
 Exposures, however, were made for ten minutes every sec- 
 ond day for at least six weeks before any marked improvement 
 was manifest. At this rate it would have required many 
 months of very prolonged exposures to effect a complete cure 
 of the case. The X-rays in this case have never been pushed 
 
 Fig. 19. — Lupus Erythematosus. 
 
 to the point of inducing a breaking down nor to the extent of 
 causing ulceration, and, except in a few instances, small scabs 
 have formed upon the surface. In another case, shown in 
 Fig. 19, the employment of the brush-discharge for six weeks 
 
THE X-RAY IN AFFECTIONS OF THE SKIN. 279 
 
 produced but slight improvement. The X-ray was then em- 
 ployed eight times on alternate days, as in the treatment of 
 lupus. In all eight exposures were made, when the affected 
 part broke down and sloughed profusely. During the slough- 
 ing, the brush-discharge was constantly employed, and in six 
 weeks the surface was completely healed. It will be found, 
 therefore, that under varying conditions the X-ray will affect 
 the cases differently. We believe, however, that with the com- 
 bined employment of the X-ray and brush-discharge, using 
 the latter at each administration until a distinct rubefacient 
 effect is produced upon the surrounding margins of normal 
 skin, satisfactory results will be obtained in all cases, and in less 
 time than from- the light treatment. 
 
 The treatment of epithelioma by the X-ray is one of the 
 greatest triumphs of this new agent. The success is already 
 universally conceded, and we believe that under a judicious 
 method of combined treatment the percentage of cures will in- 
 clude nearly all cases subjected to it. Here, as in the treat- 
 ment of lupus vulgaris, the greatest measure of success will 
 come from the employment of mixed methods, including the 
 three modalities — light, X-ray, and the brush-discharge. Sev- 
 eral cases of failure have been reported which we believe 
 might have been successful under a different modus operandi. 
 
 Let it be borne, in mind that the X-ray in these cases, as in 
 the treatment of lupus vulgaris, is employed for the pur- 
 pose of destroying the diseased tissue. It is accomplished 
 probably by cutting off the blood supply by induced contrac- 
 tion of the capillary and arterial circulation. At the same 
 time, the underlying and surrounding structures are subjected 
 to the same action of the' rays, producing in them a lowered 
 state of nutrition, which if the process of raying is kept up 
 indefinitely will not permit the restoration of the structures to 
 a normal condition. We believe that many cases reported 
 have failed to recover from the fact that the process of ray- 
 ing has been persisted in without reference to the peculiar ac- 
 tion of the X-rays upon the diseased and surrounding struc- 
 tures. In most cases where very small areas are affected, the 
 employment of the X-ray over a surrounding surface which 
 
280 
 
 STATIC ELECTRICITY. 
 
 is well screened does not interfere with the possibilities of 
 nutrition to such an extent that repair is interfered with, and 
 these cases recover uniformly under exposures for periods of 
 from six to eight weeks. When, however, a larger surface is 
 affected and the rays are used, the results are often differ- 
 ent unless other measures are employed, or prolonged periods 
 of rest intervene in the course of treatment. 
 
 It is in these cases that the application of some antiseptic 
 and stimulating measure as the brush-discharge has proved 
 of so much value. The application of the brush-discharge, 
 however, should he deferred until the tissues are breaking 
 
 
 
 Figs. 
 
 -Case of Epithelioma. 
 
 down, as they will in some cases, when there is invariably an 
 appearance of lowered vitality. If employed in connection 
 with the X-ray from the commencement of the treatment, its 
 effects will retard the progress of the case. 
 
 The case shown in Figs. 20, 21, and 22 illustrates well 
 the results of the judicious employment of the brush-discharge 
 in connection with the X-ray. This case was of ten years' 
 standing, having progressively increased to the condition 
 shown in Fig. 20. The X-rays were employed on alternate 
 days from a low-vacuum tube placed eight inches from the 
 affected surface, the surrounding tissues having been screened. 
 After eight exposures had been made the surface did not look 
 so well as when the first exposure was made, and the surround- 
 ing margin of the skin showed an evidence of marked der- 
 matitis. The exposures to the X-ray were then discontinued, 
 
THE X-RAY IN AFFECTIONS OF THE SKIN. 28 1 
 
 and the brush-discharge employed on alternate days to the 
 end of six weeks from the date of the first X-ray exposure. 
 At this time the appearance was as shown in Fig. 21. There 
 were a few spots of induration along the site of the margin of 
 the original opening, and also one point shown to the right 
 in the cut which had probably been covered with the screens to 
 some extent during the employment of the X-ray, and had not 
 healed. The X-ray was then employed as before, seven ex- 
 posures being made. The use of the brush-discharge was then 
 again resumed for three weeks with the result as shown in 
 Fig. 22. It is now two years since the last treatment of the 
 case, and there is no sign of recurrence. 
 
 To the present time the writer has treated and cured fifteen 
 other cases of epithelioma, in none of which there has been 
 an indication of recurrence, and in no case has failure followed 
 the treatment. 
 
 The case shown in Fig. 23 was a patient upon whom an 
 operation had been performed eight months previously for 
 epithelioma of the lip; an inch and a quarter of the lip had 
 been removed, and the growth had returned. At the time the 
 treatment was instituted there was an area of induration an 
 inch and a quarter in diameter, and two lines in thickness at 
 the thickest portion. The patient was unable to open his 
 mouth sufficiently to take but the smallest portion of food, 
 and it was difficult to determine whether it had not already 
 involved the bone beneath the tumor. The X-ray was em- 
 ployed from a tube of medium vacuum on alternate days for 
 five weeks, during which time remarkable improvement took 
 place. A dermatitis had been set up and treatment was dis- 
 continued, the patient disappearing for three months. When 
 he returned the central or thickest portion of the tumor had 
 disappeared, and the whole mass presented a remarkable 
 change. The induration at this time was most marked on the 
 regions which had been screened during the exposures, show- 
 ing the necessity of employing the screen judiciously in such 
 cases. In this case it is evident that better results would have 
 been obtained from the early treatment' had the whole chin been 
 exposed, and only the upper portion of the face been screened, 
 
282 
 
 STATIC ELECTRICITY. 
 
 as was done subsequently in the management of the case. 
 The patient made a progressive improvement toward recovery, 
 and again disappeared. Another observation may be made 
 from the results of this case, viz., that primary cases of 
 epithelioma are more promptly cured than those which have 
 been operated upon, and that the ulcerated surfaces permit 
 more rapid removal of the condition than in cases in which the 
 
 Fig. 23. — Epithelioma. 
 
 broken-down tissue must be removed by absorption. It will 
 also be observed that an epithelioma which does not ulcerate 
 with the possibility of the diseased tissue sloughing away 
 may be satisfactorily absorbed, and disappear under exposures 
 of the X-ray. A tube of higher vacuum will be required 
 where the affected tissues are beneath the superficial layers of 
 the skin, and not ulcerated. 
 
THE X-RAY IN AFFECTIONS OF THE SKIN. 283 
 
 Psoriasis is reported by many writers to have been favor- 
 ably affected by X-ray treatment, and on general principles 
 would be expected to improve. The writer has had good 
 results from the employment of the brush-discharge, and to 
 the present time has not employed the X-ray. If, however, 
 the X-ray is used, it should be employed as in the treatment 
 of acne, and the brush-discharge applied daily as soon as a 
 slight indication of dermatitis appears. When employing the 
 brush-discharge only, in the treatment of these cases, it is the 
 writer's custom to make the applications daily over the affected 
 area until a rubefacient effect is produced. It is not probable 
 that any local treatment will entirely eradicate this chronic 
 affection from the system of any patient. If, however, it re- 
 lieves the local manifestations, it will be a satisfaction to the 
 patient. 
 
