Short Wave Diathermy 9780231890502 Compress

SHORT-WAVE DIATHERMY
Short-Wave Diathermy
BY
TIBOR deCHOLNOKY
Associate in Surgery, New York Post-Graduate
Medical School, Columbia University
New York : Morningside Heights

COLUMBIA UNIVERSITY PRESS
1937
COPYRIGHT, 1937, BY COLUMBIA UNIVERSITY P R E S S
Printed tn the United State* of America
FOREIGN AGENTS
OXFORD UNIVERSITY PRESS, Humphrey Milford, Amen
House, London, E.C.4, England, and B. I. Building, Nicol
Rood, Bombay, India; KWANG HSUEH PUBLISHING
HOUSE, 140 Peking Road, Shanghai, China; M ARUZEN COM-
PANY, LTD., 6 Nihonbaahi, Tori-Nichome, Tokyo, Japan
PREFACE
DURING the past eight years approximately 7 5 0 articles, books

and other publications have appeared, dealing with short-wave
diathermy, the majority of these being in foreign languages.
It is only within very recent years that investigators in the
United States, although the first in the field, have set themselves
the task of studying short-wave currents in their experimental
and therapeutic application, and of analyzing the reports com-
ing from abroad, as well as of verifying the findings reported.
It must be admitted that since the start was made, the results
have been creditable.
There is little question of the value of short waves as a
therapeutic agent in some pathological conditions, although
their efficacy in others is still a matter of controversy, and
subject to further study and development. Many, perhaps
exaggerated, claims have been made as to the therapeutic value
of short-waves, some by the ubiquitous overenthusiastic prac-
titioner, but most, unfortunately, by manufacturers and sales-
men of short-wave apparatus, these only serving to throw what
will eventually emerge as an invaluable aid in therapy, into
temporary disrepute. Such undiscriminating enthusiasm is to
be deplored in any field of endeavor, but particularly so where
the fate of human health and well-being is at issue. Advances in
science are not made by uncontrolled rush of emotion, but
by balanced reason conjoined with experience. At the same time,
what is radical today may be conservative tomorrow. What is
needed now is a tolerant attitude toward those who are laboring
to bring this most significant of contributions to physical
therapy out of the mists of uncertainty, through which all new
things pass, into the clarity of scientific exactitude.
It is my hope that in offering to the medical profession this
outline of the subject in its present state of development, with
the survey of the laboratory and clinical work that have so far
been carried out, a dual purpose will be served: that the book in
itself will be of service to the profession, proving useful as a
vi PREFACE
guide to the application of short-wave diathermy; and that it
will also serve as a stimulus to the further study which is so
badly needed. There is no evading the fact that short waves
are proving the most significant contribution of recent times to
the application of electricity in medical treatment.
I take pleasure in expressing my deep gratitude to Dr.
Hermann Fischer for affording me liberal opportunity to pursue
this study, on ample clinical material. My thanks go to Dr.
Francis Carter Wood for the use of the Crocker Research
Laboratory for experimental work, and to Drs. H. M.
Marvin, Walter S. Galland, Erich Schwarzkopf, and H. W.
Kohler for their criticism and helpful comment. I am especially
happy to acknowledge my indebtedness to Dr. Ldszl6 Telkes,
who was kind enough to help me with the collection of this
material. Finally, I wish to express my appreciation of the
editorial assistance rendered me by Miss Lucile Grebenc in the
preparation of this work for the press.
T I B O R DE C H O L N O K Y
N E W YORK CITY
January 2, 1937
CONTENTS
PREFACE v
PART I. INTRODUCTION
I . H I S T O R I C A L O U T L I N E OF S H O R T - W A V E D I A T H E R M Y 3
P A R T I I . T H E P H Y S I C A L A S P E C T S OF
I I . T H E P H Y S I C A L A S P E C T S OF S H O R T - W A V E D I A T H E R M Y . 9
Principles of construction of short-wave machines; spark-gap and
tube machines; measurements
PART III. EXPERIMENTATION WITH

I I I . E X P E R I M E N T S ON B A C T E R I A AND O T H E R ORGANISMS 27
Bacteria (staphylococci, streptococci, bacillus coli, tubercle
bacillus, typhoid bacillus, gonococci, other microorganisms, general
discussion); unicellular organisms; experiments on toxins; viruses;
venom; plants
I V . E X P E R I M E N T A T I O N ON A N I M A L S 40
Effect of short-wave treatment on growth and reproduction; action of
different wave lengths on tissue; physiologic effects of short waves;
biological effects of short waves; effect of short waves on blood and
serum; action of short waves on electrolytes and colloids; local tissue
changes; inflammation; temperature regulation after short-wave
diathermy (temperature measurement)
V. WAVE LENGTHS 67
Wave lengths for short-wave diathermy; microwaves; specific effect,
or specificity
P A R T IV. T H E T E C H N I C OF SHORT-WAVE
DIATHERMY
V I . SHORT-WAVE TREATMENTS 77
Effect of short waves on prominent parts; inconvenient effects of ex-
posure to short waves; contraindications to short-wave diathermy;
surgical application of short waves (preoperative and postoperative);
combination of short waves with other forms of treatment (drugB,
VU1 CONTENTS
surgical, physiotherapeutic, mechanotherapeutic measures, irradia-

tion therapy, diets, opotherapy as required, etc.); electropyrexia;
short-wave diathermy as compared with diathermy (differences)
V I I . GENERAL AND MECHANICAL PRINCIPLES IN SHORT-WAVE

TECHNIC 97
Burns and their prevention; electrodes for short-wave diathermy
(rigid electrodes, flexible electrodes, size of the electrodes, shape of the
electrodes, technic of application, principles of application)
PART V. T H E C L I N I C A L A P P L I C A T I O N S OF
SHORT-WAVE D I A T H E R M Y
V I I I . INFECTIOUS, ALLERGIC AND METABOLIC DISEASES . 119

General considerations; infectious diseases (the common cold, pneu-
monia, pulmonary tuberculosis, erysipelas, erysipeloid, actinomyco-
sis); allergic diseases (bronchial asthma); diseases of metabolism and
of the ductless glands (gout, obesity, diabetes mellitus, disorders of the
endocrine function)
I X . DISEASES OF THE RESPIRATORY TRACT 130

Laryngitis; bronchitis; bronchiectasis; emphysema; pleurisy;
empyema; abscess of the lung; pulmonary gangrene; technic of treat-
ment
X . DISEASES OF THE GASTRO-INTESTINAL TRACT . . . . 143

The oral cavity (the dental structures, tonsillitis); spasm of the
esophagus; the stomach; (gastritis, peptic ulcer, gastric neuroses); the
intestines; the biliary passages; technic of treatment
X I . DISEASES OF THE GENITO-URINARY TRACT 155

The urinary tract (cystitis, pyelitis, nephritis, perirenal abscess; tech-
nic of treatment); the female genital tract (pelvic inflammation and
infections, dysmenorrhea); the male genito-urinary tract (gonorrheal
urethritis, diseases of the prostate, miscellaneous diseases, technic of
treatment)
X I I . DISEASES OF THE CIRCULATORY SYSTEM AND THE LYMPH

GLANDS 171
The circulatory system (the heart); the vascular system; the lymph
glands (tuberculous adenitis, Mikulicz' disease, noncontagious paro-
titis)
X I I I . DISEASES OF THE LOCOMOTOR SYSTEM 184

The muscular system (tendovaginitis, bursitis); the bones (periostitis,
osteomyelitis); the joints (arthritis, tuberculosis, technic of treatment,
general comment); traumatic injuries
X I V . DISEASES OF THE NERVOUS SYSTEM 200

Neurosyphilis; neuritides; migraine; miscellaneous nervous conditions
CONTENTS ix
(impairment of motility, Parkinson's disease, syringomyelia, epilepsy,
mental disease, brain abscess, hiccup, urinary incontinence of nervous
origin, neuroma); comment
X V . MISCELLANEOUS CONDITIONS 211

Diseases of the skin (furuncle, carbuncle, axillary sweat-gland in-
fection and abscess, paronychia, cellulitis, and other infections of the
extremities, phlegmon, miscellaneous diseases of the skin); diseases
of the head (inflammatory disease of the sinuses, diseases of the eye,
diseases of the ear, mastoiditis); mastitis
X V I . MALIGNANT DISEASE 244
PART VI. CONCLUSION
X V I I . CONCLUSION 251
BIBLIOGRAPHY 257
ABBREVIATIONS 295
INDEX 301
ILLUSTRATIONS
1. Molecular Dipoles between Condensor Plates; Electric Field

Intensity Zero 12
2. Molecular Dipoles between Condensor Plates; Electric Field
Applied 12
3. Schematic Representations of Electrolites and Dipoles; Align-
ment in the Electric Field 12
4. Parallel Connection of Resistance and Capacity . . . . 13
5. Series Connection of Resistance and Capacity 13
6. Schematic Spark-gap Oscillatory Circuit 14
7. Damped Electric Oscillations 15
8. Inductive Coupling between Two Electric Circuits . . . 16
9. Galvanic Coupling; Generator (primary) and Patient (secon-
dary) Circuit 17
10. Undamped Oscillations 18
11. Vacuum Tube Oscilator; Tuned Plate Circuit Type . . . 19
12. A Typical One-Tube Electric Oscillator 21
13. Rotating Neon Tubes of Different Oscillations: a, A Rotating
Neon Tube Indicating Uninterrupted Undamped Oscilla-
tions Delivered by a Machine with Vacuum Tube Delivering
Uninterrupted Undamped Oscillations; b, A Rotating Neon
Tube Indicating Interrupted Undamped Oscillations Ob-
tained from a Machine with 2 Vacuum Tubes; ç, A Rota-
ting Neon Tube Indicating Interrupted Undamped Oscil-
lations of a Machine with One Vacuum Tube Disconnected 22
14. Vasodilatation in the Swimming Membrane of a Frog: a,
Before Short-Wave Treatment; b, After Short-Wave Treat-
ment (E. Pflomm, Archiv fur klinische Chirurgie, CLXVI
[1931], 259) 60
15. Proper and Improper Application of Electrodes: Nose; a, Im-
proper Application, Causing Current Concentration; b,
Proper Application, Preventing Current Concentration 79
16. Proper and Improper Application of Electrodes: Knees: a,
Improper Application, Causing Current Concentration; b,
Proper Application, Preventing Current Concentration 100
17. Superficial Skin Burns, Caused by Faulty Application of
Electrodes: a, Burns, Caused by Heat Coagulation on
xii ILLUSTRATIONS
Prominent Points; b, The Same Lesions Healed, without
Permanent Scar Formation 101
18. Current Dispersion by the Unipolar Method 104
19. Current Dispersion by the Bipolar Method 104
20. Inductotherm 105
21. Glass-Shoe Electrodes 107
22. Special Electrodes: a, Vaginal; b, Breast; c and d, Sinus and
Tonsil 108
23. Flexible Electrodes 110
24. Roentgenograms, Showing Tuberculous Exudate of Six
Months' Duration, in a Grave Case of Pulmonary Tuber-
culosis: a, Before Short-Wave Diathermy; b, After 6 Short-
Wave Treatments within 4 Weeks (E. Raab, Kurzwellen
Therapie, Berlin, 1934) 123
25. Roentgenograms, Showing Gangrenous Interlobar Empyema:
a, The Gross Size of the Lesion and Its Position, before
Short-Wave Treatment; 6, Seven Weeks after Short-Wave
Diathermy. The Lesion Is Barely Distinguishable and the
Patient Has Been Discharged from the Hospital. (Courtesy
of E. Schliephake) 135
26. Roentgenograms, Showing Absorption of Lung Abscess: a, A
Fluid Level Is Distinguishable below the Clavicle in the
Right Upper, Indicating a Large Abscess in the Apex of
the Upper Lobe; b, After 3 Weeks of Short-Wave Treatment,
the Lesion Has Practically Cleared Up (Courtesy of E.
Schliephake) 137
27. Roentgenograms, Showing Gangrenous Abscess of the Lung:
a, Wedgelike Area of Density Present at Base of Right
Upper; b, On the Sagittal View, a Fluid Level Is Plainly
Distinguishable, Indicating Drainage through a Bronchus;
c, After 18 Days There is Almost Complete Disappearance
of the Lesion, Following Short-Wave Diathermy (Courtesy
of E. Schliephake) 139
28. Roentgenograms, Showing Dental Granuloma: a, Before
Short-Wave Treatment ; b, After 6 Short-Wave Treatments
(E. Schliephake, KurzweUentherapie, 1932) 145
29. Roentgenograms, Showing Recurrent Postoperative Marginal
Ulcer: a, An Arrow Indicates a Sharply Defined Niche of
Marginal Ulcer; b, Following a Course of Short-Wave
Diathermy, the Niche Is No Longer Discernible . . . . 149
30. Bartholin's Gland Abscess: a, Before Treatment by Short-
Wave Diathermy; 6, After Treatment by Short-Wave
Diathermy . . . 163
ILLUSTRATIONS xiii
31. Roentgenograms, Showing a Case of .Gonorrheal Arthritis: a,
Before Treatment by Short-Wave Diathermy; b, After 2
Months' Treatment by Short-Wave Diathermy (E. Pflomm,
from E. Schliephake, KurzweUentherapie, 1932) . 191
32. Furuncle of the Chest Wall: a, Before Treatment by Short-
Wave Diathermy; b, Four Days after Treatment by Short-
Wave Diathermy (6-Meter Waves) 214
33. Multiple Axillary Sweat-Gland Abscesses: a, Before Treat-
ment by Short-Wave Diathermy; b, After 4 Treatments by
Short-Wave Diathermy; c, After 12 Treatments by Short-
Wave Diathermy (Fourteen Days Later the Infection
Cleared Up, Leaving Very Little Scar Formation) 224
34. Special Rigid Electrodes, for Treating Axillary Abscess 225
35. Palmar Abscess in a Diabetic: a, Before Treatment by Short-
Wave Diathermy; b, After Treatment by Short-Wave
Diathermy 229
36. Roentgenograms, Showing Multiple Chronic Sinusitis: a, Be-
fore Treatment by Short-Wave Diathermy; b, Twenty-five
Days after Treatment by Short-Wave Diathermy (In 27
Days There Was Great Improvement; in 6 Months the
Patient Was Symptom-free) 236
37. Short-Wave Treatment with Breast Electrode 243
38. Action of Short Waves on Rat Tumors 246
PART I
INTRODUCTION
I
HISTORICAL O U T L I N E OF SHORT-WAVE
DIATHERMY
E L E C T R I C I T Y as a phenomenon has intrigued man since the

time of Thales, about 600 B.C., but it has been put to practical
use only within the past century. Its therapeutic application is
of even more recent date, it having gained a place in the medical
armamentarium about four decades ago. Within this short space
of time, advances in physics have been notable and have had, as
might be expected, direct or indirect effect upon this phase of
the application of electricity. The latest development in this
direction has been the new form of treatment known as short-
wave diathermy, using high-frequency currents.
The first studies in this field were made by James C. Maxwell
in 1865 and in 1887 Hertz published his discovery, based on
Maxwell's theoretical considerations. Hertz found that if a
spark jumps between two conductors as the result of different
potentials, the opposite potentials do not neutralize in a simple
way, but oscillations can be detected. These oscillations were
extremely rapid and produced electromagnetic waves which
were invisible and which had the characteristics of light waves
—that is, they could be sent through space. Fedderson was able
to demonstrate the oscillatory character of neutralization by
spark by means of a revolving mirror. This was the beginning
of radio transmission in general, and of the development of the
spark-gap transmitter in particular.
With this device a high-frequency current was generated.
The work of Nicolas Tesla in 1891 was the start of biological
experimentation along these lines. He was the first to record
the fact that heat production resulted from "bombardment of
the high frequency alternating current," and to point out the
possibility of its utilization for medical purposes. At the same
time d'Arsonval, using the same current (approximately one
4 HISTORY OF SHORT-WAVE DIATHERMY
million oscillations per second), began to experiment on animals
and human beings. Although he was successful in demonstrating
a marked decrease in the toxicity of the diphtheria toxin after
its exposure to the high-frequency current, and noted heat as
an inconvenient by-product, the attention of the medical world
was not immediately attracted. He may also be considered the
first to have used condenser electrodes with higher frequencies
than those later used in diathermy. Present-day diathermy
machines were developed from his apparatus. In 1898 von
Zeyneck used the high-frequency current to produce heat
within the organism, and was followed in this by von Berndt
and other workers. The method consists in placing two large
flat metal electrodes, in the two designated areas, directly upon
the body surface. To this form of treatment Nagelschmidt
applied the term "diathermy" and demonstrated its value. A
voluminous literature was the direct result of this remarkable
accomplishment.
The oscillation of this current was about one million. It was
only recently, with advances in the domain of radio transmis-
sion, that it became possible by using sufficient power, to in-
crease considerably the number of oscillations. This initiated
new research, starting with Stiebock in 1925, who used currents
of much higher frequencies (8 million) for therapeutic purposes.
The electrodes were, however, still in direct contact with the
patient and the procedure was therefore still a form of dia-
thermy.
Antedating this work by a year, Gosset and his co-workers
in 1924 constructed an apparatus for experiments, which pro-
duced 150 million oscillations (2-meter waves); they reported
the destructive effect of the high-frequency current upon plant
tumors caused by Bacterium tumefaciens.
Schereschewsky published his findings in 1926. He put the
object to be treated in a condenser, through which a high
frequency current was sent. The electrodes were insulated plates,
thus introducing a dielectric between the object treated and the
metal electrodes. He found that small animals, such as mice,
died within a very short time when placed in the condenser
field. Flies dropped dead at once under the influence of these
HISTORY OF SHORT-WAVE DIATHERMY 5
oscillations. In the fancy of the daily press, this was in-

terpreted as a new form of "death ray." The result of further
experimentation was published by Schereschewsky in 1928,
and demonstrated, he believed, the positive curative action
of these high-frequency currents on malignant rat and fowl
tumors.
In the course of research on radio transmitters, certain heat
effects in the vicinity of the antennae were noted. Hosmer's
physiological experiments revealed heat between the plates
through which the high-frequency current flows, substantiating
the effects noted by others. It is of interest that he warns
against the general use of this heat so produced,
as we cannot predict with certainty just where the extreme local heating
might occur before the general body temperature gave sufficient warn-
ing. The serous cavities would seem to offer the optimum condition for
such local heating, endangering the adjacent tissues.
One of the most prolific investigators in this field is Schliep-
hake, who started his remarkable work in 1926, and with
whom Esau and Patzold were associated. Esau succeeded in
solving the problem of generating high-frequency wave lengths
up to 100 million oscillations and more, of power sufficient to
have appreciable biological effects in the condenser field.
The first therapeutic application in human beings was made
by Schliephake upon himself, using air-spaced electrodes such
as are used today, by which he cured a furuncle on his nose.
He can therefore be considered the creator of short-wave dia-
thermy. At about the same time the short-wave broadcasting
station of the Vatican started experimentation to ascertain the
effects of these waves on growing plants. In 1930 Hinsie and
Carpenter, in the United States, studied the effects produced
by high-frequency oscillations, about 10 million (30 meters),
on general paralysis. These studies were followed by further
work by other investigators, among them Saidman, Pratt and
Sheard, Mortimer and Bierman.
The publication of early work in this field, briefly touched
upon in these paragraphs, started an avalanche of research on
the subject, with a voluminous aftermath of literature. It would
be impossible, within the scope of a brief chapter, to follow the
6 HISTORY OF SHORT-WAVE DIATHERMY
different lines along which the many investigators worked, or
to evaluate the results. Since these very recent beginnings,
there have been, up to 1937, well over 750 articles in the current
literature, and 18 books on the subject. The findings of workers
in the various fields of medicine will be taken up in the chapters
which follow.
PART II
THE PHYSICAL ASPECTS OF

II
T H E PHYSICAL ASPECTS OF SHORT-WAVE

DIATHERMY*
FROM the medical point of view, a brief review of some well-

known principles of physics and a short summary of the char-
acteristics of high-frequency currents, may be desirable at
the outset of this work. Those who wish to learn more concern-
ing the technicalities of the subject may find it expedient to
consult the standard textbooks, especially treatises on physics
and electricity in which the scientific and technical aspects are
dealt with in a detailed manner, both from a practical and a
theoretical point of view.
According to our present conception of the curative value
of short-wave high-frequency currents, the most important
role is to be attributed to heat, for so far no other effects have
been demonstrable with certainty. For this reason it seems
necessary, before going into the details of production of high-
frequency currents, to review certain fundamentals of electric
heat production.
It is a well-known fact that the electric current increases the
temperature of the conductor through which it flows; that is
to say, the electric energy is transformed into caloric energy.
A conception of this transformation of energy may be obtained
by the aid of the electronic theory of conduction. According to
this theory, an electric current is established by the flow of free
electrons through the conductor. Under the influence of the
electric field, the free electrons within a conductor are acceler-
ated and acquire a drift velocity which is superimposed upon
their random thermal motions. Through collisions with the
atoms of the conductor, the electrons lose their kinetic energy
'Schwarzkopf, £., and I. Levin: "Physical Basis, Technical Development, Bio-
logical and Therapeutic Applicability of Electrothermic (Diathermic) Coagulation in
Cancer" Arch. Clin. Cancer Res. II, 2, 3 (1926).
10 PHYSICAL ASPECTS
and thus generate heat. A similar theory holds good for elec-
trolytes (solutions of salts, acids, bases), when instead of elec-
trons the so-called ions are put into motion.
This development of heat follows certain physical laws which
were first expressed by Joule in the following formula. The
amount of heat produced is:
Q = Ki2rt
If the intensity of the current (i) is measured in amperes, the
resistance in ohms (r) and the time (t) in seconds, and if the
constant (K) has the value 0.24, the heat production is obtained
in gram calories. The increase of temperature of the conductor
through which the current is flowing, depends upon its mass
and its atomic structure (which is responsible for the so-called
"specific heat"), its shape, and additional factors, namely, loss
of heat by radiation and convection. Animal tissues, which
partly consist of electrolytes, are "semiconductors" of elec-
tricity, and therefore must conform to Joule's law.
In medical practice, high-frequency currents are applied for
internal heat production. The high-frequency current is an alter-
nating current, that is, one which changes its direction at regular
intervals, in contrast to a direct current, which always flows in
the same direction. Its frequency is so high that stimulating
effects do not develop in the tissues because the current impulse
causing a minor chemical reaction in one direction, is imme-
diately followed by an impulse in the opposite direction. Each
impulse thus neutralizes very rapidly the effect of the preceding
one, not allowing time for the production of the chemical changes
necessary for stimulation. The high-frequency current of about
one million cycles per second which is used in ordinary dia-
thermy, produces heat mainly according to Joule's law. If the
frequency greatly exceeds one million cycles per second, another
mechanism of heat production comes increasingly into play.
This is the development of heat by dielectric phenomena.
It is well known that a direct current does not pass
through a condenser, but that an alternating current is able to
do so. If the potential of a direct-current source is connected
to a condenser, which, in its simplest form, consists of two
separated parallel plates, the current flows only while charge
occurs. A suitable amperemeter in the circuit shows a sudden
PHYSICAL ASPECTS 11
deflection while charging, and also while discharging takes

place. If a source of alternating current is connected to a con-
denser, the meter shows a constant deflection, since charging
and discharging follow each other in rapid succession. The
meter is too inert to show instantaneous values of current. By
increasing the frequency of these alterations, keeping the ampli-
tude of the potential constant, one observes increased deflection
of the amperemeter. The current will also increase if the air is
replaced by other insulators (dielectrics) such as oil, paraffin,
mica, etc.; that is, the insulator increases the capacity of the
condenser. The ratio of the amount of current flowing through
the insulator-filled condenser to the amount of current flowing
through the air condenser, is the dielectric constant. The
dielectric constant of air is taken as 1 for the purpose of com-
parison with other materials. The dielectric constant of various
materials is as follows:
Air 1
Glass 4-10
Wood 3-10
Water 78.5
Fat 13.6
Serum 85.5
Proteins 85.0
The increased current flow in the different materials is due to
the phenomenon of polarization. The theory has been advanced
that the molecules of the dielectric are already charged nega-
tively and positively at opposite ends, and hence are dipoles
(fig. 1). These dipoles are aligned under the influence of the
electric field, so that their positive poles are directed toward
the negative condenser plate and their negative poles toward
the positive plate (fig. 2). In a high-frequency alternating field
which changes its direction several million times per second,
the dipoles reverse their direction with the same frequency, the
constant friction of neighboring particles producing heat by
what is called dielectric hysteresis. This is similar to the heat
production, by magnetic hysteresis, in the iron core of a trans-
former. In this case the molecular magnets are twisted back
and forth. This heat is also roughly analagous to that produced
by molecular friction in a metal wire, continuously bent back
and forth.
12 PHYSICAL ASPECTS
The human body consists both of electrolytes and dielectrics
(insulators), see Figure 3. The tissues may be conceived of as
being composed of resistances to which condensers are connected
in series and parallel. Figures 4 and 5 show resistances so con-
nected to a capacity. We may therefore assume that heat is
1. Molecular Dipoles between Con- 2. Molecular Dipoles between Con-

densor Plates; Electric Field Intensity densor Plates; Electric Field Applied
Zero
produced by both mechanisms, providing the frequency is high

enough (much higher than in diathermy current).
The first process is heat production in electrolytes, according
to Joule's law. Since the electrolytes contain both positive and
negative ions, they are attracted and repelled respectively by
3. Schematic Representations of Elec-

trolites and Dipoles; Alignment in the
Electric Field
the positive and negative plates of the condenser, the anions

moving toward the negative and the cations toward the positive
pole. The ions in motion collide with adjacent particles, thus
producing heat.
The second process is heat production by dielectric hyster-
esis, that is, the twisting of the dipoles of the dielectrics in the
condensers.
PHYSICAL ASPECTS 13
The different effects of diathermy and short-wave high-

frequency currents may be roughly illustrated by the following
fact: a block of wood can be heated in the condenser field by
short waves, whereas with diathermy this is impossible.
The amount of heat produced in an object or tissue depends
mainly upon the intensity of the electric field, the frequency
of the current, the dielectric constant, and the specific conduc-
tivity of the object or tissue to be exposed.
Theoretically and experimentally, it has been shown that
for a particular substance the heat generated will be a maximum
II
It
4. Parallel Connection of Resistance 5. Series Connection of Resistance
and Capacity and Capacity
at a specific frequency. In other words, for every tissue there is

a frequency which produces an optimum heating effect. Accord-
ing to Pâtzold, the heating reaches its maximum if <r = t f / 2 where
a = conductivity, t = dielectric constant, and / = frequency.
The optimum frequency can only be calculated approximately,
as the values for <r are not known exactly.
PRINCIPLES OF CONSTRUCTION OF S H O R T - W A V E MACHINES
In the so-called "short-wave machines," the commercial

low-frequency electric power available in every practitioner's
office is transformed into high-frequency power. For this reason,
different types of machines have been developed, producing
either damped or undamped oscillations. The damped oscilla-
tions are produced by a spark-gap system. The undamped
(continuous) oscillations are generated by electronic tubes,
which are so extensively used in radio transmission and recep-
tion.
Spark-gap system—If a condenser C (fig. 6) is connected
to a source of electricity, and if the voltage at its terminals
is increased to such a degree that a spark discharge takes place
across the spark-gap G, the opposite potentials do not neu-
14 PHYSICAL ASPECTS
tralize in a simple way; but, as experiments have shown, the

discharge across the gap is of an oscillatory character. The
current surges in alternating direction in the circuit, and its
amplitude decreases as the electromagnetic energy is trans-
formed into heat. In Figure 7 a diagram of a group of damped
oscillations is shown. To produce these oscillations, a certain
6. Schematic Spark-Gap Oscillatory

Circuit
amount of self-induction ¿_and capacity C is necessary in the

circuit (fig. 6).
The frequency of the current is determined by the con-
struction of the generator circuit, and calculated from Thomp-
son's formula*
i
/ =
2WVLC
Here L represents the self-induction of the oscillatory circuit
and C the capacity of the condenser. The formula expresses
the fact that by increasing the capacity or the self-induction, or
both, the frequency will decrease. By its use the frequency of
the machine can be approximately calculated. For exact calcu-
lation, however, a more complicated formula is necessary. The
frequency may also be determined by physical methods, to be
described later in the text.
PHYSICAL ASPECTS 15
In each short-wave machine at least two oscillatory circuits

are differentiated, the primary or generator circuit, and the
secondary or patient circuit. The oscillations are produced in
the generator circuit and transmitted by different couplings to
the patient circuit, in which lies the object to be treated.
The method of coupling the generator circuit to that of the
patient may be inductive, capacitive or galvanic. Figure 8
illustrates the inductive coupling. The induction coil h is placed
7. Damped Electric Oscillations
close to the induction coil / 2 , and the oscillations are transferred

from the generator circuit to the patient circuit by way of the
electromagnetic field of the high-frequency current in the ether.
There is no metallic connection. In the galvanic coupling, on
the other hand (fig. 9), the same induction coil, I h belongs to
the generator circuit and to the patient circuit. The two coils
become one by reducing to zero the space intervening between
them. In some short-wave machines, the induction coil of the
patient circuit is tapped so that higher or lower voltages may
be obtained.
In transferring the energy from the generator circuit to the
patient or secondary circuit, certain principles must be adhered
to. The frequency of the secondary circuit should be the same
as that of the primary circuit; that is, the product of the capacity
and the self-induction must be equal in both circuits. If this
requirement is fulfilled, the secondary circuit will be in resonance
with the generator circuit, and the machine will deliver its
maximum output. This condition of resonance is analagous to
the musical resonance of the tuning fork, which responds only
if its own pitch is reached. The thickness of the objects to be
treated and their dielectric constants, the distance of the elec-
16 PHYSICAL ASPECTS
trodes (condensers) from the surface, and the size of the elec-
trodes, determine the capacity of the secondary circuit.
Therefore regulating devices have to be used to establish
resonance. This may be done in three ways: (1) a regulating
device may be placed in the secondary circuit, thus rendering
resonance possible to a fixed generator circuit (constant wave
length) ; (2) the primary circuit may be varied, according to the
requirements in the secondary circuit (variable wave length);
8. Inductive Coupling between Two Electric

Circuits
(3) the frequency of the generator circuit may be varied, and

the secondary circuit tuned in with the established wave lengths
of the generator circuit.
The regulating device is either a variable condenser or a
variable self-inductor. The variable condenser consists of two
groups of plates which change their positions toward each other.
The variable self-induction usually consists of one coil, on which
a sliding contact effects regulation, or of two coils, one of which
is rotated within the other.
Tubes filled with rare gases, such as neon, may be used to
test resonance. The tubes glow when placed near one of the
oscillating circuits, the brightest glow indicating the resonance.
PHYSICAL ASPECTS 17
The state of resonance may also be determined by hot-wire

amperemeters or thermocouple meters, connected in the second-
ary circuits. The greatest deflection of the needle of the instru-
ment indicates the resonance point.
S P A R K - G A P AND T U B E MACHINES
The principle of construction of a spark-gap machine is

shown schematically in Figure 9.
9. Galvanic Coupling; Generator (primary) and Patient (secondary)

Circuit
The generator circuit for the high-frequency current con-

sists of the capacity, Cg, the self-induction coil, I, and the
spark-gap, G. Since in general it is impossible to secure a spark
discharge with the voltage obtained from the outlet of the city
current, it is necessary to use the transformer, T, to transform
the low voltage of the line to a high voltage so that a discharge
across the gap may take place. The transformer, T, consists of
a primary coil, P, having a small number of turns, while the
secondary coil has a large number of turns, the latter being
proportional to the voltage required. Transformers work only
with alternating current. If direct current is supplied, a con-
verter is required to change it into alternating current. In order
to regulate the current which enters the primary of the trans-
former, a regulating device, R, consisting either of a variable
resistance, or choke coil, is sometimes placed in series with the
primary of the transformer.
18 PHYSICAL ASPECTS
The oscillations are transferred by galvanic coupling to the
patient circuit, which consists of the induction coil, I, and the
variable condenser, Cv. The patient is "connected" to the outlet
Pi and Pt. The variable condenser may be connected, in parallel
or in series, with the condenser formed by the electrodes and
the part of the body to be treated. It has the function of bringing
the patient circuit into resonance with the generator circuit.
It also facilitates the regulation of the current, which is meas-
ured by the meter, M.
Undamped oscillations (fig. 10) of short-wave lengths can
only be produced by the vacuum tube. This device makes
10. Undamped Oscillations
possible the generation of stable, continuous oscillations. The

principle of construction of a vacuum tube is illustrated in
Figure 11.
A glass tube, evacuated by special methods to an extremely
high vacuum, contains the metallic filament, F, the metal
cylinder, A (plate) usually surrounding the filament, and
inserted between the two a grid, G (triode). The filament is
heated by a battery, B t . The positive pole of a battery, Bi, is
connected to the metal cylinder, A, which is called the anode,
and its negative pole to the lighted filament which represents the
cathode, and negative particles of electricity, so-called electrons,
are emitted by the filament. According to the well-known law
of electricity t h a t similar poles attract and opposite poles repel
each other, the electrons are attracted by the anode and travel
through the grid, thus establishing a current through the tube.
The reversal of the battery connection would produce exactly
the opposite result, and no current would flow.
PHYSICAL ASPECTS 19
The electronic current flowing through the tube is a function

of the grid and the plate potentials. The grid, being much closer
to the filament than the plate, exercises a stronger influence
upon the current than the plate. It can be used to control the
plate current. In general, the grid of a vacuum tube is biased
negatively with respect to the filament, for instance by con-
necting a battery between these two electrodes. Under these
conditions, no electrons will reach the grid. Electrons, however,
E>i
Type
will be attracted by the positive plate and will pass between the
wires of the grid. Variations in grid potential cause correspond-
ing variations in plate current, and the latter produces vari-
ations in plate potential by virtue of the voltage drop in the
plate load. Thus the change in potential across the load is an
enlarged replica of the change in grid potential (amplification).
It should be stated here that the power consumed by the grid
is very small. If the grid potential is negative (referred to the
filament potential), only a small charging current flows in the
grid circuit. With an oscillatory circuit connected to the plate,
it is possible to produce sustained oscillations if a part of the
variational plate power is suitably coupled back to the grid
circuit. This is the principle of regeneration. A regenerative
circuit is shown in Figure 11.
20 PHYSICAL ASPECTS
The anode circuit contains the oscillatory circuit (generator
or tank circuit), which consists of the induction coil 1i, and the
capacity, Cg. In connecting the generator circuit to the battery,
Bi, by the switch, S, the condenser, Cg, is charged and dis-
charged immediately through the induction coil, h , in the form
of an oscillatory current. The oscillations would die out if they
did not affect coil / 2 in which they induce currents of the same
frequency. These currents are amplified by the tube. In the
anode circuit, fluctuations take place with the same frequency
as in the generator circuit, charging its capacity at proper
intervals. Continuous charges and discharges of the condenser
thereby take place, producing undamped oscillations. In short-
wave machines working on the tube principle, the oscillations
are transferred to a patient circuit as in spark-gap machines,
by inductive, galvanic or capacitive coupling, as previously
described. By decreasing the capacity and the self-induction,
the frequencies will be higher, in accordance with Thompson's
formula, and vice versa.
With increasing frequency, the inductance and capacity of
the oscillatory circuit connected to the tube must be reduced.
In the limiting case, the interelectrode capacities of the tube
represent the condenser of the tank circuit, whereas a wire loop
between grid and plate terminals forms the inductance of the
circuit. A typical circuit is illustrated in Figure 12. Very often
two tubes are incorporated in the short-wave machine and used
in the so-called push-pull connection.
The plate voltage required depends upon the type of tube
used, and is generally between 1,000 and 4,000 volts. A constant
plate potential can be conveniently obtained by means of
rectifier tubes in conjunction with a filter. Rectifier tubes con-
tain a filament, and may be either of the high-vacuum or of
the mercury-vapor type. The filter is a combination of choke
coils and condensers, designed to smooth the ripple of the
pulsating direct current as it is delivered by the rectifier tubes.
Often the filter, and also the rectifier tubes, are omitted. In the
latter case, we have the so-called self-rectifying circuit in which
the oscillator tube (or tubes) acts also as rectifier; and in which,
during each negative half cycle of plate potential, oscillations
stop.
PHYSICAL A S P E C T S 21
Three types of current generated by different tube machines