 ' Eczema, like psoriasis, is probably a constitutional dis- 
 order, but the treatment of no affection will give greater sat- 
 isfaction to the physician than the treatment of eczema by the 
 combined employment of the X-ray and the brush-discharge. 
 Many cases have been clinically cured by the employment of 
 the brush-discharge alone. The pruritus is usually relieved 
 by the first local application, and all types of the affection are 
 cured if the treatment is persisted in. The employment of the 
 X-ray in connection with the brush-discharge hastens the ulti- 
 mate recovery. It should never be employed, however, oftener 
 than twice weekly, and if possible no dermatitis whatever 
 should be induced. To avoid this, make ten-minute expos- 
 ures with a medium vacuum tube at a distance of twelve to fif- 
 teen inches, at the same time give daily administrations of the 
 brush-discharge until the affection has entirely disappeared. 
 
 Keloids respond better to X-ray treatment only. Remark- 
 able results have been obtained in many cases. The rays here 
 should be used as in the treatment of epithelioma, following 
 up the procedure until dermatitis appears. In many cases the 
 result is all that could be desired. 
 
 Herpes is strictly a form of neuritis and yields to either 
 the wave-current or brush-discharge, and may be slightly 
 hastened by applications of the X-ray, as described in the treat- 
 
284 STATIC ELECTRICITY. 
 
 merit of acne. Here, as in the management of eczema, the ad- 
 ministration by both measures conjointly is indicated from the 
 commencement of the treatment. 
 
 The static applications in herpes should be made daily until 
 the eruption and pain have disappeared. If treated before the 
 stage of eruption in most cases it will not occur. 
 
CHAPTER VI. 
 
 THE X-RAY TREATMENT OF CONDITIONS 
 CHARACTERIZED BY DISTURBANCES OF 
 METABOLISM. 
 
 The action of the X-ray upon nutritive processes of a tonic 
 character is a subject deserving thoughtful study. 
 
 The classes of cases characterized by conditions of altered 
 metabolism include inflammatory processes, both acute and 
 chronic, in all of which, except the specific, vibratory in- 
 fluences properly administered have a potent effect toward the 
 re-establishment of normal conditions. Certain specific affec- 
 tions also which arise on account of the lowered conditions of 
 vitality, as tuberculosis, may also be benefited by the vibratory 
 effects upon nutrition associated with the induction of a more 
 active metabolism. The action of the X-ray is first to stimu- 
 late local conditions, which effect is marked when applied for 
 short periods at a distance relative to the intensity of the ray 
 employed, a greater distance being employed with tubes of high 
 vacuum. 
 
 It must be understood in order to appreciate the different 
 actions of X-rays, that excited under varying conditions the 
 qualities and characteristics vary as the musical scale. In 
 other words, the range at which the radiation is evidenced by 
 its effect upon the fluoroscopic screen, from the low-vacuum 
 tube, which will not show the bones of the hand, to the extreme 
 penetrating radiance of X-rays from a high-vacuum tube when 
 produced by an energizing source of great intensity, constitutes 
 variations more numerous than the musical scale. 
 
 Experience teaches that tissues may be stimulated to in- 
 creased functional activity or inhibited' to the extremity of pro- 
 ducing necrosis and death of the tissues by the Roentgen ray. 
 
 The destructive action of the X-ray occurring after long 
 exposures with low-vacuum tubes under intense currents of 
 large quantity, or of high-vacuum tubes similarly excited, has 
 
 Z8 5 
 
286 STATIC ELECTRICITY. 
 
 been demonstrated to produce curative effects under proper 
 regulation. 
 
 In the class of conditions under consideration it is the short 
 exposure with a high-vacuum tube, stimulating in character, 
 which induces tonic conditions with restored metabolic activity, 
 which has proved of great value. 
 
 Inflammatory conditions are influenced by the induction of 
 contraction by the rays, restoring tone, increasing circulatory 
 activity, and thereby overcoming local stasis. In order, how- 
 ever, to maintain a tonic condition and not produce the ex- 
 treme inhibitory effect of the action, which so far diminishes 
 the lumen of the arterioles as to produce local anaemia in the 
 tissues, requires a careful discrimination on the part of the 
 operator. High-vacuum tubes placed at a distance of fifteen to 
 twenty inches from the tissues are best for this purpose. The 
 exposures in these cases may be made on alternate days, but in 
 most cases two treatments weekly will be sufficient. The study 
 of the cumulative action and the requirements to bridge effects 
 is a subject of great interest with the X-ray as with static 
 administration, because it will determine results. 
 
 Acute inflammatory conditions are often favorably affected 
 by this plan of treatment. As a rule, however, better .results 
 are obtained with this class of cases from the static treatment, 
 as shown in the preceding chapters of this work. 
 
 The effect of the X-ray upon inflammatory conditions is 
 evidenced, as shown in a previous chapter, by the relief from 
 pain which, in many cases, so promptly follows the exposure. 
 The indications for its uses in inflammatory conditions are 
 only in the class of cases to which the static modalities cannot 
 be directly applied, as acute inflammatory conditions within 
 the peritoneal cavity and chronic or acute conditions of the 
 brain or spinal cord, in which it may be often difficult to demon- 
 strate the efficiency of the static modalities, especially in obese 
 and muscular adults, and also in deep facial neuritis. It may 
 also be employed in cases in which the other modalities have 
 failed. The principle of action upon which the improve- 
 ment will be anticipated will be as stated above — the lessen- 
 ing of the lumen of the arterioles and increased metabolism, 
 
X-RAY TREATMENT IN DISTURBED METABOLISM. 287 
 
 thereby shutting off the congested process, and inducing a 
 removal of local stasis. If, in these cases, the administrations 
 can be bridged with proper discrimination, favorable results 
 may be anticipated. 
 
 The following case will illustrate the principle : Mrs. 
 
 had suffered for eight years with chronic tic douloureux. Ex- 
 perience having taught the writer that the use of the static 
 modalities in such cases is unsatisfactory, he, accordingly, 
 determined to employ the X-ray. Four exposures were made 
 at intervals of three days, employing a high-vacuum tube at 
 twelve inches. After the second treatment, the pain had 
 ceased, and ten months since the last exposure there had been 
 no recurrence of the trouble. 
 
 There are numerous records of success from these exposures 
 in the treatment of internal inflammatory conditions, as in 
 chronic appendicitis. Fistulae, which had been open for 
 months or years, have been closed by this means. Inciden- 
 tally, it has been reported by various authorities that sciatica, 
 brachial neuritis, and other inflammatory conditions have been 
 greatly relieved when exposed to the X-ray. In the writer's 
 opinion, however, these conditions are always best treated by 
 the static modalities, which are uniformly successful with the 
 acute and chronic inflammatory conditions. 
 
 Locomotor ataxia has been treated recently by the em- 
 ployment of the X-ray, and the rationale of its action would 
 indicate its use in treating the' disease as an inflammatory 
 process, which it undoubtedly is. In making the exposures 
 for the treatment of tabes they should be made on alternate 
 days, and it is the writer's custom to place the tube alternately 
 over the lumbar vertebrae with the anti-cathode directed up- 
 ward, arid at the next exposure opposite the cervical or upper 
 dorsal with the anti-cathode directed downward, the object 
 being to project the rays from different directions with a view 
 to effecting a more uniform exposure of the whole length of 
 the cord. The exposures are made with high-vacuum tubes 
 at a distance of from twelve to twenty inches from the trunk 
 of the patient. 
 
 Tubercular affections when exposed to the X-ray should be 
 
288 STATIC ELECTRICITY. 
 
 treated with a view to restoring normal physiological condi- 
 tions, and improving the general resistance of the patient. 
 
 Pulmonary tuberculosis is reported in several instances to 
 have been cured by the employment of the X-ray in conjunc- 
 tion with hygienic measures. The modus operandi should al- 
 ways include all other measures which contribute to the gen- 
 eral health and improvement of the patient. The employ- 
 ment of static electricity, light, diet, outdoor exercise, and, 
 possibly, inhalations of ozone should be considered in the treat- 
 ment of every case. The X-ray in these patients is employed 
 as a stimulating tonic for the improvement of the general con- 
 ditions of the patient. The exposures should not on general 
 principles be made oftener than twice weekly, employing a 
 high-vacuum tube at a distance of from twelve to twenty 
 inches. It should be borne in mind that the resistance of the 
 tissues of tubercular patients is lowered, and that the X-ray 
 employed incautiously is liable to produce a dermatitis which 
 will increase, instead of diminishing, the chances of the pa- 
 tient's recovery. 
 