are shown in photographic Figure 13.* The first photograph (a)
was obtained with a machine in which a constant voltage was
applied to the tube, the second (b) from a machine with full
rectification, while the third (c) was produced by a one-tube
machine in a self-rectifying circuit. The differences between
these forms of high-frequency current may be of importance
from the point of view of therapeutic effect.
12. A Typical One-Tube Electric Oscillator
Obviously, the same average power may be delivered in

any one of the three different ways. With the same effective
current in the patient circuit, the maximum amplitude of a
constant potential machine is smaller than that in the set-ups
with pulsating potential. It is highest in the machines that are
self-rectifying. The energy is applied in pulsating doses if the
filter is omitted, whereas a machine of constant potential gives
somewhat smaller current of equal strength, without interrup-
tion. There may be conditions in which one or the other is
preferable for therapeutic purposes.
'Schwarzkopf, E., and I. Levin: Physical Basis . . . Arch. Clin. Cancer. Re».
II, p. 2, 15 (1926).
22 PHYSICAL ASPECTS
MEASUREMENTS
The determination of frequency is of great importance from

the scientific and therapeutic point of view.
The relation between the frequency, wave length and
velocity of light per second is:
velocity of light (300 million m/sec.)
frequency -
wave length
from which we know t h a t , for example, a 3-meter wave corre-
sponds to a frequency of 100 million cycles per second.
* % - %
^ f
%
a b c
13. Rotating Neon Tubes of Different Oscillations
a, A Rotating Neon T u b e Indicating Uninterrupted Undamped Oscillations Delivered by a
Maohine with Vacuum T u b e Delivering Uninterrupted Undamped Oscillations; b, A Rotat-
ing Neon Tube Indicating Interrupted Undamped Oscillations Obtained from a Machine with 2
Vacuum Tubes; c, A Rotating Neon T u b e Indicating Interrupted Undamped Oscillations of
a Machine with One Vacuum Tube Disconnected
One way of measuring wave lengths is by the Lecher system.

This consists of two parallel wires coupled to the output of the
machine, and a movable bridge across the wires. Across the
bridge there may be connected a flashlight bulb, glow lamp or
meter. As the bridge is moved over the wires, maxima and
minima in the indicator will appear. Successive maxima (or
minima) are one-half wave length apart.
A more convenient method of frequency measurement is by
means of a wavemeter. A wavemeter consists of an oscillatory
circuit which may be adjusted to the frequency of the short-
wave generator, usually by varying its condenser. Resonance
is shown by an indicator, similar to those used with a Lecher
system as mentioned above. On a calibrated dial the wave
length is read directly.
PHYSICAL ASPECTS 23
The output of a short-wave generator can be measured in

several ways. The simplest way is by the photometric method.
Incandescent lamps are connected in series with condensers in
the patient circuit, and a relative measure of the light intensity
of the lamps at resonance is obtained, for instance with a photo-
electric cell. The power required to give the same light intensity
is then determined by using commercial alternating power,
which can easily be measured.
Another method is a calorimetric one. A fluid is put between
the condenser plates and its temperature rise in a given time is
measured. Knowing mass and specific heat, the power output
can then be calculated.
There are now available voltmeters and ammeters for
frequencies below ten meters; but, since the phase angle between
voltage and current is not known, such measurements would
be merely relative so far as power output is concerned. It should
be noted here that measurements at ultra-high frequencies are
subject to difficulties not encountered in the same degree at
lower frequencies, and that the utmost care and the most
critical attention are required. The ideal instrument for output
measurements would be a good wattmeter, simple in construc-
tion, and consuming little power.
Attempts have been made to measure the heat generated in
living tissue during exposure to the action of the condenser
field. This may be done by thermocouple needles, introduced
into the living tissues, but careful construction and shielding
are necessary.
The current which passes through the treated part is meas-
ured by a hot-wire or thermocouple ammeter. In addition to
this, in some machines the current flowing through the tubes is
measured because there is greater current consumption through
the tubes while the output of the machine is increased. The
voltage across the filament is measured by a voltmeter and
regulated by a resistance to obtain a constant heating of the
filament of the tube.
In comparing the results of short-wave treatments, it is
necessary to know the size of the electrodes, the distance of the
electrodes from the body, the thickness and the shape of the
object, the current, the frequency (wave length) and the type
24 PHYSICAL ASPECTS
of current generated by the spark-gap or tube machines,
together with the time of treatment.
The question as to the superiority of oscillations generated
by the spark-gap or the tube machine, especially as regards
quality and action, is by no means settled. At the present time
it would seem that equally satisfactory results may be obtained
with damped, or with undamped oscillations.
There is some justifiable criticism of the term "short-wave
diathermy." It is understood that from a scientific point of
view such terminology is not well chosen, since treatment with
short-waves, in a literal sense, would consist of exposing the
part to be treated to electromagnetic waves radiated by an
antenna. But the efficacy of such a procedure seems to be small,
and, for the present at least, data concerning this aspect of the
problem are not sufficient to justify conclusions.
The expression "short-wave diathermy" is employed because
it was introduced at the beginning by professional workers in
this field, the word "waves" being much simpler than the term
"high-frequency electric field." Perhaps a better term would be
"ultra high-frequency therapy." Therefore the readers must
always bear in mind that by short-wave currents, we mean very
high-frequency currents, in the condenser field.
PART III
EXPERIMENTATION WITH
Ill
E X P E R I M E N T S ON B A C T E R I A A N D O T H E R
ORGANISMS
FROM the very beginning of experimentation with short waves,

efforts have been directed toward determining the action,
general and specific, of these waves on microorganisms, and
toward fixing, if possible, upon an optimum effective wave
length for each type. Naturally, the literature gives evidence
of much difference of opinion and contradiction in results
among investigators and research workers, and many problems
pertaining to this subject are as yet unsettled.
In all fairness, emphasis should be placed on the fact that
the research worker in this new field encounters many difficul-
ties, owing to little known or unknown factors. These are the
outcome of the difference between the physical characteristics
of medical agents already determined, and the physical proper-
ties of short waves. Difficulties are also created by the lack of
uniformity in output of the short-wave apparatus and appli-
ances placed on the market by different manufacturers. Experi-
ments conducted under the same conditions, with machines of
different makes, might give different results under conditions
not under the control of the worker, such as variation in the
tension of the outer electric current. The methods developed
for the measurement of the intensity of the generated electric
field are not yet of the precision required for accurate scientific
research work.
Theoretically the objects in the electric field may, under
similar circumstances, be subjected to various outside conditions;
e. g., temperature. With the same output of energy, a mini-
mum change in the distance of the electrodes from each other
changes the characteristics of the electric field. The importance
of the length of time of exposure of the experimental object to
treatment should be emphasized. The dielectric properties of
28 BACTERIA AND OTHER ORGANISMS
the substances used in experiments are also of importance. For
instance, in bacterial investigations the physical and chemical
composition of the various media must be taken into account.
Neither can the differences in size, shape and material of the
containers of bacterial cultures be ignored.
The morphology of the bacteria, their virulence, age, and
so on, and perhaps, because we deal with a physical agent,
their physical characteristics also, must be considered when
interpreting the outcome of these experiments. Countless
variables come under consideration when interpreting the
results of experiments. Such considerations hold good in any
branch of short-wave experimentation.
Using the same source of energy, the effect of short waves
may be proportionately higher when applied to microorganisms
than when used on more complex organisms such as laboratory
animals. If one assumes that short waves have no other than a
heat effect, then it would be possible, theoretically, considering
that flies and mice may be killed instantly by an output of energy
which would have a beneficial therapeutic effect on the human
organism, to produce effects which would be inimical to bac-
teria owing to their distinctly smaller size. In other words, the
same output of energy might more easily kill the minute living
organism than the larger, more highly organized animal. From
a practical point of view, however, we have to deal with other
complicating factors. In infections, for instance, the bacteria
are embedded in tissues which are supplied with circulating
blood. If one wishes to increase the temperature of the micro-
organisms to the point which is fatal to them, the tissues of
the carrier may also be destroyed, which is not desirable. This
action would be analagous to that of electric coagulation. Here
the circulating blood plays its role, carrying away and dis-
tributing throughout the body the heat created in the treated
parts, in accordance with the heat-regulating mechanism of the
body.
BACTERIA
Tribute should be paid to the numerous experiments of

Haase and Schliephake and others, for their investigation of
the effect of short waves on bacteria. They found that short-
BACTERIA AND OTHER ORGANISMS 29
wave exposures kill bacteria at a lower temperature than does

the hot-water bath. This might indicate, they believe, that
there is, in addition to the heat effect, another effect as yet
undertermined, inherent in the short-wave field, though they
warn against drawing conclusions prematurely.
STAPHYLOCOCCI AND STREPTOCOCCI
Haase and Schliephake conducted in vitro experiments on

Staphylococcus albus, with wave lengths of from 3 to 20 meters,
and found that at the same temperature, the waves differ in
efficiency, and that the bacteria are killed in the condenser
field at different rates of speed, according to wave length.
Liebesny, using 7-meter waves, noted a deleterious effect on
Staphylococcus albus, but could not influence other types of
staphylococci. He thinks that the different wave lengths affect
the bacteria very differently, sometimes in a biopositive and
sometimes in a bionegative way, and finds that the 15-meter
wave has the highest lethal effect on most of the pathogenic
bacteria.
Szymanowsky and Hicks, using the 2.5-meter wave, and
Lentze, employing 3.5, 4, and 4.5-meter waves, reported nega-
tive results. Hasch6 and Leunig used waves of from 8 to 16
meters on staphylococci, in distilled water, in physiological salt
solution, and in bouillon, and on streptococci in milk, and
observed no direct effect.
Their findings are contrary to the results of the experiments
of Haase and Schliephake. The latter worked with a tempera-
ture of from 50° to 55°, whereas Hasch6 and Leunig chose body
temperature, believing this to be more satisfactory for practical
purposes, as this is the temperature under which bacilli thrive.
The treatments lasted from 20 minutes up to 8.5 hours. Hasch6
and Leunig emphasize the fact that their experiments were
conducted with bacilli in vitro and not in vivo. Consequently,
the experiments cannot show the effect of those chemical and
biological reactions that would take place in a living body,
following a rise in temperature.
Lippelt and Heller retarded the growth of staphylococci
with from 4 to 8-meter waves, which did not influence the
growth of Streptococcus haemolyticus.
Haase and Schliephake found that short waves have a
positive bactericidal effect on streptococci. Similarly, Liebesny
reported that 15-meter waves have the most damaging effect
on streptococci, whereas the effect of the 4-meter wave is prac-
tically negligible.
Pratt and Sheard, interestingly enough, showed that it is
possible to alter the cataphoretic velocity of streptococci by
application of the proper dosage of short-wave electrical energy.
The change in the physical nature of the microorganism might
be associated with changes of the biologic activity or the selec-
tivity of the cultures, which were tested by injection into
animals. Experiments conducted with 11-meter waves on certain
strains of streptococci, induced mutations not demonstrated in
untreated control strains of the same culture.
Schmidt-Hoensdorf found that the streptococci of mastitis
are injured in the short-wave electric field, and that the maxi-
mum effect can be reached with 3.6-meter waves. The effect
was enhanced when the electric conductivity was increased
through the use of physiological salt and boric-acid solutions.
On the other hand, Szymanowsky and Hicks had negative
results with the 2.5-meter wave.
B A C I L L U S COLI
Fabian and Graham used the 20, 30, and 40-meter waves on
bacteria, and found that in a high-frequency displacement cur-
rent of 10 megacycles and an intensity of 0.08 ampere, the
number of colon bacilli increased nearly 300 percent during a
period of 3 hours. With the intensity of the current increased
10 times, the lethal effect became evident. A 10-megacycle
current was the most effective, a 7.5-megacycle current being
least effective. The effect of the 15-megacycle current lies
between the two. The high-frequency displacement currents
produced a regular death curve for bacteria. When the loga-
rithm of the number of bacteria surviving was plotted at regular
intervals against time, a typical survivor curve resulted.
Results were variable. Groag and Tomberg found the 4 and
15-meter waves to be lethal for colon bacilli; Liebesny could not
influence the growth of this type; and Lippelt and Heller found
that short-wave treatment favored the growth of these bacilli.
Hasch£ and Leunig reported negative results with strong as

well as with weak doses, and concluded that short waves do
not influence cultures of Bacillus coli in distilled water, tap
water, or bouillon media. Recently, Grasser could not disclose
any effect other than that of heat, with the 6-meter wave.
Growth was stopped only at high temperatures.
T U B E R C L E BACILLUS
In guinea pigs and rabbits inoculated with tubercle bacilli,

Haase and Schliephake found retardation of the development
of the disease after treatment, although a cure did not result.
The treated animals generally lived a few days longer than the
untreated controls. In in vitro experiments, Schliephake found
that at body temperature the tubercle bacilli were killed in
from 3 to 8 hours' exposure in the short-wave electric field.
Warm-water bath controls have shown that the 4.8-meter wave
destroys the bacteria in a much shorter time than the warm-
water bath. At 50° C., this difference amounts to half an hour,
but at body temperature the difference is also noticeable.
Using the 4.8 meter-wave on agar cultures of tubercle
bacilli, Haase found that whereas after five minutes of short-
wave treatment the growth of the bacilli is still considerable,
after 9 minutes the growth is much impaired, and after 10
minutes growth is completely stopped.
Schliephake tested the effect of a series of wave lengths of
from 3 to 100 meters at low intensities, and observed that
while control bacilli developed in from 6 to 8 days, the treated
ones did not develop until the twentieth day. He reports that
the maximum damaging effect was obtained at the 31.5-meter
mark; the 35-meter wave had no growth-retarding effect at any
time, which was also true for the 98-meter wave. Thus it would
seem that there are two or more points along the wave-length
scale for maximum and minimum effects.
In Liebesny's work, the 7.5 and 15-meter waves were found
to have the most injurious effects on the tubercle bacilli, human,
bovine and avian. Lentze's experiments with 3.5, 4 and 4.5-
meter waves were negative. Recently, Kling and Rubin were
unable to note in their animals any effect of short waves, other
than that of heat.
Beerens and Remouchamps were unable to modify the evo-
lution of the tuberculous process in inoculated guinea pigs
with the 5-meter wave.
TYPHOID BACILLUS
Izar and Moretti noted great attenuation of the para-

typhoid A bacillus after treatment with the 4-meter wave,
while Lentze, on the other hand, reported negatively on all his
experiments on the typhoid group with the 3.5, 4 and 4.5-meter
waves.
GONOCOCCI
The reports of Liebesny on the injurious effect of the 4-meter

wave were not repeated by Nagell and Berggreen, who obtained
different results. They experimented on gonococci in vitro,
using 4, 8 and 15-meter waves, the electrode distance being 17
cm. In all the experiments, the time of the treatment was six
hours, with intervals. The results of these workers were nega-
tive, from which they conclude that short waves do not kill or
attenuate gonococci in vitro.
Liebesny showed that the effect of short waves on the
microorganism differs according to the technic employed and
the characteristics of the waves themselves. In the field of
urology, those infections which are caused by streptococci,
staphylococci, gonococci and tubercle bacilli, are most amenable
to short-wave diathermy.
OTHER MICROORGANISMS
A variety of bacteria have been subjected to short-wave

action, with variable results.
Liebesny claims to have cured, with the 4-meter wave, 2
cases of actinomycosis which remained unaffected by the 15-
meter wave. On the other hand, he found that the latter treat-
ment promoted the growth of a relatively large number of non-
pathogenic and pathogenic fungi. In this respect his experience
with Aspergillus niger serves as a warning against evaluating
results by the immediate outcome, rather than by more distant
end results. The seemingly lethal effect may be followed after
a few days by a rapid and intensive growth, surpassing in
rapidity the growth of the controls. A possible explanation of