 In the treatment of tubercular joints there have been, un- 
 doubtedly, good results obtained from the employment of the 
 Roentgen ray. The cases published, however, do not show 
 conclusively what extent of exposure is demanded for the 
 treatment of the condition. The writer has had experience 
 in but few cases which lead to the conclusion that the effects 
 are derived from the influence of the X-ray upon congestion, 
 and the improvement of the local condition. The exposures 
 should be made upon alternate days or twice weekly at a dis- 
 tance of twelve to twenty inches, employing a high-vacuum 
 tube for the usual period of ten minutes, and never pushed to 
 the extent of producing a local dermatitis. The prognosis 
 will depend upon the extent of the invasion and the involve- 
 ment of the bony and ligamentous structures of the joint. 
 
 When bone is already involved and cannot be removed 
 surgically, it is impossible to expect to effect a satisfactory 
 result. It is only then in cases where the involvement is slight 
 that a favorable prognosis can be given, and in such it should 
 always be guarded. The general principles of the employ- 
 
X-RAY TREATMENT IN DISTURBED METABOLISM. 289 
 
 ment of the X-ray for its tonic effect, as suggested in the 
 treatment of the above conditions, will hold good in its applica- 
 tions to similar conditions, but there is not enough evidence at 
 present to confirm the notion that it should be generally em- 
 ployed in lieu of other measures which have proved effi- 
 cient. 
 
 It is probable that in most cases in which the X-ray is em- 
 ployed in the treatment of inflammatory conditions the 
 proper application of the static modalities would produce in- 
 finitely better results. 
 
 Hodgkin's disease has been demonstrated by various ob- 
 servers to have been clinically cured by the employment of the 
 X-ray. In these cases, the exposures should be made at a 
 distance of from twelve to twenty inches, employing a medium- 
 or high-vacuum tube for its tonic effect upon the structures. 
 When treating, exposures should be made directly over the 
 glands affected, and also over the trunk of the patient. This 
 may be done upon alternate days, giving daily exposures, and 
 taking care that the same portions of the body are not ex- 
 posed on succeeding days. If the exposures are made at 
 twenty inches from the body the danger of dermatitis will be 
 slight, and with a high-vacuum tube the effect will be to favor- 
 ably influence the condition. 
 
 Gumma tumors beneath the integument and possibly else- 
 where may be demonstrated in the future to be amenable to 
 local treatment by the X-ray. A case which recently came 
 under the writer's observation in which the diagnosis of the 
 tumors as of syphilitic origin were undoubtedly correct, one 
 upon the upper end of the sternum, and extending for two 
 inches upward upon and above the clavicle, and the other about 
 two inches in length over the lower third of the tibia, promptly 
 disappeared when exposed on alternate days for a short period 
 
 in all twelve exposures to the X-ray. These tumors were 
 
 exposed with the anti-cathode placed at a distance of twenty 
 inches from the integument over the tumors. No dermatitis 
 was induced, and the tumors began to diminish after the sec- 
 ond exposure. 
 
INDEX 
 
 Abdominal skiagraph, taking of, 
 191 
 
 tumors, X-Ray in, 236 
 Abrasions call for care, 78 
 Accessories to the X-Ray, 231 
 Acne, vacuum tube discharges and 
 X-Ray in, 269 
 
 pustular, two cases, 269 
 
 screening, for X-ray treatment, 
 268 
 
 simple case, 269 
 
 types of, treated by X-ray, 269 
 Acute inflammatory conditions, 
 
 X-ray in, 286 
 Adeno-carcinoma, case of, 249 
 Administrations, frequency of, im- 
 portant, 70 
 
 forms of, 27 
 Affections, peripheral, 124 
 Allen, Dr. A. H., 117 
 American apparatus, 1 
 Anaemia, treatment of, 152 
 Anaesthesia, areas of, 146 
 Angina pectoris, no 
 Anode, the anti-cathode, 176, 184, 
 
 193 
 Anterior poliomyelitis, 116 
 Anti-cathode, definition of, 161 
 
 in Jackson tube, 176 
 
 in X-ray tube, 161 
 
 of Crookes tube, 17s 
 
 over the center of the object, 
 
 193 
 platinum in, 184 
 the anode, 176, 184 
 thin platinum in, 184 
 Antiseptic, brush discharge, 47, 64, 
 
 76, 77 
 Aneurism, diagnosis of, by X-ray, 
 
 215 , . , 
 
 Apparatus, friction machine, 6 
 
 of d'Arsonval, 3 
 
 X-ray, 167 
 Argyll-Robertson pupil, 105 
 Arthritis, rheumatoid, 83-90, 91, 
 92 
 
 osteo-, go, 91 
 Asthma, 130 
 Athetosis, prognosis of, 129 
 
 Atrophy of the skin produced by 
 
 X-ray, 207, 267 
 Auto-infection from absorption of 
 
 toxins, 238, 239 
 
 Baking an X-ray tube, 179, 180, 
 
 279 
 Beck, Dr., on X-ray dermatitis, 
 
 232 
 Bell's palsy, 119 
 
 Biliary calculi, localization of, 213 
 Blanched spot when spark is ap- 
 plied, 64 
 Blepharospasm, 125 
 Bony prominence, landmark in 
 
 development, 212 
 Box, illuminated, for studying a 
 
 skiagraph, 200 
 Brachial neuritis, 99 
 Breeze, technique of, 34 
 
 physiological actions of, 34 
 Bridging defined, 70 
 
 importance of, 70 
 
 in sciatica, 99 
 Bright's disease, 153, 154 
 Bruises, 77, 78 
 Brush-discharge, actions of, 64 
 
 advantage of, 36 
 
 an unfortunate term, 36 
 
 and X-ray, 272 
 
 as a term, 35 
 
 and X-ray in lupus erythemato- 
 sus, 275, 277 
 
 choice of polarity, 37 
 
 electrodes, wood for, 38 
 
 grounding for, 36 
 
 heating electrodes for, 37 
 
 in brachial neuritis, 99 
 
 in congestions of the liver, 154 
 
 in connection with the X-ray. 
 272 
 
 in dermatology, 132 
 
 in functional insanity, 149 
 
 in gout, 82 
 
 in inflammatory diseases, 77, 78 
 
 in lupus, 272 
 
 in paralysis, 122 
 
 in psoriasis, 283 
 
 in epithelioma, 280 
 
 291 
 
292 
 
 INDEX. 
 
 Brush-discharge in herpes, 284 
 in lupus vulgaris, 273 
 in torticollis, 129 
 invaluable in skin diseases, 132, 
 
 134 
 method of application in lupus, 
 
 2 73 
 method of application in skm 
 
 diseases. 135 
 physiological actions of, 64, 
 
 134 
 when most effective, 36 
 pole employed, 37 
 source of, 36 
 
 special electrodes for, 38, 39 
 technique of application, 36. 37 
 vs. breeze and spray, 64 
 
 Bull, Dr. W. T., 242 
 
 Burns, deep X-ray, 233 
 
 Cage, static, 15 
 
 Calculi, best skiagraphed by coil. 
 211 
 biliary, 213 
 development of the negative for, 
 
 212 
 diagnosis of, by the X-ray, 210 
 two skiagraphs necessary, 213 
 Cancer of the uterus, jacketed 
 cavity tube in, 199 
 of the bladder, X-ray in. 264 
 of the bladder, Dr. Cleaves' 
 
 jacketed tube in, 265 
 of the breast, method of ex- 
 posure in, 254 
 of the breast, case of, 25s 
 of the breast, recurrent, 254 
 of the face, X-ray in, 241 
 of the female breast, 253 
 of the larynx, 250 
 of the larynx, treatment pro- 
 longed, 251 
 of the pelvis, 258 
 of the pharynx, X-ray in, 193 
 of the rectum, X-ray in, 264 
 of the soft structures, 241 
 of the tongue, X-ray in, 252 
 of the uterus, 258 
 of the uterus', case of, treated by 
 
 X-ray, 258, 259 
 of the uterus, jacketed cavity 
 
 tube in, 259 
 of the uterus, preoperative ray- 
 ing, 259 
 Cardialgia, 109, no 
 Care of the machine, 18 
 Case of static machine closed 
 against moisture, 10 
 
 Cataphoresis practically impossi- 
 ble, 62 
 
 Cathode concaved, 176 
 stream, definition of, 160 
 
 Cauterization impossible, 67 
 
 Chair holder, 14 
 operating, 12 
 
 Change in faradic batteries, 3 
 
 Charcot, Morton a student of. 28 1 
 
 Charging the machine, methods 
 employed. 23, 24 
 the machine, provision favorable 
 for, 234 
 
 Chemical action insignificant, 62,. 
 121 
 
 Chlorosis, 152. 153 
 
 Chorea, 126 
 
 Classification of static modalities,. 
 27 
 of subjects, plan of. 70 
 
 Cleaves. Dr., water rheostat of r 
 
 Si 
 X-ray tube for bladder treat- 
 ment, 265 
 Coccygodynia, prognosis and 
 
 treatment of, 106 
 Cohn, Dr. Sigismund, 142 
 Coil, advantages of, 171 
 and static machine, relative 
 
 merits of, 171. 172 
 best for skiagraphing calculi,. 
 
 170. 171 
 demanded, 170 
 disadvantages of, 172 
 employing large ampere cur- 
 rents, 170 
 employing small ampere cur- 
 rents, 170 
 for soecial X-ray work, 170 
 for X-ray, 169 
 
 important features of. 169, 170 
 interrup'.ers, 173 
 Coley, Dr. W. B., 241 
 Coley's serum treatment, 242 
 Conclusion, 156 
 Conductive discharge, 27, 48 
 Congestion diminished by X-ray, 
 
 221 
 Congestions of the liver, 154, 155 
 Conservatism in radiotherapy nec- 
 essary, 218 
 Constipation, 142, 143, 144 
 Contact with street current to be 
 
 avoided, 25, 26 
 Contraction of protoplasm by 
 X-ray, 221, 222, 23s, 266 
 produced by X-ray, 221, 222, 
 23S, 266 
 
INDEX. 
 
 293 
 
 Contractions, muscular structures 
 by X-ray, 222, 235, 266 
 pathological muscular, 123, 124 
 Contracts before X-ray treatment, 
 
 225 
 Contracture in hysteria, 145 
 
 treatment of, 128 
 Contractures, cause of, 124, 128 
 
 from paralysis, 121 
 Convective discharges, 27 
 forms of administration, tech- 
 nique, 33 
 Convulsive tic, 125 
 treatment of 125 
 Cossor" tube, modification of, 250 
 Crookes, Sir William, 175 
 Crookes tube, 175 
 
 anti-cathode of, 17s 
 Cumulative effects of the X-ray, 
 
 223, 227 
 Current controller, 15, 51 
 Currents of great frequency of 
 d'Arsonval, 3 
 of high-frequency and small 
 quantity having frequency of 
 oscillation under control ver- 
 sus currents of d'Arsonval, 
 
 3 
 
 of Morton, 48 
 Current, voltage of, 9 
 Currents, relative merits of, 2 
 
 Damp house objectionable, 18 
 Danger of X-ray in internal can- 
 cers, 257 
 Dark room, 19s 
 
 light to be employed, 195 
 D'Arsonval apparatus, 3, 52 
 Deep X-ray burns, 233 
 Dermatitis from the X-ray, 232 
 Dermatology, 132 
 
 brush-discharge in, 132 
 
 wave-current in, 132 
 
 high-frequency in, 132 
 Detail greater from low vacuum 
 
 tubes, 187 
 Developed plate quickly dried, 200 
 Developing a plate to bring out 
 detail, 212, 213 
 
 sensitized paper, 189 
 
 sensitized paper, method of, 198 
 
 solution, 197 
 Development, extent to carry, 198 
 
 fixer, use of, 199 
 
 in dark room, 198 
 
 of skiagraph, 198, 212 
 
 use of retarder, 198 
 Diabetes mellitus, 153 
 
 Diagnosis of calculi, 210 
 Diathesis, rheumatic and gouty, 79 
 Dislocation, 79 
 Disruptive discharges, 27, 28 
 
 methods, 28, 32 
 Distance of tube in X-ray ther- 
 apy, 226 
 Distortion, 191 
 
 how to prevent, 192 
 
 reasons for, shown, 191 
 Dosage, how regulated, 69 
 Dr. Cleaves' small jacketed tube 
 
 in cancer of the bladder, 265 
 Dr. Massey's method in cancer of 
 
 the rectum. 264 
 Drying a developing plate, 200 
 Du Bois-Reymond's law, 62 
 
 qualifications of, 62, 63 
 Dysmenorrhea, 138 
 Dyspepsia, nervous, 148 
 
 Earliest type of tubes, 177 
 Eczema, treatment by brush-dis- 
 charge, 283 
 
 treatment by X-ray, 283 
 Effects, constitutional, of static-in- 
 duced current insignificant, 65 
 
 constitutional, of various mo- 
 dalities, 65 
 
 local, of sparks, 64 
 
 local, of wave-current. 63 
 
 of brush-discharge in derma- 
 tology, 132 
 
 of currents of small quantity, 
 great frequency, and high 
 potential, 62 
 
 of friction sparks, 66, 75 
 
 of intervening material between 
 surface of patient and elec- 
 trode, 35 
 
 of static electricity upon 
 phthisis, 77, 151 
 
 of static modalities upon hyper- 
 aemia, congestion, and pain 
 important, 71, 73, 74 
 
 of static modalities upon germ 
 life, 77 
 
 of the wave-current on secre- 
 tions, etc., 64, 66 
 
 of the X-ray upon photographic 
 plates, 161 
 
 on pain of tabes, neuralgia, and 
 migraine, 104, 106, 11 1 
 
 tonic, of wave-current, 63 
 
 upon circulatory apparatus, 65 
 
 upon contusion, sprains, syno- 
 vitis, etc., 77 
 
 upon necroses, 75 
 
294 
 
 INDEX. 
 
 Effects upon nervous irritability, 
 
 6 S 
 upon respiration, 65 
 
 upon tuberculosis, TJ 
 Electric heater for drying, 20 
 Electrification interrupted, 38 
 Electrode balls, 13 
 
 brush, 35 
 
 crown or tassel, 34 
 
 point for breeze, 15 
 
 position of, for wave current, 57 
 
 roller, use of, 14 
 
 size of, 58 
 Electrodes cut in various shapes 
 to conform to parts, 89 
 
 for wave-currents, 57 
 
 material of, 58 
 
 necessary, 11 
 
 of wood, for brush-discharge, 38 
 
 special, for high-frequency, 43, 
 
 44, 45, 46 
 special, for wave-current, 58 
 thickness of metal for, 58 
 when employing the wave-cur- 
 rent, 57 
 