this phenomenon may lie in the fact that waves which may be
sufficient to retard the growth of the conidium may, on the
the contrary, favor the development of the mycelium, in the
end again fostering flourishing growth of the conidium.
Negative effects on the pneumococcus are reported by John-
ston, Szymanowsky and Hicks, whereas Heller succeeded in
retarding their growth. Szymanowsky and Hicks found that
the 2.5-meter wave had no effect on the diphtheria bacillus or
on bacteriophage.
Izar and Moretti met with varying results, finding typhoid,
paratyphoid B, the dysentery bacilli and others uninfluenced by
treatment for twenty minutes. The bacillus of Bang and
Micrococcus melitensis were not attenuated by the 15-meter
wave, were slightly attenuated by the 8-meter wave, and were
destroyed by the 4-meter wave.
Carpenter and Boak injected Treponema pallidum intra-
testicularly into experimental rabbits. Of the 25 rabbits inocu-
lated and treated, 21 did not develop chancres when treatments
were begun early—4, 5, and 7 days after injection. Five of these
21 rabbits developed testicular nodules during treatment, but by
intensifying the exposures, the lesions disappeared. One rabbit
developed a chancre, while the testes of a second became en-
larged, edematous and indurated. The control rabbits, untreated
bui similarly infected, developed the typical lesions of experi-
mental syphilis.
In in vitro experiments on Bacillus pyocyaneus, Bacillus
prcdigiosus, and Bacillus Salmonella with the 30-meter wave,
Johnston found that the heat generated by short waves had
no effect on colony formation, pigment production, the biologic,
antigenic or other properties of the bacteria, and that the
virulence of the bacterial species was not attenuated.
GE.VERAL DISCUSSION
In interpreting the results of short-wave experiments on

bacteria, one should take into consideration the focal-heat
theory of the effect of short waves. According to this, the heat
is generated within the smallest particles of the organism, and
consequently therefore within the invading bacteria. In cooling,
it is the surface that cools evenly, but this cooling may never
reach the deeper layers nor penetrate the bacteria. Therefore,
the waves may create lethal temperatures within the bacteria,
while the heating of the organism remains below that which can
be considered as lethal for the given types of bacteria. This may
account for the fact that short-wave experiments were successful
in destroying bacteria, while at the same temperature, control
experiments with the hot-water bath failed. Groag and Tom-
berg attributed to the focal heat this lethal effect on bacteria,
when the heat in the object was lower than the heat created
with the water bath.
It should be borne in mind that at the present time it is
practically impossible to register correctly the temperature of
any living object under treatment in the condenser field. As a
result, it is possible that in some of the experiments reported
as successful, the bacteria were actually destroyed by the lethal
heat generated in the experimental specimen, notwithstanding
the fact that owing to faulty temperature registration, a sub-
lethal temperature was recorded. The very favorable outcome
of the experiments on bacteria by Haase and Schliephake were
criticized for precisely this reason.
Lentze, therefore, pointed out the importance of technic
and of temperature-recording methods in in vitro experiments
on bacteria. He states that in such experiments, the investigated
solution must be stirred continuously and that the taking of
the temperature of the solution presents many practical diffi-
culties. He thinks that Haase and Schliephake overlooked these
facts when they reported experiments whose outcome was
different from his own. He believes that Haase and Schliephake
attained temperatures which were lethal to the bacteria, while
at the same time they were not able to measure this tempera-
ture with accuracy.
This statement seems to be supported by those unsuccessful
experiments in which the recorded temperature always remained
sublethal. Dausset and Dognon state that it is difficult to
sterilize with 4 and 8-meter waves at a temperature of 40° C.,
and that it is possible only with great intensity and after treat-
ments of long duration.
At the same time, the objections advanced by Lentze against
the reports of Haase and Schliephake can be raised against his

own series of experiments on pathogenic bacteria. One may
with equal justice suspect that he and others over-cautiously
went to opposite extremes, and recorded a temperature which
in reality was too low to give any results. If the focal-heat
theory is correct, then the lethal effect of short waves does not
depend so much upon the temperature attained within the
treated object as upon the focal heat created in each single
bacterium. But this focal heat cannot be measured at the
present time. Groag and Tomberg also lean to this view. They
experimented with 4 and 15-meter waves on Actinomycoses
bovis, Trichophyton tonsurans and Bacterium, colt, and found
that short waves have a lethal effect on the organism, provided
the electric energy in the condenser field is powerful enough to
create the required focal heat.
The problem as to whether short waves have only a heat
effect or a vibratory effect, or also a specific effect, is taken up
in another part of this work. It suffices to say here that no one
has as yet succeeded in separating the focal-heat effect from the
alleged specific effect; consequently, whether or not short waves
can kill bacteria with their specific effect, without increased
heat in the experimental object, cannot be stated definitely.
This view is shared by Groag and Tomberg, while Lentze, on
the basis of his experiments, denies the possibility of a specific
effect in the wave lengths investigated by him. Naturally, these
are purely theoretical considerations, and concern processes
which are entirely apart from those which might be observed
in human pathology.
We may also reserve judgment on the question of wave
length, when the intensity is not stated. It may be that with
similar power, various experiments might exhibit less marked
differences in bactericidal effect.
In conclusion, one may say that there are wave lengths, but
chiefly different dosages within the same wave length, which
may favor the growth of certain bacteria, and kill or hinder the
growth of others. In other words, the same wave may have a
biopositive and also a bionegative effect on the microorganism.
It would be necessary to determine the exact wave lengths at
which body cells suffer the least damage and bacteria the most.
Further research is needed to determine exact dosage, and wave
lengths which would be most efficient in the disorders caused
by microorganisms.
It may be assumed that the bactericidal effect of the short-
wave field is ascribable to the heat effect, and that, for practical
purposes, there is no known specific heat effect, or heat effect
depending upon wave length, which may be directly used in
therapy with distinct advantage.
U N I C E L L U L A R ORGANISMS
Kahler, Chalkley and Voegtlin used the 4 and 30-meter

waves in their experiments on Paramecium candatum, with no
noticeable biological effects, even after long exposure, if its
temperature remained sublethal. Lentze employed the 3, 4 and
8-meter waves in vitro, cooling his experimental object in ice
water to keep the temperature not over 37° C. The lethal
temperature for Paramecium is 39° C. Two treatments at half-
hour intervals for twenty minutes each were without result.
E X P E R I M E N T S ON T O X I N S
Investigation on toxins attracted the attention of such early

workers as d'Arsonval. He treated diphtheria toxin with short
waves, and established the fact that the waves bring about the
diminution of its toxicity.
Bonome, Viola, Cacciani and Dubois report that they suc-
ceeded in attenuating the toxin of diphtheria, of streptococci
and of cobra venom.
Szymanowski, Hicks, and Mellon gave their attention to
the investigation of the three major bacterial toxins, diphtheria,
tetanus and botulinus, in raw broth filtrate. They employed
the 1.9-meter wave, using the hot-water bath for control. The
toxin was first chilled to 7° C. and then exposed in the con-
denser field to four minutes of treatment, during which its
temperature rose to 38° to 40° C. Thereafter the toxin was
again chilled, and then treated with short waves for four
minutes. This procedure was repeated until the computed length
of time of the treatment was from fifteen to sixty minutes. The
experiments have shown that fifteen minutes of short-wave
treatment definitely attenuated the toxin, whereas the control

experiments did not affect it. Szymanowski and his coworkers
experimented by spreading the toxin in a 0.5 mm. layer between
the walls of two concentric tubes, chilled benzol being circulated
in the inner tube. The temperature of the toxin layer did not
rise above 15° C. In another series of experiments, cold air was
used as the cooling agent. The results showed a considerable,
but not complete, inactivation of the toxin. The activity of the
treated toxin was as follows:
15 minutes of short-wave treatment, 25 times weaker
1 hour " " " 50 "
6 hours " " " 100 "
than the original toxin. This suggests further investigations, in
order to determine the properties of the treated diphtheria
toxin as an immunizing substance. It is also supposed, judging
by clinical observations, that abscesses treated by short waves
may produce an effect similar to autovaccine therapy, resulting
from the absorption of the killed bacteria. This is discussed
below, in Chapter XV, "Miscellaneous Conditions" (see page
211).
VIRUSES
Carpenter and Page pointed out that the increased heat

generated in the body by short waves, established an environ-
ment that is in general unfavorable to the development of the
virus. The heat increases the rate of those chemical processes
which are concerned with the general defense mechanism of the
body against the infectious agents.
VENOM
Physalix and Pasteur investigated the effect of short waves

on cobra venom, and arrived at the conclusion that they modify
the snake venom in the same way as the ultraviolet rays do,
and that short waves cannot be used to transform the venom
into vaccine.
PLANTS
Von Oettingen experimented with the 3-meter wave, on

freshly sprouted cress, treating one batch for five minutes, a
second batch for ten minutes, and keeping a third batch un-
treated, as a control. Exposure for five minutes increased
growth, whereas exposure for ten minutes had a strongly re-
tarding effect. These results were repeated with sprouted beans.
The after effects showed that the short-wave influence was not
temporary, but was reflected in the continued strength and size
of the plants. On the other hand, the plants exposed for ten
minutes never regained their strength, remaining markedly
stunted. In all these experiments, the generated heat never rose
above that which is normal for the plants. Von Oettingen con-
cludes that it is not the heat effect, but a specific effect of short-
waves, that influences plant growth.
Experimenting on wheat and beans which had been soaked
in water for 24 hours, Ludwig and Ries found that unipolar
treatment increased and accelerated the sprouting of the seeds,
and was noticeable in the later growth of the plants. The bipolar
method, on the other hand, retarded the sprouting, although it
had no lethal effect on the seeds.
Herzum treated white-bean shoots over a period of 12 days,
giving to one group 2 daily treatments of 2 minutes each, and
to a second group daily treatments of 10 minutes each. All the
plants in the latter group perished after the fifth day. As the
temperature was kept normal throughout these treatments,
Herzum concludes that the thermic effect plays a subordinate
part in the results, attributing the growth-promoting effect to a
selective action inherent in short waves.
Jorns also experimented on cress, placing the seed on wet
sand, using the 7-meter wave and dividing the material into 3
batches, which he exposed for 5, 10 and 15 minutes daily. All
3 were favorably influenced, the greatest benefit being shown by
the lot treated for 15 minutes. In another series, the treatment
was extended to 30 minutes. Sprouting was accelerated, but it
was noted that the plants did not develop so rapdily nor so
strongly as those in the control group.
In further experiments, Jorns placed the seed in a dry en-
vironment. Acceleration in sprouting was evident, but the plants
did not develop so strongly nor so rapidly as those in the control
batch.
It would be premature to draw final or definite conclusions
from these experiments. Under certain conditions, however,
short waves seem to accelerate the sprouting and the growth of
plants. In plant experimentation, attention should be given to
the temperature generated during the treatments, as a rise
of the heat within the seeds may definitely change the outcome of
the investigations, by having a lethal effect on the germ. From
an agricultural point of view, further research in this field is
highly desirable.
IV
E X P E R I M E N T A T I O N ON ANIMALS
PHYSICAL agents, when discovered, are subjected to physical,

chemical and biological experimentation. To this short waves
have been no exception. Esau and Patzold studied the physical
quality of short-wave and ultrashort-wave currents. At the same
time, and independently, Schereschewsky was the first to experi-
ment with the waves on small laboratory animals. His observa-
tions have laid the corner stone for the study of the physiologic
and biologic effects of short waves. He observed that white mice
die within a few minutes after exposure, if the current is suffici-
ently strong.
For a short time the mice are quiescent, after which they become agi-
tated. The ears, tail and paws turn bright pink which in many instances
becomes livid or cyanotic as the exposure is prolonged. Salivation and
increased nasal secretion are present; the head and under parts become
wet and bedraggled. The paws are covered with beads of moisture, and
after a variable time convulsions, accompanied by convulsive winking
take place. In the male considerable swelling of the genitalia can gener-
ally be observed. Dyspnea sets in and finally respiration ceases. The
heart continues to beat for a little while after respiration has stopped.
The body of the mouse is warm, but the recorded rectal tem-
perature has revealed 42.2°, 43.1°, and even 44° C. Although the
elevation of temperature is sometimes moderate, the primary
fatal effect observed consists of raising the body temperature
to a degree incompatible with life. Increased temperatures from
5° to 6° C. were noted in the living, but in dead mice tempera-
tures from the same exposures were increased only 0.7° to 1° C.
and with no gains nor losses. This would suggest that heating
effects differ from diathermic effects, since it is easy to raise the
temperature of dead tissues well above the point at which
albumin is coagulated. In the case of sublethal exposures, the
small hemorrhagic areas about the blood vessels of the ear
necrotize after forty-eight hours and the ears drop off. Tails
EXPERIMENTATION 41
affected with dry gangrene also drop off. Alopecia, developing

in the supraorbital region or at the tip of the snout, has been
observed. In one case panophthalmitis, resulting in loss of
vision, developed. Different frequencies were used. The highest
frequency, 140 million (2.1 meters), had the lowest lethal effect,
but this increased gradually with decreasing frequencies, with
an abrupt decline from the low point of 9 million.
Christie and Loomis found that lethal action remained con-
stant up to a frequency of 50 million cycles (6 meters). When
this frequency was exceeded, both the heat production and the
lethal effect diminished. These authors conducted a series of
experiments with 2, 6, 14 and 18-meter wave lengths, on dead
and living mice. The rate of heat production in dead mice was
found to be, on an average, approximately the same as that in
live mice, at all frequencies. This is contrary to Schereschewsky's
findings, but the discrepancy can be explained by the fact that
Christie and Loomis purposely allowed the dead mice to cool
down to room temperature before subjecting them to treatment,
whereas Schereschewsky exposed them immediately after
death. We found that a dead mouse with a temperature of
38° C., loses heat at the rate of more than 1° C. per minute, so
that in Schereschewsky's experiments heat was being lost by
the mice as rapidly as it was being generated in them. This
obviously applies only to dead mice, as the metabolism of a live
mouse is in itself sufficient to maintain, up to a certain limit, a
constant temperature.
Baldwin and Dondale, by their experiments on rats, with
short waves of from 5 to 6 million cycles (60 to 50 meter waves),
observed the same histological changes as Christie and Loomis.
On the basis of his studies on live and dead animals, Mortimer
found that living animals heat up evenly in their various organs,
but that the heat production varies in dead animals. He attri-
butes this to the fact that the living animals may be more
quickly heated, as metabolism and muscular work are factors in
heat production. This is contrary to what Christie and Loomis
found.
It should be mentioned here that heat in the living organism
is distributed evenly by the heat-regulatory system. Mortimer
also noticed that the electrostatic field between the plates is not
42 EXPERIMENTATION
homogeneous, the heating effect varying in different parts of the
field. This again differs from the observations of other authors.
Mortimer found that the lethal effect of short waves can be
fully accounted for on the basis of heat production. The histo-
logic changes observed closely parallel those attending death
from heat prostration.
The experiments noted above were conducted with relatively
very strong electric energies, which instantly generated such a
high degree of temperature in the small experimental animals
that they perished from "heat stroke."
Sublethal doses, calculated on the basis of size and biological
requirements of the animals, bring about histological changes
which are similar to those caused by heat from other sources, as
noted by Schereschewsky, Schliephake, Mortimer and others.
As Mortimer observed,
Sublethal doses could be given to rats daily for a month and to a dog
daily for two months without ill effects. The histologic changes are those
found in animals subjected to hyperthermia induced by other means.
Pflomm found that rats endure for a long period daily short
wave treatments, given in sublethal doses.
Knudsen and Schaible, experimenting on dogs with currents
of 9 to 12 million kilocycles frequency, found that the body
temperature can be raised to any desired point by exposure to a
short-wave high-frequency field. The temperature returns to
normal quite rapidly, unless the animal has been heated above
42° C. Those heated above 42.5° C. for any great length of time,
do not survive the procedure, although these investigators have
recorded instances of an animal being heated momentarily to
44.5° C. and surviving the experience.
Carpenter and Page found that it is comparatively easy to
raise the body temperature of laboratory animals, such as mice,
rats, guinea pigs and dogs. Their bodies are small and they are
not so well able as man to eliminate effectively an increased
amount of heat. They have a hairy coat and do not possess the
great areas of sweat glands and the extensive peripheral vascular
net characteristic of man. These factors suggest that human
beings will react to heating in a manner different from that of
other animals.
Hosmer, experimenting with short waves of from 12 to 30
EXPERIMENTATION 43
meters, observed that tadpoles and rats were killed within a few
minutes, corroborating Schereschewsky's earlier findings. This
author warned against the treatment of human bodies, because
of the danger of possible damaging effects due to causes unknown
at the time, as cited in the historical outline.
McKinley and Charles experimented with the 3.5-meter
wave on 2,000 wasps, and found the average time for a lethal
effect to be 11.5 seconds. Headle and Burdette killed insects
after one to two minutes of exposure with the 24-meter wave,
owing to the intense heat created in the body. Dead insects
were heated to a much lower degree than living ones, by the
same exposures. The workers found that
The more highly developed the nervous system the quicker the lethal
effect. . . . This fact leads to the conclusion that the development of
heat in tissue is decidedly aided by nervous activity.
E F F E C T OF S H O R T - W A V K T R E A T M E N T ON G R O W T H
AND REPRODUCTION
Jellinek experimented with the 3-meter wave on mice. To