 Electrolysis practically impossible, 
 62 
 
 Elimination increased, 66 
 
 Empyema, 215 
 
 Enlarged glands, effects of the 
 X-ray on, 238 
 
 Engines, gas and gasoline, 16 
 
 Epilepsy, treatment of, 124 
 
 Epilation, 270 
 
 Epithelioma, treatment by X-ray, 
 279, 280, 281, 282 
 
 Experiment with mouse, 67 
 
 Exophthalmic goiter, treatment of, 
 
 155 
 Exposures at right angle, 209 
 length of, in skiagraphy, 194 
 method of, in cancer of the 
 breast, 255, 256 
 
 Files interrupter, 168 
 
 First epoch of the history of the 
 X-ray, 157 
 
 Fixer used in development, 199 
 
 Fixing in the process of develop- 
 ing, 199 
 
 Fixing the sensitized paper, 202 
 
 Fluorescence, 163 
 
 Fluoroscope, 181, 182 
 not a definite test of the quality 
 of the rays, 187 
 
 Focus of the X-ray tube, 185 
 
 Foreign bodies, method of locat- 
 ing, 208 
 
 Forms of administration, 2 
 Fractures, 79 
 
 and dislocations, X-ray in, 208 
 Franklin, Benjamin, 28 
 Friction sparks of great value in 
 
 locomotor ataxia, 104 
 Friedlander shield, 262 
 
 Gastralgia, 109, no 
 Gastroptosis, 148 
 
 Geissler pattern of vacuum tubes, 
 40 
 tubes, 40 
 Geissler tubes first used with high 
 frequency, 42 
 tubes for high-frequency dis- 
 charges, 42, 43, 44, 45, 46 
 tubes, long, 41 
 Germ life affected by high fre- 
 quency and brush-discharge, 
 47 
 not affected by X-ray, 223 
 secondarily affected by X-ray, 
 223 
 Gibson, Dr. J. D., 134, 151 
 Glands, removal of, 238 
 Glass impervious to X-ray, 184 
 lead in X-ray tubes, 184 
 of X-ray tubes, 184 
 thickness in X-ray tubes, 184 
 Glazed appearance of surface 
 
 after X-ray, 221 
 Gleet, 141, 142 
 Goiter, exophthalmic, 155 
 
 simple, 156 
 Gout, method of treatment, 82, 83 
 Grad, Dr. Herman, 256, 263 
 Great value of currents adminis- 
 tered with patient insulated, 
 
 Green color of fluorescence of the 
 
 X-ray tube, 161 - 
 Ground connections, 25, 59 
 Grounding, methods of, 25 
 Gumma tumors treated by the 
 
 X-ray, 289 
 
 Hair follicles affected by the 
 X-ray, 221, 266 
 
 Hair, removal of superfluous, 270 
 
 Hay fever, 130 
 
 Headache, in 
 
 Heart displacements and hyper- 
 trophy, diagnosis of, 215 
 
 Heating the tube to reduce resist- 
 ance, 186 
 
 Hedley, Dr., 1 
 
 Herpes, treatment by brush-dis- 
 charge, 284 
 
INDEX. 
 
 295 
 
 Herpes, treatment by X-ray, 283 
 Hiccoughs, 126 
 
 High-frequency administrations in 
 connection with the X-ray, 232 
 administrations with a coil, 40 
 in skin affections, 132 
 and X-ray in acne. 132. 269 
 as administered with the Files 
 
 interrupter, 133 
 physiological actions of, 46, 134 
 discharges, 39 
 discharge, Geissler and vacuum 
 
 tubes with, 40 
 High-frequency discharge, method 
 of administration with, 41 
 discharge, origin of term, 39 
 effects upon germ life, 47 
 spark-gap essential to, 41 
 therapeutics of, 47 
 use of, with coil, 42 
 High tube gives best definition, 
 
 187 
 High-vacuum tube increases pene- 
 trating quality of the X-ray, 
 187 
 X-ray tube, 187 
 Hodgkin's disease, treatment by 
 
 X-ray, 289 
 Holtz machine, 67 
 Hospital, static electricity in, 4 
 Humidity controlled by cooling 
 operating room, 21 
 effect of, on wave-current, 60 
 Hygrometer, 17 
 Hyperemia and congestion, 72, 73, 
 
 74, 75 
 Hypochondriasis, 146. 147, 148 
 
 treatment of, 148 
 Hysteria, 145, 146 
 
 Idiosyncrasy of patient, 68 
 to the X-ray, 230 
 
 Idiosyncrasies individual to the 
 X-ray, 158 
 
 Illustrative cases, two of epithe- 
 lioma, 219, 220, 221, 222 
 
 Impotency, 140 
 
 Important features of an X-ray 
 coil, 168 
 
 Incandescent bulb covered in dark 
 room, 196 
 
 Indications for preoperative ray- 
 ing, 237 
 for therapeutic employment of 
 the X-ray in malignant dis- 
 ease, 237 
 for treatment of X-ray derma- 
 titis, 233 
 
 Individuality of X-ray tubes, 183 
 Inflammatory conditions, 72, 73 
 
 classifications of, 72, 73 
 
 technique of treating, 74 
 
 X-ray treatment of, 286 
 Influence of amperage on the 
 
 X-ray, 166 
 Insane asylum, static electricity in, 
 
 4. 
 Insanity, functional, 148, 149 
 Insomnia, 144 
 
 Instantaneous skiagraphy, 195 
 Insulated platform, 57 
 Insulation interrupted versus 
 
 wave-current, 34 
 Intensity of radiation and high- 
 vacuum tube, 187 
 Interior construction of static ma- 
 chine, 21 
 Internal cancers, X-ray in, 256 
 Interrupted electrification, 33 
 Interrupter, Files, 168, 173 
 
 Willyoung, 174 
 
 mercury jet, 175 
 
 series, 172 
 
 static, 172 
 Interrupters, break wheel, 174 
 
 coil, 173 
 
 construction, material of. 172 
 
 electrolytic, 173, 174 
 
 mechanical, 175 
 
 use of, with low vacuum tube, 
 186, 187 
 
 used with X-ray apparatus, 172, 
 173 
 
 Wehnelt, 174 
 
 Jacketed cavity tube, 250, 264 
 in cancer of the uterus, 2=Q 
 Jackson, Herbert, 176 
 Jeffries, Dr. F. M., report on case 
 of sarcoma, 264 
 
 Keloids, treatment by X-ray, 283 
 
 Large ampere currents give larger 
 volume of radiation, 187 
 with X-ray tube, 187 
 
 Laryngitis, tubercular, 152 
 
 Length of exposure, table of rela- 
 tive, 194 
 X-ray therapy, 226 
 
 Length of exposures in skiag- 
 raphy, 194 
 
 Length of spark-gap relative to 
 effect sought, 186 
 
 Leyden jars for static-induced 
 current, 12, 61 
 
29^ 
 
 INDEX. 
 
 Light employed in dark room, 195 
 Liver, congestions of the, 154, 155 
 
 enlargements, diagnosis' of, 216 
 Local anaemia produced by the 
 
 X-ray, 222 
 Localization of foreign bodies, 
 
 207, 208 
 Localizing screen, 210 
 Locomotor ataxia, aetiology of, 100 
 
 indications and treatment, 102 
 
 pathology of, 101 
 
 prognosis of, 102 
 
 symptoms of, 101 
 
 treated by X-ray, 287 
 Low vacuum X-ray tube, 185, 186 
 Lupus, brush-discharge in, 272, 
 276, 277, 278 
 
 erythematosus by X-ray, 275 
 
 erythematosus, treatment of, 277 
 
 vulgaris, 271 
 
 vulgaris, treatment by X-ray 
 and brush-discharge, 272 
 
 Machine, location of, 18 
 Malignant disease of the bone, 240 
 Massey, Dr. G. Betton. 264 
 Medical profession skeptics, 4, 07 
 Medico-legal aspect of the X-ray, 
 
 225, 226 
 Melancholia, 148 
 Metabolism affected by X-ray, 222, 
 
 223 
 increased by static modalities, 66 
 Metal plate, position of. 191 
 Metastasis not due to the X-ray., 
 
 239 
 Method of developing X-ray 
 
 plates, 198 
 Method of exposure in cancer of 
 
 the breast, 254 
 Migraine, in, 112, 113 
 Modalities, in spasmodic torticol- 
 lis, high potential, 130 
 Modified Cossor tube, 250 
 Moisture absorbed by calcium 
 
 chloride, 19 
 absorbed by cracked ice and 
 
 salt, 19 
 absorbed by quicklime, 19 
 Morton, Dr., preface, 48, 51 
 Morton currents, 48 
 Motors, 16 
 Muffler for use with spark-gap, 
 
 IS, 16 
 with wave-current, use of, 60 
 Muscular contraction, induced, 63, 
 " 64 
 contractions, 123 
 
 Muscular contractions, classifica- 
 tions of, 123 
 contractions, indications of, 123 
 contractions, treatment of, 124 
 spasm relaxed, 63, 64 
 Myalgia, method of treatment, 
 
 82 
 Myasthenia gastrica, ISS 
 
 Necrosis produced by the X-ray, 
 
 221, 223 
 Negative, development of, by cal- 
 culi, 212 
 Nephralgia, 109 
 Neuralgia, 106 
 
 facial, 107 
 
 intercostal, 107 
 
 of testicle, in 
 
 of the rectum, ill 
 
 ovarian, no 
 
 plantar, 109 
 
 symptoms of, 106 
 
 treatment of, 106 
 
 visceral, 109 
 Neurasthenia, 138, 139 
 
 sexual, 139 
 
 symptoms of, 137 
 
 treatment of, 138 
 Neuritis, 95, 96 
 
 brachial, 99 
 
 treatment of pelvic, etc., 98, 99, 
 100 
 
 facial, 100 
 
 within the pelvis, 98 
 Neuroses, occupation, 127 
 
 occupation, treatment of, 127 
 
 painful, 95 
 
 painful, general conditions of, 95 
 
 psychical and functional, 136, 
 137 
 
 Occupation neuroses, 127 
 
 (Edema following fracture, 75 
 surgical, 75 
 
 One-pole current, 53 
 electrifies -the whole body, 53 
 
 Operating chair, a convenience, 12 
 
 Orthopedic appliances in treat- 
 ment of contractures, 28 
 
 Osier, Dr., 109 
 
 Osteo-arthritis, diagnosis of, 90 
 treatment of, 91 
 
 Otitis media, treatment by high 
 frequency, 46 
 
 Ovary, neuralgia of, no 
 
 Ozone attacks hard parts of ma- 
 chine, 19 
 inhalations, 77 
 
INDEX. 
 
 297 
 
 Pain, local, relieved, 57 
 
 in tabes, 104, 105 
 Palsy, Bell's, 119 
 Paralysis, 114 
 
 caused by brain lesions, 114 
 
 contractures from, 121 
 
 diet in, 120 
 
 due to congestive lesions, 05 
 
 facial, 119 
 
 from syphilis, 120 
 
 from traumatism, 115 
 
 general treatment of, 114 
 
 peripheral, 119 
 
 trophic centers in, 120 
 
 wave-current in, 117. 121 
 Pathological changes induced by 
 
 the X-ray, 221 
 Pa'ient comes skeptical, 67 
 
 management of, when employ- 
 ing wave-current, 60 
 Patients aroused by accidents, 60 
 
 become drowsy, 69 
 
 intimidated, 67 
 
 should be relieved at first sit- 
 ting, 68 
 Patient's comfort to be consulted, 
 60 
 
 fears, how calmed, 67 
 
 lassitude. 65 
 
 say-so important, 70 
 Penetrating quality of the rays 
 greatest in high-vacuum tube, 
 187 
 
 qualities of the X-ray, 161, 187 
 Penetration of X-ray, 162, 163 
 Pennington shield, 261, 262 
 Peripheral affections, 124 
 Physical characteristics of the 
 
 X-ray, 161 
 Physiological actions of high-fre- 
 quency. 46 
 
 actions of X-ray, 220-224 
 
 effect of currents, general, 62, 66 
 Placing a sensitized plate in de- 
 veloper, 198 
 Plates, double-coated, 188 
 Platform, 12, 57 
 Podalgia, 109 
 Polarity, change of, 25 
 
 how determined, 25 
 
 of wave-current for administra- 
 tion, 59 
 
 varying effects of, 59 
 Poliomyelitis, anterior, treatment 
 
 of, 116 
 Posturing the subject, 189 
 Preoperative raying, 237 
 
 disadvantages of, 237 
 
 Preoperative raying, indications 
 for, 237 
 
 Principles, general, of static ad- 
 ministration, 67 
 
 Printing frame, 201, 202 
 from sensitized paper, 201 
 
 Process of making a skiagraph, 189 
 
 Prostatitis, 140, 141 
 
 Protoplasm contracted by the 
 X-ray, 221 
 
 Psoriasis by X-ray, 283 
 treatment by brush-discharge, 
 283 
 
 Pulmonary tuberculosis, treatment 
 by X-ray, 288, 289 
 
 Pus cavities, diagnosis of by 
 X-ray, 215 
 
 Quality of radiance, 164 
 
 of the tube in skiagraphy, 184, 
 185, 208 
 
 Radiation, volume of greater, with 
 large ampere currents, 187 
 volume of the rays increased by 
 interrupters, 167, 185 
 Radiography, 7 
 derivation of term, 160 
 stereoscopic, 202 
 Radiotherapy, application of term, 
 160 
 conservatism in, 218 
 dangers in, small, 257, 258 
 interest awakened in, 217 
 introduction, 217 
 Raying, preoperative, 237 
 Reaction during X-ray exposures, 
 
 238 
 Rectum,' neuralgia of, in 
 Reflexes abolished, 105 
 Relation of amperage to volume of 
 
 radiance, 187 
 Relative merit of coils, 168 
 merit of currents, 2 
 merit of static machine and coil 
 for X-ray, 171, 172 
 Removal of glands, 238 
 Renovation of machine, 21 
 Resistance lowered, as tube be- 
 comes warm, 186 
 reduced by heating the tube, 186 
 Retarder used in developing, 198 
 Rheophore when administering 
 
 the wave-current, 57 
 Rheumatism, method of treat- 
 ment, 79, 80, 81, 82 
 Rheumatoid arthritis, method of 
 treatment, 88 
 
2 9 8 
 
 INDEX. 
 
 Rockwell, Dr. A. D., 154 
 Roentgen ray, 160 
 Roentgen's discovery, 157, 158, 160 
 Roller, 14 
 
 Rubefacient, brush-discharge, 76 
 Ruby incandescent bulb, 196 
 lamp in dark room, 196 
 
 Sarcoma of the face, case of, 241 
 of the uterus, case of, treated by 
 the X-ray, 203 
 Sciatica, 96 
 
 spark-gap, regulation in, 97. 98 
 Sciatica, treatment of, 96 
 Screening for treatment of acne, 
 267 
 in X-ray treatment, 168, 228. 
 229, 260 
 Screens for X-ray use, 169, 170, 
 
 182 
 Second epoch of the history of the 
 
 X-ray, 158 
 Secretion made active, 64 
 impaired, 144, 145 
 usually at first inactive in neu- 
 rasthenia, 144 
 Self-toning paper or sensitized 
 
 paper, 163; 201 
 Seminal vesiculitis, 142 
 Sensitive conditions over the ver- 
 tebral column, 142 
 Sensitized paper, conditions of, 
 201 
 development of, 202 
 fixing of, 202 
 self-toning, 201 
 use of, 189 
 Sensitized plate, placing sheet of 
 
 metal beneath, 191 
 Sensitized plates, 188, 198 
 choice of, 188 
 plates, care of, 188 
 extra sensitive, 188 
 Series ball interrupter increases 
 volume of radiation, 167, 185 
 Sheet of metal beneath the sensi- 
 tized plate, 191 
 Shield, Friedlander, 261 
 Pennington, 261, 262 
 Size of electrodes, 58 
 
 relative to effect sought, 58 
 Skiagraph, a positive, 201 
 care and development for cal- 
 culus, 195 
 development of, 19s 
 ' how to study, 200, 201 
 method of making, 189 
 not a negative, 201 
 
 Skiagraph print, a negative, 201 
 
 process of making, 189 
 
 taking an abdominal, 191 
 Skiagraphing stone in the bladder, 
 
 214 
 Skiagraphs, two, important for 
 
 stone in the kidney, 21 1 
 Skiagraphy, derivation of, 160 
 
 instantaneous, 195 
 Skiascopy, definition of, 160 
 Skin diseases, constitutional treat- 
 ment of, 132 
 
 X-ray. and accessories in, 266 
 Solution for developing, 197 
 Souffle technique, 34 
 Spark-gap, a measure of vacuum 
 of tube, 185, 186 
 
 currents of Dr. Morton, 48 
 
 distinctive features of all static 
 currents as sjiown by Morton, 
 48 
 
 essential to high frequency, 41 
 
 in blepharospasm, 121 
 
 in convulsive tic, 125 
 
 in epilepsy, 124 
 
 in prostatitis, 140 
 
 regulation of, in sciatica, 97, 98 
 Spark length regulated in various 
 ways, 59 
 
 Leyden-jar technique, 28, 32, 61 
 Sparks, classified, 31 
 
 direct technique of, 31 
 
 employment of, 76 
 
 friction, 31 
 
 friction, in neurasthenia, 145 
 
 friction, in occupation neuroses, 
 127 
 
 friction, technique of, 31 
 
 friction, value in locomotor 
 ataxia, 104 
 
 in brachial neuritis, 90 
 
 in contractures, 128 
 
 in hiccoughs, 126 
 
 indirect technique of, 31 
 
 in functional insanity, 149 
 
 in hysteria, 146 
 
 in neurasthenia, 145 
 
 in paralysis, 121 
 
 in sciatica, 97 
 
 in spasmodic torticollis, 129 
 
 in torticollis, 129 
 
 Leyden-jar, 31 
 
 negative or positive, 28 
 
 painful over bony prominences, 
 30 
 
 painful to breasts, genitals, and 
 finger nails, 30 
 
 physiological action, 64 
 
INDEX. 
 