two groups of mice he gave daily short-wave treatments for from
one to two weeks, the animals being put in the condenser field
several times daily, each time for one hour. He found that the
animals thus treated developed faster than the untreated con-
trols, and that they gained 20 percent more in weight. This was
corroborated by the experiments of Halphen, Heurard and
Auclair, who observed increasing weight of rabbits without
increasing temperature.
Further experiments on the growth and fertility of rabbits
were made by Boak, Carpenter and Warren. They administered
short-wave treatments to 24 rabbits. Repeated elevation of
body temperature of male and female rabbits to 41° C. from 2 to
5 times per week by 30-meter waves, beginning at from 29 to 171
days of age and extending in the female through the first period
of gestation, failed to retard growth or to interfere with mating,
fertilization or the development of young in utero. Litter mates
were kept for controls. The rabbits exposed to short-wave fever
showed, in the majority of cases, a greater percentage gain in
weight than did the control litter mates. The estrus period of the
44 EXPERIMENTATION
treated group was, on the average, 2 weeks longer than the un-
treated group. The fever-treated females averaged 5.5 young per
litter, with an average weight of 41 gms., while the untreated
females averaged 7 per litter, with an average weight of 36.5 gms.
Repeated elevation of body temperature by short waves is a
safe procedure when temperatures greater than those within
physiological limits are not employed. Considering the small
group of treated and untreated rabbits (24), it cannot be con-
clusively stated what effect the treatments will always have,
although the result indicates that these will be favorable.
No retardation in the growth of white rats and no appre-
ciable impairment in the reproductive capacity were observed
by Knudsen and Schaible, who experimented with waves of
from 9 to 12 millions' frequency (33.3 to 25 meters) on white
rats. They exposed young rats from one-half to one hour daily,
raising the body temperature to 40.5° C. Repeated exposure of
rats to a rise to 40.5° C. in temperature does not seem to produce
pathologic lesions.
Von Oettingen attempted to determine the effect of short
waves on the testicles of mice, and noted considerable damage
to the tissues and cells, in some cases leading to complete
necrosis. The treatments lasted 15 minutes daily, over a period
of 6 or more days.
Similar experiments were carried on by Jacobson and Hosoi
on germ cells. The temperature of the experimental dogs rose
from 108.3° F. to 111° F., and that of rats from 98.3° to 101.8° F.
Degenerative changes were produced in the testes, and the
authors point out that the male germ cells are very susceptible
to heat, and that consequently the high temperature which was
created in experimental animals may account for the degenera-
tive changes.
Jellinek placed parrot eggs in the condenser field and ex-
posed them to continuous treatment of from 2 to 4 weeks dura-
tion. The temperature of the eggs did not go above 29° C., and
the room temperature was kept at 26° C. The experiments
showed that short waves accelerated the hatching.
EXPERIMENTATION 45
A C T I O N O F D I F F E R E N T W A V E L E N G T H S ON T I S S U E
Using the 3-meter wave on rabbits, Schliephake observed

that fat, bone, and liver increase their temperature to a higher
degree than do skin, brain and muscle tissue; and according to
Schliephake and Ostertag certain wave lengths under 4 meters
exhibit selectivity for certain cell groups in the brain of these
animals, while adjacent cells exposed in the field to exactly the
same degree remain unaffected.
Using dogs, Pratt and Sheard experimented with 10.9-meter
waves and a current density of 0.1 to 0.05 ampere per square
inch. They treated the intra-articular and sub-cutaneous tissues
of the knees, and found that the two tissues heat to a different
degree under the same exposure. It has, furthermore, been
shown that the reactions of anesthetized animals to the general
hyperthermia produced by short waves, are quantitatively
different from those produced in unanesthetized animals.
Measurements of temperature of tissues of dead animals have
shown that bone is heated much more markedly than is muscle
tissue, and have indicated that the changes of temperature pro-
duced by this high-frequency field are strictly dependent upon
the situation and the constitution of the various tissues.
Schaefer placed different types of tissues in layers and then
treated them with short waves. He found from these experi-
ments that there is a definite relation between the conductivity
of the tissues and the heat action of the wave lengths. The
better the conductivity of a given tissue, the shorter the wave
length one can use. From the practical point of view of therapy,
one would, for example, protect the skin and treat a deeper-
lying structure with short wave lengths; while for skin treat-
ments a longer wave length would be used.
Reiter experimented with waves of different lengths, and
found that below a certain wave length limit, various tissues are
heated differently by the same amount of energy of the same
wave length. The tissues, in order of heating capacity, are con-
nective tissue, skin, kidney, spleen, blood, liver, lungs, brain,
and fat. The heating of fat is always much slower, owing to its
poor conductivity as compared with that of other tissues. Above
12 meters, the differences in heating capacity between various
46 EXPERIMENTATION
tissues are very slight—in fact, are rather undefined. The differ-
ences increase with the diminution of the wave length, the great-
est being found with the shortest wave length. Patzold con-
firmed these findings, stating that there exists for every tissue an
optimum wave length. In other words, every tissue has a wave
length which produces an optimum heating effect. According to
Patzold, the heating reaches its maximum if K = E. V/2, where
K = conductivity, E = dielectric constant, and V = frequency.
The optimum wave length can be calculated only approxi-
mately, as the values for K are not known exactly. Patzold has
shown that the degree of heating in a time unit is governed by
the wave length and by the conductivity and the dielectric con-
stant of the electrolyte. He has been able to show selectivity in
blood, as well as in human tissue.
Bachem found that when objects of different conductivities
were exposed to short waves, once in series, once in parallel
circuit, identical heating results were obtained. But different
heating was observed if electrolites of different conductivities
and various biological material were placed in the electric field
under strictly identical conditions. This author found that for
each material, the maximal heating occurred with different
wave lengths; for example, the relative heating of the 5-m. wave
in descending order is fat, bone marrow, bone, lung, skin,
spleen, liver, hair, brain, muscle; while blood corpuscles are
heated more, and blood serum less, than whole blood.
Heller succeeded in treating, with 3.75-meter waves, isolated
sections of the body, without affecting other parts. He succeeded
in producing a transverse lesion of the spinal cord of a frog,
producing, within a few minutes of exposure, paralysis of the
lower parts of the body. He was able to prove that small surface
electrode plates are useful, and suitable for local treatment of
certain parts of the body without affecting the adjacent tissues.
The short-wave effect was studied on amputated human
extremities by Schliephake, who found that fat tissue warmed
up best, although individual differences as to the degree of
heating, within the same electric output, were apparent. The
factors which govern the transformation of electric energy into
heat are based on the constitution of the cells and the proto-
plasm. In accordance with this, Schliephake found, in treating
EXPERIMENTATION 47
whole parts of the body, that in different layers different de-

grees of heat were obtained, depending upon the tissue com-
position. Experiments with waves of from 3.5 to 15 meters have
shown that the highest degree of heating occurred in fat tissue,
and this was especially marked with the 3.5 meter wave. This
selectivity of the heating phenomenon, as demonstrated in
subcutaneous tissue, is due to the pronounced fat content of
this layer. The subcutaneous fat is heated least with the 7-
meter wave, and best with the 14.5-meter wave. Muscles and
bones also differ in their heating capacity.
The very interesting experiments of Schliephake, Bachem
and others, though showing the different heating effects of the
different wave lengths are of theoretical significance only, be-
cause in the living organism the circulation, the metabolic proc-
esses and the heat-regulating mechanism of the body create
conditions which are as yet unknown, but whose significance
may be of practical value. For this reason, it would be of interest
to continue such experiments in living tissues as those per-
formed by Coulter and Carter, remembering, at the same time,
that the results obtained in normal living organisms may not be
always duplicated in disease, owing to the definite changes in-
duced by some pathological conditions.
Jorns worked with rabbits, to ascertain what effects the
treatment has on growth of hair. He used from 6 to 8 amperes,
for 3 to 5 minutes daily, for 3 weeks, and found no increase in
hair growth. Concerning the healing of wounds, the growth of
bone, and the regeneration of fractured bone, he found that
short waves do not increase these processes.
Using the 25-meter wave on dogs, Jacobson and Hosoi
found fatty degeneration of parenchymatous organs, dehydra-
tion of tissues, congestion and focal hemorrhages. Cloudy swell-
ing was probably more marked in their animals than usually
results from external application of heat. The degree of con-
gestion in the appendages, leading to thrombosis and gangrene
of the tail, ears and feet, was a quantitative difference requiring
careful consideration in the application of such heat to human
beings. The acidosis and glycogen depletion are also natural re-
sults of intracellular hyperthermia. Other changes, such as
lymphoid degeneration and necrosis, have the same significance.
48 EXPERIMENTATION
PHYSIOLOGIC E F F E C T S OF SHORT W A V E S
Kellner observed contraction of atrophic muscles, which did

not react to other forms of stimulation.
Pflomm observed vasodilatation, lasting for several hours.
Hyperemia was lasting and definite, and blood and lymph cir-
culation increased, a phenomenon which will be further dis-
cussed below, in Chapter IV—Inflammation.
Quantitative and qualitative studies of the circulatory reac-
tions of anesthetized dogs, by Wiggers and Orias, reveal certain
differences in the manifestations of the hyperthermia which is
produced by high external temperatures and that produced by
short waves. In hyperpyrexia caused by the former, blood
pressure tends to decline with temperatures above 41° C. The
pulse pressure decreases, rises more gradually to a peak, and is
lacking in secondary vibrations. This suggests that systolic dis-
charge is reduced, and that the force of ventricular contraction
is decreased. The manifestation of short-wave heat, however,
takes the form of an enormous increase in systolic and diastolic
pressures, after the temperature exceeds 41° C. The pulse pres-
sure increases greatly in amplitude, rises sharply to a peak, and
exhibits many secondary vibrations. These features suggest that
the force and vigor of ventricular contractions are improved,
until the crisis is reached. On the other hand, many features of
the curves suggest that the systolic discharge delivered by each
beat may not be increased, and perhaps is decreased. Vascular
changes doubtless contribute to the blood-pressure changes, but
whether these are in the nature of an increase in peripheral
resistance or of a decrease in elasticity of vessel walls, requires
further study to determine.
Despite the fact that changes in the heart rate, pulse pressure
and pulse form, without changes of temperature within the heart
cavities, have been observed, this does not prove that the
passage of short waves exerts an effect independent of local
temperature changes in the cardiac or vascular structures. When
short-wave diathermy in animals is continued long enough,
death occurs, as in other forms of hyperthermia, through pri-
mary failure of the respiratory center, which is followed by
circulatory failure due to asphyxia.
EXPERIMENTATION 49
Animals kept between temperatures of 39.8° and 41° C. for

2 hours, manifest a circulatory reaction, as the temperature de-
clines and returns to normal. The blood pressure falls, and the
pulse pressure clearly indicates that systolic discharge is de-
creased and ventricular expulsion is less forceful.
Reiter observed that an animal treated with a large dose of
short waves (4 meters), showed, shortly after the treatment
and in the sharply limited treated area, all the signs of inflam-
mation equally in all the layers of the treated parts. The veins
were enlarged to several times the normal size, and blood was
found in varying amounts outside of the veins. If wave lengths
of 20 meters were applied for the same length of time at the same
intensity, causing the same degree of heat, such effects were not
produced. With wave lengths below 20 meters, the upper limit
of this phenomenon is about 10 meters. Below this limit, the
effect constantly increases, the most marked being found with
the shortest wave lengths used. Reiter therefore ascribes this
vasodilatation to a specific effect, limited to a certain wave
length. Such specificity was not mentioned by other authors.
From 6 to 15 treatments, each lasting 4 minutes daily, were
administered to the thyroid gland of 8 rabbits by Jörns. It was
found that the thyroid function was retarded to the same extent
as that following surgical removal. At the end of the short-wave
treatments, the glands were removed and studied. A general
hyperemia of glandular tissue was noticeable, accompanied b y a
decrease of the colloid content in the acini, the majority being
empty. The epithelial cells of the follicles were unchanged, and
there was no evidence of cell injury, such as tissue necrosis or
vessel changes. The observations of Last indicate the inhibitory
influence of the 4-meter wave on thyroid function. The 15-
meter wave gave negative results.
B I O L O G I C A L E F F E C T S OF S H O R T W A V E S
In experiments on dogs, Nasset used 10 and 100-million

frequency currents (30 to 3 meter wave lengths), and found that
during the treatments the blood was concentrated 40 percent or
more. With a b o d y temperature below 41° C., the hemoglobin
saturation of venous blood was increased; above this tempera-
50 EXPERIMENTATION
ture, it was diminished. The loss of water from the blood stream
was accompanied, and probably partially compensated for, by
extensive storage of corpuscles in the spleen. The carbon-
dioxide content of the blood was diminished 30 percent. The
alkali reserve, as measured by carbon-dioxide capacity, was de-
creased, but to a lesser extent than the carbon-dioxide content.
This disturbance in the acid-base relations of the blood may be
the consequence of three factors, namely, hyperthermia,
hyperventilation, and a greatly accelerated metabolic rate. The
maximum increase in heat production above basal, observed in
dogs, was 31.3 percent. A current of 10 million frequencies per
second apparently elicited the same response as a current of
100 million per second. The pulmonary ventilation was increased
fifteen times, with a simultaneous reduction of the carbon-
dioxide content of the expired air to 0.5 percent.
Wallace, Fenn and Latchford measured the oxygen con-
sumption of frog muscle, during treatment with alternating
currents of approximately 100 million and 10 million frequencies
per second, and noted no effect which was not attributable to the
heating effect of the current.
Nasset, Bishop and Warren, experimenting with a current
of one million frequency, noted that in anesthetized dogs in
which the high-frequency current raised the body temperature
from 3.6° to 8.5° C., the respiratory metabolism was increased
from 27 to 172 percent. In some cases the respiratory rate was
increased 25 times.
Schliephake and Weissenberg exposed rabbits to the 3.4-
meter wave, in order to determine the influence of the treatment
on the blood sugar. In one group of animals, the electrodes were
placed on the hind-brain, in a second group the pancreas was
treated, while the third group, used as control, had the back and
lower extremities exposed to the short-wave field. In the first
group, the sugar content of the blood rose to more than double
the original amount, after a few minutes of treatment. In the
next four hours the curve went down below the starting point
and in the following eight hours it again rose slowly. In the
second group, there was a slow rise of the blood sugar, followed
by a gradual fall to below the starting point. In the third group,
only slight changes were noted. The changes in sugar content
EXPERIMENTATION 51
of the blood differ, according to the regions of the body treated.

Izar and Moretti found no change in the blood sugar in man,
after treating the upper abdomen with different wave lengths.
In anesthetized dogs, Nasset, Bishop and Warren found
that when the average body temperature reached 41° to 42° C.
the blood sugar concentration showed a large increase. Gross
changes in chloride concentration were not observed. Although
the metabolic rate increased, the carbon-dioxide content of the
blood decidedly diminished.
Pflomm took blood from the cubital vein after the forearm and
hand had been treated with short waves, and found an increase
in the blood sugar, ranging from 1.2 to 0.2 percent, up to 4.0
percent. These figures would seem to show an acid reaction of
the serum and an increased hydrogen-ion concentration. After
treatment of the forearm, Pflomm found 7.7 as compared to
7.85 before treatment; after treatment of the knee, 7.8 as com-
pared to 8.0 before; and, in another patient, 7.5 after, as compared
with 7.7 before, treatment. Similar differences were noted in
serum exposed to short waves outside the body. Pflomm at-
tempts to explain this as an alteration in the albumins, although
a change in dispersion may also explain the increased sedi-
mentation rate and the increased phagocytosis (Torus).
After exposing animals to a high-frequency field, Knudsen
noted loss of weight, dependent to some extent upon the length
and intensity of treatment. The decrease in blood volume
amounted in some instances to 25 percent. This was also evi-
denced by the increase in cell volume and hemoglobin. The
blood volume returned to normal within twenty-four hours.
Raising the temperature of animals to 41.78° C. does not pro-
duce any great change in hydrogen-ion content of the plasma,
although there is a tendency toward alkalosis. With higher
temperatures, however, the tendency is toward acidosis, ap-
parently because of a great increase in the production of lactic
acid. This increase is probably due to greatly increased tissue
metabolism, resulting in a tissue anoxemia. Changes in the
chloride, total protein, and total base are accounted for by the
dehydration. Bicarbonate was greatly reduced, owing to ex-
cessive pulmonary ventilation, with rise in the body tempera-
ture. Changes in inorganic phosphorus were somewhat variable,
52 EXPERIMENTATION
although with a maximum temperature of 41.7° C., there is a
marked reduction. The nonprotein nitrogen of the blood was
generally increased, in some instances over 200 percent. Urea
nitrogen, creatinin and amino-acid nitrogen were also increased.
These increases were accounted for by the increased metabolism
resulting from rise in temperature, and by the oliguria. The
blood-sugar content in most of the experiments showed an in-
crease, in some cases amounting to as much as 150 percent. The
greatest increase in blood sugar occurred in those experiments in
which the hydrogen-ion concentration had been lowered the
most.
Narr and Nasset, in experiments on dogs, noted that in
hyperthermia induced by high-frequency currents, the urea, the
amino-acid, and the uric-acid fractions of the nonprotein
nitrogen of the blood maintain essentially the same relative
concentrations, up to a rectal temperature of 42° to 44° C. There
was some evidence that at these high temperatures protein
metabolism, as judged by urea production, may be doubled.
There was no evidence of a disturbance of the endogenous pro-
tein metabolism. Oliguria and anuria are almost invariable
signs of hyperthermia carried to 42° C. or higher. It is sug-
gested that damage to the renal parenchyma is an important
factor in the loss of kidney function.
Mortimer noted that the blood-chemistry changes observed
in dogs subjected to sublethal doses, are very similar to the
blood changes noted in diathermy experiments. Calcium was
unchanged or rose, chlorides increased or decreased, carbon-
dioxide combining power decreased markedly; total solids,
nonprotein nitrogen, and uric acid increased. Mortimer at-
tributes all effects of the ultra short-wave exposures to heat
generation.
E F F E C T OF S H O R T W A V E S ON B L O O D A N D S E R U M
In the interest of therapeutics, it is important to know what