 299 
 
 Sparks, rows of, 30 
 short and friction, in tremors, 
 
 130 
 to hollows or angles, 30 
 Spasm, clonic and tonic, 123 
 Spasmodic conditions, 123 
 
 dysmenorrhea, 138 
 Speed controller, 15, 16 
 Spondylitis deformans, 92, 93, 94 
 Sprains, JJ 
 
 Spray intensity increased by 
 woolen cloth, 33 
 physiological action, 35 
 technique, 33-35 
 Spray with brush electrode for 
 
 inducing timid patient, 33 
 Square and level for localizing, 
 
 209 
 Stand electrode in headache, 113 
 Static and coil circuits compared, 
 170 
 bath, 33 
 cage, objections to employment, 
 
 34 
 cage, technique of employment, 
 
 34 
 cage versus wave current, 34 
 current, 52 
 induced current, 53 
 currents in constipation, 142 
 electricity in insane asylums 
 
 and hospitals, 4 
 electricity, physiological actions, 
 
 62 
 electrification, 33 
 induced, a two-pole current, 53 
 induced current, history of. 49 
 induced current in constipation, 
 
 x 43 
 induced current, Leyden jars 
 
 for, 50 
 induced current, value of for 
 
 local treatment, 51 
 induced current most adaptable 
 
 of two-pole currents, 53 
 induced current, physiological 
 
 action of, 65 
 induced current, technique of, 
 
 49, SO 
 insulation, 23 
 insulation in functional insanity, 
 
 149, 
 interrupters, 172 
 machine, advantages of, 171 
 machine, disadvantages of, 172 
 machine for X-ray work, 167 
 machine, general consideration 
 
 of types, 6, 7, 8, 167 
 
 Static machine in well-equipped 
 
 office, 157, 170 
 machine preferred for X-ray, 
 
 170 
 machine, test of excellence, 11, 
 
 167 
 machines, location of, 118 
 machines, renovation of, 21 
 machines, test of efficiency, 167 
 modalities considered to be 
 
 placebos, 67 
 modalities, constitutional effects, 
 
 6 S 
 modalities, local effects, 63, 64, 
 
 65 
 modalities preferred in inflam- 
 matory conditions, 74 
 Static resonator, 134 
 Stereoscope, radiographic, 204 
 Stereoscopic radiography, 202 
 
 not practical, 206 
 Stone in the bladder, method of 
 
 skiagraphing, 214 
 Stone in the kidney, 213, 214 
 Studying a skiagraph in a dark 
 
 room, 201 
 a skiagraph in an illuminated 
 
 box, 200-201 
 Summary of constitutional action, 
 
 66 
 Superfluous hairs, removal of, by 
 
 X-ray, 270 
 Surfaces glazed by the X-ray, 221 
 Sweat glands affected by the 
 
 X-ray, 266, 267 
 X-ray action on, 266, 267 
 Swelling currents in constipation, 
 
 143 
 Sycosis, 270 
 Synovitis, treatment of, 94 
 
 Tanning from X-ray, 229 
 
 Target, 161 
 
 Technical consideration of adjust- 
 ment of tube, 226 
 
 Terms hard, soft, and medium 
 hard, 161, 185 
 
 Tesla transformer, 167 
 
 Tesla, Oudin, and d'Arsonval 
 resonator, 173 
 
 Testicle, neuralgia of, ill 
 
 Tetanus induced, 63 
 
 Therapeutic uses of the X-ray, 
 
 J 74 r , 
 
 Third epoch of the history of the 
 
 X-ray, 158 
 Tic-douloureux, 107, 287 
 chronic X-ray treatment of, 287 
 
300 
 
 INDEX. 
 
 Tissues lowly vitalized destroyed 
 
 by X-ray, 232 
 Toepler-Holtz machine, 7, 8 
 Tonic effect of X-rays from high- 
 vacuum tube, 223 
 
 effects from the X-ray, 223 
 Torticollis, 129 
 
 spasmodic, 129, 130 
 Toxaemia resulting from X-ray 
 
 necrosis, 222 
 Transformers, step-up, 134 
 
 street-current, 3 
 Trays used in development, 197 
 
 various sizes, 197 
 Treatment of tubercular joints by 
 X-ray, 288 
 
 of X-ray dermatitis, 232 
 Tremors, 130 
 Tube, adjustable, 177 
 
 choice of, 191 
 
 clamp, 179 
 Tube, Crookes, 175 
 
 distance of. 226 
 
 low-vacuum, 161 
 
 modified Cossor, 251, 261 
 Tube-holders, essential features 
 in, 181 
 
 X-ray, 181 
 Tubercular affections treated by 
 the X-ray, 288 
 
 enteritis, 152 
 
 joints and glands, 152, 288 
 
 laryngitis, 152 
 Tuberculosis, 150, 151, 288 
 Tubes, individuality of, 183 
 Tumors, diagnosis by X-ray, 214 
 " Two-pole " current, a relative 
 term, 53 
 
 static-induced current, S3 
 
 Ulcers, treatment by the X-ray, 
 
 271 
 Use of the jacketed tube, 259 
 
 Vacuum and Geissler tubes, rela- 
 tive value of, 43 
 electrode, various types of, 40- 
 
 46 
 of tube best determined, 186 
 of tube measured by the spark- 
 gap, 185, 186 
 of X-ray tubes, 185 
 terms applied to, 161 
 tubes, Geissler pattern of, 40 
 tubes, technique of employment, 
 
 "Variation and penetrating power 
 of X-rays, 185, 186, 187 
 
 Vesiculitis, seminal, 142 
 Vibration, X-ray form of, 220 
 Vigoreaux, 28 
 Violet and ultra-violet rays, 231, 
 
 271 
 rays in connection with the 
 
 X-ray, 231 
 Vitality of all tissue lowered by 
 
 the X-ray, 222 
 Voltage, measure of, for static 
 
 currents, 9 
 of currents. 9 
 Volume of radiation, 186 
 
 Washing the plate before fixing, 
 
 199 
 Watches to be removed, 60 
 Water and gas pipes for ground- 
 ing, 25, 26 
 Wave-current, a one-pole current, 
 2. S3, 54, 55, 56 
 
 effect of on secretions, etc., 132 
 Wave-current, effects upon hyper- 
 semia and congestion and pain 
 discovered, 57 
 
 excites activities, 66 
 
 history of, 54, 56 
 
 in anaemia, 152 
 
 in asthma, 130 
 
 in angina pectoris, no 
 
 in anterior poliomyelitis, 117 
 
 in blepharospasm, 125 
 
 in Bell's palsy, 119 
 
 in Bright's disease, 153 
 
 in coccygodynia, 107 
 
 in congestions of the liver, 154 
 
 in constipation, 142 
 
 in contractures, 128 
 
 in convulsive tic, 125 
 
 in dermatology, 132 
 
 in diabetes mellitus, 153 
 
 in dysmenorrhea, 138 
 
 in epilepsv. 124 
 
 in exophthalmic goiter, 158 
 
 in facial neuralgia, 107 
 
 in functional insanity, 147 
 
 in hiccoughs, 126 
 
 in hypochondriasis, 148 
 
 in hysteria, 143 
 
 in insomnia, 144 
 
 in locomotor ataxia, 104 
 
 in myasthenia gastrica, 158 
 
 in neuralgia, 106 
 
 in occupation neuroses, 127 
 
 in paralysis, 117 
 
 in prostatitis, 140 
 
 in rheumatoid arthritis, 87, 88, 
 89 
 
INDEX. 
 