effects exposure to short waves may have on blood and serum.
McLennan and Burton experimented on defibrinated horse
blood, in order to study the selective heat effect of short waves on
blood. They found that the relative heating of the blood cor-
puscles increased with the higher frequencies. Greater heating
EXPERIMENTATION 53
occurred with 9-meter as compared with 15 and 43-meter waves.
Raab reports that Rahlwes observed rapid disintegration of
leucocytes in smears, after short-wave diathermy. If the pro-
portion of disintegrated leucocytes was 1:2 before the treatment,
this was reversed to a 2:1 proportion after short-wave diathermy.
At the present moment, no acceptable explanation can be given
for this phenomenon.
With the 3-meter wave and with the same energies, Schliep-
hake treated an equal amount of serum, blood, and clot, and
from the results it appeared that the red blood cells must heat up
more rapidly than the serum in which they are carried. Owing
to heat equalization, a medium temperature will be created in
the blood.
In further experiments, Schliephake diluted blood with water
and with isotonic sodium-chloride solution. With exposure to
short waves, it was clear that the higher the sodium-chloride
content of the mixture and consequently the more diluted the
blood, the nearer did the degree of heating approach that of
pure sodium-chloride solution. The mixing of blood with water
causes hemolysis, behaving quite differently under the influence
of short waves. Forty c.c. of blood and 60 cm. of water give the
ideal mixture in which the degree of heating with short waves is
highest, gradually decreasing as the mixture becomes more
diluted. From this experiment, Schliephake concludes that in
mixture the red blood cells heat at a different rate from that of
the surrounding liquid, and that the substances freed by
hemolysis behave differently in watery solution than within the
red cells themselves. It is likely that this phenomenon is the
outcome of the dissociation within and without the red blood cells.
McLennan, Schereschewsky, and others found that the
relative heating in high-frequency fields of various body fluids
and tissues, proves that all show a greater degree of heating
than does blood serum. Plasma shows little difference, while
blood heats considerably more than plasma. Red blood cells
heat more than plasma, the maximum effect being noted at a
wave length of 4.69 meters. The heating of different tissues and
blood sera was studied, and the most conspicuous differences
were observed in the case of the lower frequencies. With the
highest frequencies, heating became more nearly uniform, al-
54 EXPERIMENTATION
though lung and brain tissue still showed a considerably greater
tendency to heat than did blood serum at this frequency.
Von Oettingen found that the amount of the circulating
blood decreased in the animals so rapidly during the treatments
that it was difficult to secure enough for tests.
Schliephake found that the coagulation of blood is increased
shortly after short-wave treatment, making it difficult to take
blood from the animals. The addition of such an amount of
sodium citrate as under normal conditions will prevent coagu-
lation, does not hinder coagulation after exposure to short waves
(Schliephake). The quickest coagulation time in experimental
animals was one hour after the treatment! The sedimentation
rate of red blood cells was also accelerated (Von Oettingen). The
idea that changes in coagulation time may be related to changes
in the thrombocytes was shown to be unfounded by Pflomm,
who noted only slight variation in the number of thrombocytes
in proportion to those of the red blood cells.
Experimenting on dogs, Knudsen and Schaible found that
there is an increase in the blood, in both the red cells and the
total white cells. Beside the increase in red cells, there is in
many instances a marked increase in immature forms of red
cells, suggesting a stimulation of the hemopoietic tissues.
In the case of human beings, Noller and Schliephake found
conditions the same as in other animals. Those who were re-
peatedly examined, showed a typical increase or decrease in
the number of red blood cells, although there was definitely a
decrease if repeated intensive treatments were administered
through the chest. Short-wave treatments directed to the torso
and the extremities, resulted in a leucopenia; but if the head
was exposed to the short waves, leucocytosis resulted (Schlie-
phake). It was found that in general the leukocytes wander to
the treated area, although this finding is subject to some in-
dividual variations.
After treating the upper abdomen in man with the 8-meter
wave, Izar and Moretti found that the number of red blood cells
decreased with concomitant leucocytosis and lymphocytosis.
Jorns, experimenting with 4.8-meter waves on human
leucocytes, noted an increase in the phagocytic activity: in vitro
10 to 20 percent, in vivo, 14 percent. He found that the short-
EXPERIMENTATION 55
wave field influenced the serum, rather than the white blood
cells. Treatment with higher power was detrimental to the
leucocytes, decreasing their vitality.
The experiments of Schultze-Rhonhof show that the waves
have no effect on the red blood cells, except that the blood be-
comes more condensed, owing to the loss of fluid by sweating in
consequence of the elevation of the body temperature. The
number of white blood cells, on the other hand, decreased in
number during the treatment, but a few hours later increased
above normal and did not return to normal until twenty-four
hours later.
Hinsie and others studied the white blood cells in patients
treated for general paralysis with short waves. There was a
75-percent rise in the leucocyte count, which reached its
maximum at the end of the ninth hour (the patients being kept
in blankets for seven hours following treatment), and regained
the normal level at the end of the twentieth hour. The leucocy-
tosis was characterized by an increase in the polymorphonuclear
neutrophiles.
Pflomm observed that the dissociated calcium ions appear in
the treated tissue, and partly disappear in the blood.
Schaefer experimented with 3- to 6-meter waves, and found
that the blood shows a high absorption of high-frequencies, as
contrasted with cases exposed to low-frequency currents. Ac-
cording to his experiments, the blood corpuscles are responsible
for the increased absorption, whereas the plasma seems to be
neutral toward the change in frequency.
Schliephake thinks that the surface changes in the cell
membranes are probably the cause of the increased absorption,
and that the antitoxins are activated. These actions and inter-
actions promote absorption, and are very complicated.
Haber, in his experiments with the 22 meter-wave on guinea
pigs, observed no modification in vivo of the complement of
the serum.
On further research, Izar and Moretti found that the com-
plement of guinea-pig serum will be increased by treatment
with the 15-meter wave, whereas it will not be affected by 4 and
8-meter waves. The proteolytic effect of pepsin will be increased
with the 8-meter wave, but will not be influenced by the 14 and
56 EXPERIMENTATION
15-meter waves. The agglutinin can be increased by treatment
for forty-five minutes, using the 15-meter wave; the precipitin
can be similarly increased. The nonspecific anticomplement
action is greatest after treatment with the 4-meter wave, and
least when using the 15-meter wave.
Izar and Formulari found that human sera which aggluti-
nated the typhoid bacteria, were unchanged after treatment with
the 15-meter wave, but the quantity of agglutinin diminished
after twenty minutes' exposure with 4 and 8-meter waves.
May and Schaefer experimented with wave lengths 1 to 10,
in an effort to ascertain the dielectric constant of different ma-
terials, among others, that of the albuminous substances,
especially paraglobulin B and the strongly dialysed horse serum.
They found no change in the dielectric constant.
Jorns studied the oxydase reaction after short-wave treat-
ment of stable and labile cell oxydases. He used human white
blood cells, diluted with physiologic salt solution, in an effort
to prevent coagulation which might cause changes in the serum
albumin. The experiments were in vitro, with 7-meter waves,
using 16.5 voltage and 2.3 to 8.3 amperes. The experimental
material was divided into four lots: (1) a lot not treated; (2) a
lot treated for ten minutes; (3) one treated for twenty minutes;
(4) and one treated for thirty minutes. He found that short-
wave exposure in the dosage noted, which is powerful enough to
interfere with cell function, has no effect on the mechanism of
oxidation or on cell metabolism. Raising the length of exposure
to one hour was without effect, the oxidase reaction stopping
only after the cells had been destroyed by the short waves.
As the increase of temperature was never more than 26° C.,
even after an hour, it follows that the destruction of the blood
cells was not brought about by hyperthermia, but by the specific
electrical effect of the short waves.
Kobak observed that short-wave treatment tends to raise
the refractometric index, increase the viscosity, raise and lower
the blood sugar, and increase the sedimentation rate.
ACTION OF SHORT W A V E S ON E L E C T R O L Y T E S AND COLLOIDS^
Essau, experimenting on solutions of electrolytes, found that

the electric condenser field acts directly on the molecules, or on
EXPERIMENTATION 57
the colloid particles which they carry. The treatment generates

heat in these particles, and the heat spreads from the focus out-
ward, so that in every solution one portion becomes more heated
than the others. This is shown by one of Essau's experiments:
water mixed with soda, lye and paraffin oil is placed in the
short-wave condenser field. This mixture begins to boil at 60°
to 70° C. The tiny drops of water in the solution must have
been heated up to 100°, whereas the paraffin oil in the mixture
is only slightly heated.
Schliephake studied various solutions of salts, acids and
bases under short-wave treatment, and ascertained that for
every separate wave length there is a dilution at which the
temperature is particularly high.
In bringing electrolytic solutions into the condenser field
with wave lengths successively changed, Patzold noted that
there was always a certain wave length at which the increase in
heat reached a maximum for a given electrolyte solution.
McLennan found that the heating of a solution of elec-
trolytes in a high-frequency electrostatic field, depends not upon
the composition, but upon the specific conductivity of the
liquid; and that it rises to a maximum for a certain conductivity,
whatever the size and shape of the specimen heated. The con-
ductivity at which the maximum effect occurs is proportionate
to the wave length; with longer waves, the maximum heating is
observed in solutions of lower concentration than with short
waves.
Schliephake placed two diffusion shells, one containing 0.4
percent sodium-chloride solution and the other 0.1 percent
collargol solution, in a water bath. When treated with the 8-
meter wave, it was noted that after five minutes there was a rise
of 2° C. in the temperature of the salt solution, that of the silver
1.1° C., and that of the surrounding water 0.8° C. With the
15-meter wave, the situation was reversed, the temperature in-
crease of the silver solution being higher and that of the salt
lower, while the water showed a very slight increase of temper-
ature. The experiment was also carried out with the diathermy
current, the solution containing tubes being placed, one within
the other, without changing the ratio of heating. This would
seem to indicate that the short-wave action is not influenced by
58 EXPERIMENTATION
the glass containers or by the surrounding water, but that the
heating effect is taking place in the interior.
In order to get some information concerning the reaction of
different types of tissue to high-frequency waves, as measured
in terms of temperature produced, Headle and Burdette made
a study of various chemical compounds which are characteristic
of living matter, particularly of animal matter. They found that
all organic compounds, but especially glycogen and peptone,
heat well; but that cholesterol, which is characteristic of nervous
tissue, stands out preeminently in this respect.
For further work on electrolytes, see the section on wave
lengths for short-wave diathermy, and also other sections.
LOCAL T I S S U E CHANGES
The superficial or deep tissue changes which might be ex-

pected after short-wave diathermy, have engaged the attention
of investigators from the beginning. On the basis of purely
physical considerations, it was assumed that local damage may
be expected in parts adjacent to the electrodes. The principal
effect observed is a marked hyperemia. If the electric energy is
further increased, coagulation of the adjacent surface will take
place, especially if the electrodes have been placed directly upon
the skin. Necrosis of the skin and the underlying tissue will
follow, and demarcation of the destroyed area, after a period of
time, will be followed by granulation and slow secondary healing.
This is, of course, an extreme, and to be observed only in the
laboratory, where such results are induced for experimental pur-
poses. Damage to such a degree is not found in clinical work,
with the exception of the case reported by Kling and Berg,
noted on page 102; but insignificant burns from sparking, occur-
ring either on the operator's hands from touching the metal
parts, or on the patient while being treated, are met occasion-
ally, but these usually heal without complication.
In the laboratory, it was observed that, after a certain
amount of treatment, the animals shed their hair. This is at-
tributable to the concentration of the electric current at the
hair follicles, an increased heat effect being generated in these
areas. Such a degree of concentration in the human patient is
EXPERIMENTATION 59
prevented by the patient's subjective sensation. Prickling pain,

however, has been observed in the course of treating hair-
covered areas, and may be explained as above. Some investi-
gators (Schliephake) advise the shaving of hairy parts, or at
least compression of the hairy surface, if such uncomfortable
effects are noted. By using properly air spaced electrodes, we did
not find it necessary to resort to such preventive measures.
Schliephake observed spontaneous fractures in experimental
animals, after repeated exposures to short waves, without
damaging effects in the surrounding soft parts. This demon-
stration of the deep effect of short waves points to caution and
careful application in the human subject. Although the ap-
paratus in general clinical use do not furnish an intensity great
enough to cause such deleterious effect, the possibility should be
kept in mind when using a machine of higher output.
Experimentally, varying effects are observed after exposure
of the spinal cord to short waves. After treating the cervical part
of the spine, Schliephake noted spastic contractures and palsy
in the lower extremities, which disappeared after varying lengths
of time. In our animal experiments, we frequently observed
palsy of the hind legs of rats after exposure of only a few minutes
to strong currents, before local necrosis of prominent parts had
taken place. This may possibly be attributed to a nerve or a
vascular injury.
INFLAMMATION
Judging from clinical evidence as represented by the ob-

servations reported, the field for the most successful employ-
ment of short-wave diathermy is that of inflammatory dis-
orders, acute, subacute and chronic.
The inflammatory process is the defense reaction of the
organism against the invader or irritant, and the therapeutic
agent should act both as a protection and as a support. Success
leads to resolution of the inflammatory process, whereas failure
of the measure or measures employed is apt to result in a process
that may be localized, as in an abscess, or terminate in cellulitis,
local gangrene, sepsis, sapremia, according to the peculiarity of
the disorder.
Increased capillary pressure, according to Ludwig, causes
60 EXPERIMENTATION
exudation, which can be arrested by decreasing the pressure.
In inflammatory processes, the semipermeable membrane of
the vessels will be greatly increased through the dilatation of the
capillaries and, if adequate pressure is maintained, the lesion
of the vessel wall will allow not only an escape of serum, but also
of other blood elements. Pflomm, Dreyer, and Tonsen have
shown that hyperemia is present for two or three days, and
sometimes even longer, after intensive application of short
waves, owing to partial palsy of the sympathetic (fig. 14). This
14. Vasodilatation in the Swimming Membrane of a Frog

a, Before Short-Wave T r e a t m e n t ; b. After Short-Wave T r e a t m e n t
palsy of the capillaries, which cannot be influenced by adrenalin,

results in a decrease of blood pressure from purely mechanical
causes. From the area of higher pressure in the edematous tissue,
the fluid streams back to the blood vessels. Consequently the
edema decreases, the compressed capillaries are freed, the flow
of blood in the affected area is improved, and the circulation is
reestablished. The damaged capillaries, which are permeable for
the albumins, will be closed again by fibrin, under the influence
of the activated calcium ions. The colloid toxins of the bacteria
are then unable to penetrate the repaired capillary walls; hence
there will be a reduction in toxins assimilated, resulting second-
arily in a fall in the temperature and improvement in the
patient's condition.
The increased blood flow in inflammatory processes is mainly
arterial. Because the venous capillary system is unable to drain
properly, the increased flow results in extravasation and in-
EXPERIMENTATION 61
creased tissue pressure. It is thought that short waves facilitate

drainage by enlarging the venous capillary system. For this
reason it would seem logical to suppose that sepsis deriving from
a local condition also might be controlled through the decrease
of the compression caused by edema. Presumably there would
be no overflow of bacteria-containing lymph which could spread
the infection by way of the lymphatic circulation.
The increased phagocytosis which is activated by short
waves (Pflomm, Jorns), is an important aid to the organism
against the invader.
While the mechanism of the therapeutic action of short
waves may be chiefly that of a heat effect, or "cell resonance,"
specific effects which may be as yet unknown, cannot be disre-
garded as possible factors. D'Arsonval, Szymanowski, Mellon,
Hicks, and others found a decrease in the toxicity of the diph-
theria toxin. In addition to this attenuation by short waves,
Dubois and others observed a marked attenuation of the strepto-
coccus toxin and of cobra venom. These laboratory observations
are not sufficiently conclusive to support the belief that a similar
action will be obtained in the complex mechanism of the living
body, but clinical observations contribute to the view that short
waves exert an antitoxic effect. These conclusions are purely
empirical as yet, and any attempts to explain them biologically
or chemically with scientific exactitude would be futile. The
following experiments, illustrating the action of short waves as
observed on inflammatory processes are of interest.
Pflomm constructed an "artificial capillary" in the form of a
tube, made out of the bladder of a hog, connected to an elec-
trolyte container. This tube was placed in a jar, containing a
different solution for each experiment. An even pressure and
stream were maintained under the same temperature. In the
short-wave field, when the outer fluid was heated a diminution of
the pressure and an increase in the concentration in the tube
followed, showing a change in osmotic conditions and indicating
also that the warmer fluid passes through the membrane to the
cooler side. It was also found that the heat generated was greater
in the calcium solution than in the potassium and sodium, from
which it may be assumed that the exchange of fluid between the
capillaries and the surrounding media is increased under the
62 EXPERIMENTATION
influence of short waves. Since the process of exchange in in-

flammatory conditions is often disturbed, the reestablishment of
a normal balance by means of short waves would lead to a cure
(Schliephake).
In experiments with turpentine abscesses in dogs, Schliep-
hake found that there is an increased heat production in the
abscess in the condenser field, in contrast to that in the sur-
rounding normal tissue. This is understandable if we consider
that in the adjacent normal tissue the circulation of the blood
tends to equalize the increased temperature, in contrast to that
in the abscess cavity, where no blood circulates and no heat is
carried away. Pflomm believes that the increased heat production
in the inflamed area is due to the varying ionization mechanism
of the inflammation. In acid media, the tissues heat better than
in alkaline. If there is no emergency, it is therefore inadvisable to
evacuate the acid pus at the time of the first few treatments, as
greater heat production is secured by means of the abscess,
thereby promoting bactericidal and antitoxic effects and prob-
ably inducing some degree of auto-immunisation, although this
last is still uncertain.
The lymphangitis and lymphadenitis also subside with the
diminished capillary pressure in the inflamed area. The pain,
which is often severe, owing to compression and the possible
toxic irritation of nerve ends, is relieved by the decompression
and the possibly antitoxic effect of the short waves. According to
Kowarschik, the analgesic effect may be explained by the in-
creased hyperemia and the supposed electric action of the
short waves.
Hasch6 and Leunig, basing their conclusions upon the re-
sults of their experiments, state that short waves have no
specific bactericidal effect, even though emphasizing the cura-
tive action in inflammations and in suppurative infections. They
offer no explanation for this view.
In explaining the action of these wave lengths, Lob assumes
that the situation is somewhat analagous to that of Bier's
hyperemia. He believes that the result is increased exudation,
and tissue pressure favoring the penetration of microbes and
toxins to the adjacent deeper tissues. He observed a deterior-
ation in the local and general conditions of the patients, and con-
EXPERIMENTATION 63
sequently advises wide and sufficient surgical drainage of the

infected area, if deemed necessary by the surgeon; and concludes
that after the surgical drainage, short-wave diathermy shortens
the period of convalescence, owing to hyperemia and increased
exudate. It is possible, however, that such aggravation of the
patient's condition may be due to overdosage, this being the
opinion of more experienced workers in this field (Schliephake,etc.)
Groag and Tomberg note that comparatively slight dosage
may exert action similar to that observed with diathermy, and
that the latter is contraindicated in acute inflammatory con-
ditions. Faulty application of the electrodes may also result in
an effect similar to that obtained with diathermy, and may pre-
vent the creation of the desired electric field, with its focal heat
and its supposed specific electric influences. This may explain
the disagreement in the literature as to results obtained in
treating inflammatory conditions. It should also be remembered
that in short-wave diathermy, the electrodes are placed opposite
each other to create an electric field. Should they be placed along
the axis of the treated area, the action would be similar to that
of diathermy.
On the whole, it may be stated conclusively that short-
wave diathermy is a measure of definite value in inflammatory
processes. It is practically unanimously agreed by investiga-
tors that short waves should be employed in acute, subacute
and chronic inflammations. Not even high temperature in
the patient is a contraindication and, according to Schliephake,
the more acute the inflammatory process, the more effective
will the short waves be. They by themselves will cure inflam-
matory processes in a shorter time than any of the usual pro-
cedures, but the advisability of their employment in conjunction
with surgery, still rests upon the judgment of the surgeon.
As to the intensity, wave length and time of application, no
measurable, exact data can be furnished. Individual reactions,
and the pathological conditions to be treated, may require in-
dividual consideration, to be determined in the future. But from
the point of view of science, it is desirable that all the facts con-
cerning exact dosage should be ascertained. From a practical
point of view, considering our present knowledge of short-wave
diathermy, that intensity should be used which causes in the
64 EXPERIMENTATION
patient an agreeable warm sensation, and not a sensation of heat.

Superficial lesions require less current and shorter time of ap-
plication than deeper lesions. The duration of each treatment
should be from ten to twenty-five minutes. The optimum wave
lengths are as yet undeterminded for each specific condition. We
feel that shorter wave lengths may curtail more effectively the
more virulent conditions. In our own clinical material, we found
that the 6- to 12-meter wave lengths gave the best results in
inflammatory conditions. Although some promising results have
been obtained in specific infections, the main indication for the
use of short-wave diathermy in inflammatory conditions is in
those of nonspecific source.
TEMPERATURE REGULATION AFTER SHORT-WAVE DIATHERMY
It is known from experimental work that the body tempera-

ture of animals can be raised in the short-wave electric field.
This increase of temperature is attributable to the heat generated
in the organism by the electric energies. Such heat artificially
induced in the animal is compensated for by reflex action—by
the heat-regulating system. The increased respiratory rate and
heart action aim at equalization, but when these resources are
exhausted, the animal succumbs to heat stroke, the lethal effect
being more rapid if the animal is kept in a closed space, ade-
quately aerated.
Heat regulation varies in the animal body after local treat-
ment. Differences in temperature were noted by mouth, by
rectum, and in the part treated (Schliephake). A fall in tempera-
ture is observed in almost all animals after the treatment, and
generally a greater fall in the parts treated. The differences ob-
served are attributable to local circulatory disturbances. Three
types of primary disturbance of the heat regulating mechanism
were observed (Schliephake). With the mildest, the body
temperature increases in a few hours after the exposure, and this
is followed by variations in temperature in the succeeding days
(not observed in the control series). In spite of this, the animals
showed no other disturbances. The temperature returned to
normal after one or two weeks.
A second group exhibited evidence of central disturbance
EXPERIMENTATION 65
during treatment, such as increased respiratory rate, increased

secretion from the nose, and increased temperature. This in-
crease in temperature was maintained for a longer time than
that of the first group, becoming normal in a few animals after
two or three days, but in others showing marked variation later,
on an average 2.5° F . daily. These animals were obviously de-
pressed, and did not keep themselves clean. Most of them suc-
cumbed within a few weeks to pneumonia, purulent pleurisy, or
pericarditis.
In the third group exposed to a strong short-wave field, the
temperature fell, mostly within a few minutes after the treat-
ment, and the animals died in a few hours from severe pneu-
monia or pleurisy.
The action differs according to the wave lengths employed.
Schliephake found that the 10 to 15-meter range was not so
effective as the 3-meter wave length. The nervous disturbances
are more marked with the shorter wave lengths.
Anesthetized animals reacted somewhat differently to short-
wave treatment. During the exposure, the mouth temperature
rose, but fell rapidly afterward. The impression was gained that
the heat regulation and adjustment to electric excitation are less
satisfactory in the conscious than in the anesthetized animal.
TEMPERATURE MEASUREMENT
The accurate measuring of the temperature in the objects

under treatment by short waves is one of the most difficult
problems in this field. The recording of temperature has been
tried with mercury and with alcohol thermometers and with
thermocouples. The main difficulty arises from the fact that
whatever the measuring method, the recording instrument itself
comes under the influence of the short waves, and it is not
possible entirely to exclude induction of the current from the
condenser field into the recording instrument.
Brinch and Killerich experimented with thermocouples, in an
effort to find a workable method of temperature measurement.
The application of thermocouples proved to be impossible in all
cases where the treated object is too small, or where it cools off
very rapidly. In all other cases, the major difficulty lies in the
fact that the thermocouple behaves differently in the condenser
66 EXPERIMENTATION
field than it does outside the influence of the short waves. Just
as each different wave length and each degree of intensity of the
current influences the body tissues differently, so it influences
the material out of which the temperature-recording instrument
is built. As a consequence, these instruments may not be ab-
solutely reliable for short-wave diathermy.
Albrecht heated an agar block with short waves. It had
already been ascertained that the same agar block changes its
color to red at a certain temperature, when heated with a gas
flame. He noticed the same color change with a certain wave
length. Naturally this means only that with a certain wave
length and intensity, a certain material can be heated to a
definite temperature in a given length of time. As few materials
show such color change when heated, far reaching conclusions
cannot be reached by this method.
Debye and his pupils (quoted by Korb) demonstrated that
there are substances which are free of dipolar effects in the
electric field. The best material to employ for temperature
measurement in the short-wave field is benzol (Patzold, Korb)
because of its coefficient of expansion. Such a benzol ther-
mometer is very accurate, and for this reason may be used to
advantage for therapeutic and experimental purposes.
V
WAVE LENGTHS
W A V E L E N G T H S FOR S H O R T - W A V E DIATHERMY
As THE technical possibilities of producing shorter waves were

developed, it was natural that these came to be used in a
variety of experiments. Research workers found that by in-
creasing the frequency, in other words, by shortening the wave
length, the physical qualities of a given wave length differed
from those of other wave lengths. Similarly, differences were ob-
served in their physiological and biological action, and, in the
beginning of short-wave diathermy, many claims were made for
their specific effect on bacteria and in pathological conditions
differing widely in nature. Since those early days, however, a
better understanding of the possibilities and attributes of these
wave lengths has been reached. Electromagnetic waves have a
definite influence upon the body. Radium and X-rays, for ex-
ample, because of the extraordinary shortness of the waves and
the high effectiveness of the energy under which they are
generated, exercise a very pronounced effect upon the structure
of atoms, so that serious injuries—may be done to the exposed
tissues—for instance, cancer.
The ultraviolet end of the spectrum is less serious, while the
visible light rays may, under normal conditions, be called harm-
less. The infra-red and heat waves have only a slight effect
on atoms.
For the purpose of therapeutic application to the human
body, waves with a length of from 3 to 30 meters seem to be
the most important. As the wave length shifts within this range,
sometimes one, sometimes another tissue becomes warmer than
the rest. Theoretically, there may be assigned to every tissue a
wave length at which it is particularly susceptible to heating,
while other portions remain less affected. It is possible that
68 WAVE LENGTHS
individual differences may exist in human beings. Again theo-
retically, there might be wave lengths specifically adequate for
the cure of certain pathological states. Reiter, for instance,
claimed that the 3.4-meter wave was the most efficient in
destroying tumors (experimental). The same was found in the
case of human carcinoma in vitro. (See also Chapter X V I . )
Schereschewsky and Schliephake were the first to call at-
tention to those electromagnetic waves which are shorter than
6 meters. It was observed that these waves have a decided in-
fluence on animals placed within their field. Smaller animals
sometimes died within a few minutes. The temperature of
rabbits rose rapidly to 42° C., or even higher. These waves also
influence the nervous system, rats showing great irritability
after longer treatments, as compared with animals not treated.
Experiments with electrolytes proved that with varying
concentrations, the intensity of the heating varies. Esau,
Patzold, Bachem, and McLennan and Burton have been able to
prove certain relationships between the wave length, on the one
hand, and the conductivity constant and the dielectric constant
on the other. The effect on a certain electrolyte was found to be
optimum, when the dielectric properties had a definite mathe-
matical relationship to the wave length. As there are certain
differences between the various kinds of cells and the liquids in
the body, it must be possible, in certain circumstances, to in-
fluence these in different ways.
In the treatment of parts of the human body, Schliephake
found that waves from 1 meter up to 16 meters have different
heating qualities. If the wave length of 16 meters is exceeded,
then any other alteration of the wave length scarcely affects the
ratio in which the various layers become heated. If, on the other
hand, the wave length in the region under 16 meters is varied,
then the ratio values for the heating of the different tissues also
vary. If, for example, with one wave length muscle is heated
more and fat less, then with another wave length fat may be
heated to a greater degree than muscle.
After Schliephake had proved that with a wave length of 4
meters the blood corpuscles in a certain quantity of blood were
heated to a greater degree than the surrounding serum, Schaefer
produced the corresponding proof that the absorption of elec-
WAVE LENGTHS 60
trical energy in the blood corpuscles is much greater than in the
serum. In order to ascertain the dielectric constant, Schafer
experimented with 1 to 10-meter waves on basic biological sub-
stances, such as different kinds of gelatin, serum, albumin
(especially paraglublin B), and grape sugar and urea solutions.
He found that the dielectric constant is not dependent upon the
wave length. At the same time, he warns against drawing
definite conclusions, as the substances investigated were in large
part strongly diluted with water, and it is likely that the con-
stant of the solution is greatly influenced by the constant of
the water. This result coincides with the findings of Furth and
Kellner, but it is contrary to the outcome of Marinesco's experi-
ments.
Haase and Schliephake found that the more concentrated
an electrolyte is, the shorter is the wave which will produce the
optimum heating effect; and the more diluted the electrolyte is,
the longer will be the wave that will produce the optimum effect.
McLennan experimented with wave lengths of from 8 to 200
meters, and found that with shorter wave lengths the maximum
effect was produced in a solution of higher conductivity.
Izar and Moretti noted that the agglutinogenic character-
istic of human serum can be differently influenced with different
waves. The nonspecific anticomplement in syphilitic serum will
be increased, in proportion to the increase of wave length. When
treating the brain of experimental animals with the 8-meter
wave, the urea content of the circulating blood decreased. Treat-
ment with 4 and 15-meter waves had no such effect. These
investigators also studied the catalytic effect of copper elec-
trodes. This decrease in urea content was proportionate to the
wave length used. The shorter wave lengths proved to be the
more effective.
Richards, Loomis and Brunori found that maximal heating
can be attained in human beings with the 6-meter wave length.
Theories concerning the variability of the results are expressed
by them as follows:
1.—Owing to the presence or absence of synchronism between waves
used and the subject under their influence (resonance or non-resonance).
This situation presents itself with great frequency in dietetics, pharmaco-
therapeutics, and so on, where one individual will react in a more or less
marked manner to a given substance or to a certain influence, while an-
70 WAVE LENGTHS
other individual reacts in a contrary manner. 2.—Owing to the ener-
getic intensity of such waves. In this respect it will suffice to say that
when these radiations are in resonance with an organism they can also
be made destructive if the doses are great or if they are applied for too
long a period.
Recent investigations of Coulter and Carter failed to demon-
strate different heating effect on tissue with 25, 18, 12 and 6-
meter waves.
Much remains to be accomplished in the field of wave-length
determination for pathological conditions. As Schliephake thinks,
we shall unquestionably have advanced much further when we
discover the relationships existing between the various wave
lengths and the different pathological conditions. I t is possible
that the clarification of present uncertainties may bring diseases
as yet unconquered within reach of a curative measure.
MICROWAVES
There have been few experiments with short waves of less

than one meter in length (Denier). The difficulty is that at the
present time there is not available a short-wave machine that
can produce such waves with the strength required for thera-
peutic purposes. T h e microwaves must first be tried on models
and animals before they can be applied to human beings. In-
vestigators believe that the centimeter waves will have a
genuine selective effect, and that therefore they may be of still
greater importance than the short waves now employed.
S P E C I F I C E F F E C T , OR S P E C I F I C I T Y , OF SHORT W A V E S
Specific effect, or specificity, is a term which can be used in

two different connotations. In one sense, the term means that
short waves in general have characteristics, or effects, which no
other therapeutic agents possess to a similar degree. Such
specificity has been proved with short waves in the case, for
example, of pyogenic inflammations. In another sense, specificity
may be taken to mean the specific effect of certain wave lengths
within the realm of short waves. Such specific effect was al-
ledgedly discovered by some investigators in their much-con-
tested experiments on tissues and microorganisms.
WAVE LENGTHS 71
Concerning the question of specificity of short waves, there

has been wide diversity of opinion, some believing that the
specific action of short waves is their only important effect.
Others deny such specific action, acknowledging only the heat
effect; while still others incline to admit the possibility of both.
The greatest obstacle to a clear and ready understanding of
this question is the fact that short waves usually generate heat
in the object treated. Even in those cases in which the heat is not
noticeable, the question remains as to whether the results are
attributable to the "focal heat" or to a specific effect. No one
has as yet succeeded in keeping these two aspects entirely
separate. Groag and Tomberg went so far as to state that the
focal heat is essentially nothing but the specific effect.
Considering the focal heat theory from an electrochemical
and electrobiological point of view, one can consider each cell or
group of molecules as an electrically well-balanced unit, the
electric equilibrium being necessary for the vital functions of the
cells. Theoretically, the short-wave field can be looked upon as
an outside influence, which in one way or another can put this
equilibrium out of order. Consequently, disturbances will occur
which may unfavorably influence functions, or may be so severe
as to impede or perhaps to destroy, the cell functions of lower
organisms. The disturbances of the electric equilibrium are
probably more evident in the case of microorganisms, where the
entire organism is exposed to relatively strong action of the
short-wave field, than would be the case in the human body,
where only a small portion is treated with short waves. There-
fore, if by further research the specificity of each wave length
could be ascertained (for example, the dosage for microorgan-
isms), this might, theoretically, advance present knowledge con-
cerning the specificity of short waves in human pathological
conditions.
At the same time, it has by no means been proved that short
waves do not influence the molecules in some way other than
that of focal heat absorption or by a vibratory effect.
In Schliephake's opinion, those tissues which have a high
resistance to electric current warm up much later than do those
which offer less resistance. He observed that on surfaces where
two different kinds of tissue meet, the resistance, and conse-
72 WAVE LENGTHS
quently the heating, is more intense. In order to demonstrate the
effect of short waves on surface tension, he exposed drops in a
stalagmometer to a condenser field, and found
that the size of the drops in certainfluidsis much modified. For instance,
in blood and serum they are decreased in size. This is not in any way a
heat effect for the size of the drop is entirely independent of the tempera-
ture. We must accept the fact that in the interior of the body the dividing
membranes between individual cells and colloids are in some way in-
fluenced. This is a definite specific effect produced only by short waves
and quite independent of heat.
Schliephake's conclusions are not accepted in all quarters,
Holzer and Weissenberg especially professing themselves dis-
satisfied with the experiment, and claiming that similar effects
could be produced by other means.
Mortimer and Osborne deny specific action other than heat,
but there are some effects which are not as yet exactly known or
understood. Here belong the remarkable disturbances of heat
regulation which Schliephake produced in rabbits by short-wave
treatments, and which, according to the histological investiga-
tions of Ostertag, are due to the selective destruction of definite
ganglion cells of the vegetative nuclei in the medulla oblongata.
These phenomena occurred only with wave lengths between
3.20 and 3.70 meters.
In Reiter's experiments on inoculable rat sarcoma, it was
proved to his satisfaction that there is a definite selective in-
fluence on these cells by a wave length of 3.40 meters. Other
waves he found much less effective. A counterblast to this argu-
ment is offered by Haase and Lob and the present author, who
claim that the influence of short waves on benign and malignant
tumors rests exclusively on their heat effect, healing being
brought about by the induced hyperemia. In fact, these authors
refuse to admit the existence of any specific biological effect of
short waves on tumors.
Thus the arguments continue, for and against, and an
abundance of research data is adduced to support the assertions
of both sides. Among those believing in a heat effect only are
Christie and Loomis, Richards and Loomis, Fenn and Latchford,
Wiggers and Orias, Heinle and Phelps, Heller (experimenting on
eggs), Szymanowski and Hicks, and Coulter and Carter. Horsch
denies a wave-length specificity; neither could Baldwin and
WAVE LENGTHS 73
Dondale establish a specificity of wave length in their experi-