 301 
 
 Wave-current in sciatica, 96, 97 
 in seminal vesiculitis, 142 
 in sexual neurasthenia, 140 
 in simple goiter, 156 
 in spasmodic torticollis, 129 
 intensified by connection em- 
 ploying Leyden jar, 56 
 intensified by external capacity, 
 . 55, 56 
 
 in torticollis, 129 
 in tremors, 130 
 in tuberculosis, 151 
 in tuberculous joints and 
 
 glands, 152 
 local effects, 63 
 modifications, 55, 58 
 modifications compared, 60 
 modifications, static - induced 
 
 preferable, 56 
 physical action of, 53 
 physical local effect. 53 
 technique, 57, 58, 59, 60 
 tonic effects of, 53, 65, 66 
 versus brush-discharge 64 
 versus interrupted insulation, 34 
 versus static cage, 34 
 
 Wehnelt interrupter, 174 
 
 Wesley, John, administered 
 sparks, 28 
 
 Wet clothing and certain fabrics 
 absorptive, 30 
 
 Williams, Dr., Holtz machine, 163 
 
 Willyoung interrupter, 174 
 
 Wimshurst machine, 7 
 
 Wood for brush-discharge elec- 
 trodes, 36 
 
 Woolen cloth or paper intensifies 
 discharges, 31 
 
 Working up the tube, 186 
 
 Wrist movement when adminis- 
 tering sparks, 30 
 
 Wry neck, 129 
 
 X-ray, absorbed, 161 
 
 accessories to, 231, 266 
 
 action on sweat glands, 266 
 
 an invisible force, 220 
 
 and accessories in skin diseases, 
 266 
 
 and brush-discharge in treat- 
 ment of lupus erythematosus, 
 275 
 
 and brush-discharge in treat- 
 ment of lupus vulgaris, 272 
 
 apparatus, 183 
 
 auto-infection, 239 
 
 burns, deep, 233 
 
 cause atrophy of the skin, 222 
 
 X-ray coils, 168 
 contraction diminishes blood 
 
 supply, 222 
 cumulative action of, 223, 227 
 cumulative effect of, 227 
 dermatitis, treatment of, 232 
 dermatitis, types of, 232 
 effect on hair follicles, 221 
 effect on local stasis, 223 
 effect on sweat glands, 221 
 effect upon metabolism, 223 
 effects not due to high-potential 
 
 discharges, 220 ■ 
 effects on germ life, 223 
 effects on living tissue, 247, 248 
 effects on ulcerated surface, 222 
 effects upon protoplasm, 221, 
 
 222, 235, 266 
 epochs of, 157, 158 
 exposure, frequency of, 227 
 exposure, length of, 226 
 exposure, length of, in skiag- 
 raphy, 194 
 exposure, making of, 194 
 first destroys low-vitalized tis- 
 sues, 222, 236 
 form of vibration, 220 
 for removal of superfluous 
 
 hairs, 270 
 idiosyncrasies, 218, 230 
 in abdominal tumors, 236 
 in acute inflammatory condi- 
 tions, 286 
 in cancer of the face, 241 
 in cancer of the female breast, 
 
 253. 254 
 in cancer of the pelvis, 258 
 in cancer of the pharnyx, 253 
 in cancer of the uterus, 258 
 in chronic tic-douloureux, 287 
 in connection with the brush- 
 discharge, 272 
 in connection with the vacuum 
 
 tube discharges, 269 
 in connection with the ultra-vio- 
 let rays, 231, 271 
 indications for therapeutic em- 
 ployment, 237 
 in malignant diseases of the 
 
 bone, 240 
 in psoriasis, 283 
 in the treatment of acne, 267, 
 
 269 
 in the treatment of herpes, 283 
 in the treatment of epithelioma, 
 
 279 
 in the treatment of gumma 
 tumors, 289 
 
3°2 
 
 INDEX. 
 
 X-ray in the treatment of herpes, 
 
 283 
 in the treatment of Hodgkin's 
 
 disease, 289 
 in the treatment of keloids, 283 
 in the treatment of locomotor 
 
 ataxia, 287 
 in the treatment of pulmonary 
 
 tuberculosis, 288 
 in the treatment oi sarcoma and 
 
 carcinoma, 235, 239 
 in the treatment of tubercular 
 
 affections, 288 
 in the treatment of tubercular 
 
 joints, 288 
 lessens congestion, 221 
 lowers the vitality of tissue, 222, 
 
 236 
 medico-legal aspect of, 225, 226 
 metastasis not due to, 239 
 nomenclature, 160 
 pathological changes caused by, 
 
 223, 224 
 penetrating qualities of, 161, 162 
 physical characteristics of, 161, 
 
 221 
 physiological effects of, 220 
 plates, method of enveloping, 
 
 188 
 plates, preparation of, for use, 
 
 188 
 produces contraction, 221 
 produces local anaemia, 222 
 producing atrophy of the skin, 
 
 221 
 product of electrical discharges 
 
 in proper vacuum, 220 
 quality of in skin diseases, 267 
 refracted, 161 
 relative penetrability of tissue, 
 
 207 
 relieves pain, 221 
 screens, 229, 230, 231, 267 
 slightly reflected, 161 
 stand, 180, 181 
 stimulating effects of, 223 
 tanning, 229 
 therapeutic uses of, 225 
 therapy, distance of tube in, 226 
 therapy, frequency of exposure 
 
 in, 227 
 therapy, length of exposure in, 
 
 226 
 tonic character of, 223 
 treatment of cancer of the 
 
 tongue, 252 
 treatment of inflammatory con- 
 ditions, 286 
 
 X-ray treatment of ulcers ; 271 
 treatment, Screening in, 228 
 
 267 
 tubes, 183-185 
 tube, adjustment of, 183 
 tube adapted to various appara- 
 tus, 184 
 tube, baking, 179 
 tube, best general purpose, 185 
 tube, characteristics of, 184, 
 
 185 
 tube, choice of, in skiagraphy, 
 
 191, 208 
 tube, distance in skiagraphy, 193 
 tube, early type of, 177 
 tube, features of construction, 
 
 183, 184, 185 
 tube, focus of, 185 
 tube, glass employed, 184 
 tube, hard, 160 
 tube, high vacuum, 161, 185 
 tube-holder, 179, 180, 181 
 tube, individuality of, 183 
 tube, Jackson type of, 176 
 tube, low vacuum, 161, 185 
 tube, metal parts of, 184 
 tube, modified Cossor, 251 
 tube, position of, to prevent dis- 
 tortion, 191 
 tube, properly focused, 185 
 tube, quality of best, suited to 
 
 skiagraphy, 184, 185 
 tube, regulating, 177 
 tube, resistance within, 186 
 tube, special, for cancer of the 
 
 larynx, 250, 251 ' 
 tube, special, for large ampere 
 
 currents, 184, 185 
 tube, short-lived, 184, 185 
 tube, size, a bulb, 177 
 tube, soft, 185 
 
 tube, vacuum determined, 185 
 tube, vacuum of, 185 
 tube, various types of, 183-185 
 tube warmed, resistance low- 
 ered, 186 
 tube, water cooling, 177 
 tube with smaller coils, 170 
 tube with static machine, 167 
 tube, working up, 186 
 unknown, 160 
 
 vibrations not electrical dis- 
 charges, 22 
 X-rays, intense, give best defini- 
 tion, 187 
 of large volume produce great- 
 est local effect, 259, 262 
 rich in number, 186