ments. Nasset believes he has found evidence suggesting that
there is no specific effect of high-frequency current on the oxygen
consumption of the experimental animal. But the observations
of Bergami and Schütz when activating ferments with different
wave lengths; the changes noted by Izar and Moretti in the
catalytic action of colloidal copper solutions, as induced by
short waves; and the alteration in the complementary effects of
sera, according to wave length employed in exposure, all seem to
point to differences in action of different wave lengths, and also
perhaps to suggest a specific action.
In clinical practice, we gain the impression that in short-
wave diathermy specificity cannot as yet be taken for granted.
At least, there is as yet nothing from a practical point of view
which justifies such a conclusion. It is highly possible that the
different effects, reactions and results which are obtained in
treatment, may be explained by differences in the apparatus em-
ployed, or possibly by individual reactions to the strength of the
electric energy used, by the method of application, by the degree
of heating, or by the length of application.
PART IV
THE TECHNIC OF SHORT-WAVE DIATHERMY
VI
SHORT-WAVE T R E A T M E N T S
IN SHORT-WAVE diathermy, the principle of individualizing the

treatment prevails just as it does in general medical practice.
Because the dosages of this therapeutic agent cannot as yet be
exactly measured, satisfactory results can be obtained only with
reliable apparatus, operated by an experienced physician who
understands the factors involved in the curative properties of short
waves. These properties are: length of application, intensity of
current, possibly wave length, and technic of application.
Generally speaking, the length of application depends upon
the condition of the patient, the location of the lesion, and the
nature of the pathological process. If we have a patient with low
blood pressure, who is in a generally weakened condition, it is
wise to start with a treatment that is shorter than would be
given a patient with a strong constitution. If the lesion is located
on the body surface, as in the case of superficial infections, then
a relatively shorter time is advisable than in the case of an in-
flammatory condition in the pelvis, or a lung abscess, where
thicker layers of tissue must be penetrated and deeper-lying
tissues reached. It has become evident, from the work by in-
vestigators, that conditions involving the nervous system should
be treated differently from those followed in infection. In the
first instance, as the work of Ravault, Ceccaldi, Weissenberg,
and other authors indicate, better results are obtained by treat-
ments of moderate duration; whereas in the infections, longer
application of the electric energy is fully indicated, the operator
being at the same time careful to avoid overtreatment.
From a practical point of view, the intensity of the high-
frequency energy cannot be exactly measured. Owing to techni-
cal difficulties, we must rely for guidance upon the patient's
subjective sensation of heat. B y increasing or decreasing this,
we may obtain a comparative measure of the energy which will
be satisfactory in practice. We know from work done, that in
78 SHORT-WAVE TREATMENTS
certain neuralgias not only a short time of application but also a
minimum of intensity is necessary in order to secure the best
results. Beneficial effects may be obtained when the patient re-
ports only a slight sensation of heat or none at all, but the cur-
rent flow is indicated through the warning light inserted in the
circuit. Schliephake believes that there is danger of overdosage
of short waves, and in the use of improper electrodes. Particular
care must be exercised in the case of patients whose sensory
apparatus is deficient, and also in anesthetized subjects.
In our clinical practice, we have observed the failure of short-
wave diathermy in cases which were treated with the same ap-
paratus and the same dosage as successful cases, but in a room
the temperature of which was below 70° F. This has been attrib-
uted to the greater dissipation of heat taking place in the cooler
atmosphere. These heat losses may be compensated for by
machines of a capacity sufficient to counteract such excessive
heat dispersion.
Unfortunately, the machines put out at the present time by
the manufacturers vary greatly in output. Standardization of
machines, as has already been mentioned, is very desirable, and
deserving of immediate cooperative action.
It is presumed that the different wave lengths within the
scope of short waves vary in their effects, in different pathological
conditions. Schliephake states, "By working steadily we may
some day reach the point of being able to select and apply the
optimal wave length for every disease and microorganism."
Although experimentation and clinical observations suggest
that certain conditions are more amenable to one wave length
than to another, still we cannot as yet make an unreserved state-
ment as to the specific wave length to be employed in a specific
pathological condition. The wave lengths most successfully em-
ployed, as judged by a survey of the literature and by our own
clinical observations, are indicated below, in the section devoted
to the application of short-wave diathermy in disease, to which
the reader is referred.
E F F E C T OF SHORT W A V E S ON PROMINENT P A R T S
In animal experiments, it was found that the legs, ears, and

tails necrosed after exposure to a certain intensity, though the
SHORT-WAVE T R E A T M E N T S 79
animals themselves did not perish. Experiments on phantoms

and models also revealed that the concentration of short-wave
energies was more marked on prominent points (fig. 15). Hein-
rich demonstrated sparking at a certain distance, by placing a
Wire on an electrode having a tip toward the other electrode.
If the tip of the wire is slowly retracted, arcing, which may
measure several centimeters, is obtained.
If a hand is placed in the electric field, so that the dorsum is
toward one electrode and one finger toward the other, marked
15. P r o p e r a n d I m p r o p e r A p p l i c a t i o n of E l e c t r o d e s : N o s e
a, Improper Application, Causing Current Concentration; b, Proper Application, Preventing
Current Concentration
heat quickly develops in the tip of the finger (Schliephake). The

heat concentration is especially strong in metal objects near the
body, for which reason, and as a precaution against burns, rings,
earrings, brooches and other metal objects should be removed
before treatment is begun.
Because of these demonstrated facts, the operator should
keep in mind the fact that the heat concentration is greatest in
prominent parts. Undue concentration can be avoided by proper
placement of properly constructed electrodes. This is discussed
at length below, in the chapter on electrodes.
I N C O N V E N I E N T E F F E C T S OF E X P O S U R E TO SHORT WAVES
In the early stages of short-wave investigation, Whitney

noticed that men working for hours at a time near the short-
wave machines showed dizziness and nervous irritation. Horsch,
Katsura and Ito, v. Kohler, Kowarschik, Laqueur and Remzi,
Liebesny and Schliephake, also reported slight inconvenient
effects upon doctors and personnel giving the short-wave treat-
ments continuously for many hours. The symptoms of those
affected took the form of dizziness, nervous irritation, some-
times sleepiness or insomnia, fatigability, restlessness, early
menstruation, and headaches. These symptoms are marked in
some persons, while others remain entirely free from them. In
order to protect himself against the waves in the course of
experimental work, Kovarschik covered his working gown and
his head with a thin veil of metal that absorbed the waves and
gave perfect protection. Schliephake suggests the use of a metal
netting around the machine and a metal lamé-covered coat for
the personnel. Some of these inconvenient effects were felt by us,
especially when many treatments had to be administered in
sequence. It seems that 6-meter and shorter wave lengths cause
more inconvenience than those longer than 6 meters. All in-
vestigators agree that these inconvenient effects soon disappear,
sometimes within a few hours, and that no permanent after
effects have been reported. Some short-wave apparatus is
constructed to overcome the possible effects on the personnel,
by having the machine completely enclosed in a metal cabinet.
This prevents the emanation of most of the waves, even though
the electrodes, and the cables leading to them, are of necessity
still outside the cabinet.
Bell and Ferguson, using radio aerials in their short-wave
experiments, noticed that the taller men with blond complexion
suffered more from the electric effects than the shorter and
darker-complexioned men.
Theoretically, damage by short waves, as pointed out by
Wetzel and Kiesselbach, may take place as a result of over-
heating in areas in which the circulation is slow—for example,
in the ventricles of the brain, in the eye, the semicircular canals,
and other places. Here the extremely sensitive cell function may
be harmed. Nevertheless, during the eight years in which short
waves have been applied therapeutically many hundreds of
thousands of times in clinical practice, no permanent damage has
resulted from treatment improperly administered. Neither have
short waves proved harmful to the personnel engaged in ad-
ministering them. This is especially striking as compared with
SHORT-WAVE T R E A T M E N T S 81
the hazards of other agents, X-rays for example. Administration

of short-wave diathermy by those inexperienced in its use may
lead to damage, just as any tool in the hands of the inexperienced
may cause injury.
C O N T R A I N D I C A T I O N S TO S H O R T - W A V E DIATHERMY
The fact that not many contraindications to short-wave

diathermy are clearly given, is proof of the little we know of
the subject. There are certain clinical conditions, however, in
which unsatisfactory results have been observed, but in the
present state of our knowledge it is impossible to state with cer-
tainty whether or not short-wave diathermy was responsible for
the ultimate deleterious effect or for the fatal outcome. Because
of this uncertain state of affairs, it is advisable to give thought
and care to the application of short waves in human disease.
Judging by the misadventures reported in the literature by
various authors, two of the primary contraindications would be
cardiac decompensation and tuberculosis. Saidman, treating a
case of lupus, observed generalized spread of the disease, with
adenopathy and abscess. Last observed aggravation of the
symptoms and the condition of tuberculous arthritis. In spite of
the favorable reports by others (Schedtler, Raab, etc.), and even
bearing in mind the possibility that the technic or strength of the
current employed may have been at fault, it would seem a wise
course on general principles to use caution in the employment of
short-wave diathermy in a disease such as tuberculosis. Some
patients with hypotension are poor subjects for short-wave
diathermy. It further depresses the blood pressure, and respira-
tory embarrassment and palpitation may manifest themselves
after treatment.
Large varicose veins may rupture after short-wave treat-
ment.
According to Lob, acute phlegmonous tendovaginitis, acute
osteomyelitis, acute pyogenic infections of the bones and joints
should not be treated with short waves previous to surgical
intervention.
It has been observed that some types of patients, presumably
those showing great lability of the autonomic nervous system,
will react to short-wave diathermy with headache, nervousness
and depression, especially if the treatment is prolonged. Our
findings bear out those of other investigators, that short-wave
diathermy in such patients is best discontinued. The patients
were free of symptoms after a few days of rest.
Schaffler and R6zsa think short-wave diathermy inadvisable
in Bacterium coli infections. Experimental bacteriological in-
vestigations are discussed above, in Chapter III, "Experiments
on Bacteria and Other Organisms."
Hackemann reports cases in which he operated shortly after
termination of short-wave treatment, and found the tissues
engorged, and, in the peritoneum, marked dilatation of the
capillaries. The operation, as a result, was very bloody and the
oozing of blood in stitches and sections was very disturbing.
This statement is confirmed by Raab, who found that a greater
number of ligatures were needed, as compared with cases not
treated with short waves. For this reason short-wave diathermy
before major operations should not be employed, if no definite
benefit to the patient is to be expected. The operation may be
performed by electrosurgery, to control the oozing of blood.
Malignancy, so far, is an absolute contraindication, accord-
ing to Raab. In the present state of our knowledge, we are not
able to influence by short-wave diathermy with the customary
clinical dosage, the continued progression of the growth in the
human organism. Huwer, Haas and Lob observed increased
growth in the malignancies, following short-wave treatment.
This was denied by Fuchs and the present author. In our own
cases of inoperable cancer, no effect was observed from short-
wave diathermy, with daily treatments of from ten to twenty-five
minutes' duration, using from 6 to 12-meter wave lengths, being
given for a period of two weeks. For this reason, we feel that
time should not be wasted, and that radical operation should
be resorted to whenever possible, or that the patient should be
given the benefit of roentgen or radium therapy. For fuller
details, see below, Chapter XVI, "Malignant Disease."
SURGICAL APPLICATION OF SHORT W A V E S
The first surgical use of short waves was made by Stiebock,

who successfully destroyed the tonsil, and without the necessity
SHORT-WAVE TREATMENTS 83
of giving an anesthetic. This does not mean that there would be
any advantage in short waves employed surgically, as compared
with other electrosurgical procedures. But it is possible that
their application would be less painful. The coagulation and
desiccation would proceed as when using the longer wave
lengths of the high-frequency current. If, for instance, the size
of an electrode were reduced to a small surface, or connected to
a tonsil electrode, the current concentration would be sufficient
to destroy tissue wherever it was applied. The type of wire em-
ployed in electrosurgical procedures has been recommended for
use in the coagulation of tonsils by short waves. Frlihwald and
Stiebóck claim that short-wave coagulation is deeper and that
it may be carried out by the unipolar method. Careful exercise
of this method may bring good results.
Ravault mentions the possibility of coagulation and hemo-
stasis by short waves, by using a special device. In an effort to
determine the biological and histological effects of short waves
from 100 to 10 meters, and of ultra short waves from 10 to one
meter, Katsura and Ito experimented on tissue, dogs and men,
studying the bleeding, pain, degree of coagulation on the wound
surface, muscle cramp, and current intensity in cutting.
Liver and kidney were studied microscopically from one to
twenty-one days after surgical intervention, and it was found
that the picture after cutting with short waves was the same as
that after electrosurgery with the 300-meter wave length, that
is, the diathermy current.
The spark of short-wave and ultra short-wave currents in
both types of apparatus is so small as to be almost impercept-
ible, and destroys less tissue. The division of fatty tissues is
possible without increasing the amperage, in contrast to the
diathermy current. More bleeding and oozing were observed
with the ultra short-wave cut than with the Bovie machine.
The bulb electrodes do not diminish bleeding, as the short-wave
current is more diffused. Less muscular contraction was ob-
served while operating, and it is interesting that coagulation of
blood vessels does not occur at the point where the artery clamp
is applied, but about one cm. distant from the clamp. This
makes it dangerous for use in surgery. When little necrosis is
present, primary healing may take place. Summing up, these
authors found that electric cutting is possible with short waves
and ultra short waves, just as with the diathermy current, and
without any important differences. The cutting is sharper and
less painful, and less contraction of muscles occurs, but more
bleeding is characteristic of the short-wave method. The zone
of coagulation on the wound is smaller. The bactericidal power
in coagulated areas is less than in those from the Bovie apparatus
Considering these observations, it seems at present doubtful
whether short waves, with the present technic, will be superior
as electrosurgical procedures, since they have only in lesser
degree the well-known advantages of the longer wave lengths.
Nevertheless, extension of these observations, especially by
further research, may result in establishing a field for short
waves in active surgical practice.
PREOPERATIVE AND POSTOPERATIVE

APPLICATION OF SHORT WAVES
Preoperative application of short-wave diathermy may be

tried in all cases of local inflammation and infection where no
immediate surgical intervention is indicated. In infections of the
extremities and other parts of the body—in furuncles, cellulitis,
and so on—if the treatment fails to check their progress,
operation can still be resorted to. In general, however, it will be
found that resolution takes place without the necessity of sur-
gery, or the infection will have become limited and circum-
scribed. Abscess formation and pointing will be hastened, and
incision for drainage, preferably by electrosurgery or cautery,
can be performed without disturbing mechanically the defensive
wall formed by the body against the invading organism.
In the case of lung or brain abscess, providing no emergency
intervention is indicated, short-wave diathermy should be given
a trial before resorting to surgery, as not infrequently it may
lead to convalescence and cure without the necessity of a
hazardous operation. It constitutes a conservative first measure
in the empyemas.
In cholecystitis where no immediate danger of a perforation
exists, short-wave diathermy may regress the inflammation,
especially if no stones are present. In adnexitis, also, the desired
result may be obtained, both in acute and chronic cases.
Berry called attention to a group of cases of common in-

cidence, in which the patients complained of abdominal pain but
presented no physical signs of definite pathology. If proper and
repeated physical examinations fail to uncover a suspicion of an
organic lesion or of malignancy, short-wave diathermy is to be
preferred to exploratory laparotomy. Then, if no relief is ob-
tained, surgery can still be resorted to. Chronic appendicitis can
become symptom-free through treatment with short waves.
There are cases exhibiting the weakening results of severe or
long-standing infectious processes. In such the use of short
waves therapeutically may decrease the virulence of the in-
fection so that operation can be performed with less risk. The
procedure may also serve to clear a proposed operative site of
infection, as a preparation for surgery—for example, the tonsils,
before tonsillectomy.
Such a view may provoke differences of opinion as to the real
benefit of short waves in combination with surgery. Neverthe-
less, it seems to us that the results obtained justify the expecta-
tion that some hazardous operations will be entirely eliminated
thereby, or at least that the operative intervention will be
simplified, reducing the risk to the patient. But this problem,
together with many others connected with short-wave diathermy,
awaits further research and clinical observation.
The field for the postoperative use of the short-wave dia-
thermy embraces all drained infections, wounds sluggish in
healing, and all conditions in which the invigorating effect of,
and the hyperemia induced by, short waves are desirable. Both
Lob and Peemoller state that postopative adhesions are favor-
ably influenced in certain cases, and these findings have been
substantiated by other workers. The claim is made that post-
operative fistulas may be readily closed by this means (Lob,
etc.). Lob reports quicker and firmer healing after tendon sutures
if short waves are used as a supplementary measure. Following
operations on joints (including plastic procedures) and menisci,
when hematomas have formed or sensitivity persists, short
waves may hasten the resumption of normal function. Post-
operative effusion into joints is quickly resorbed under this
stimulus. Laqueur and Remzi successfully treated such cases.
Regional lymphadenitis due to infection softens and decreases
86 SHORT-WAVE T R E A T M E N T S
in extent after a few short-wave treatments, as we observed in

our practice. Sensitive postoperative scars are greatly benefited
by short-wave treatment, and spasm easily eliminated by five or
six exposures. Postoperative and nonspecific infiltrations, espe-
cially hematomas and exudates, are quickly resorbed by this
means. There are few references to fractures, except experi-
mentally. It may be that the hyperemia and the analgesic effect
of short waves would hasten the consolidation of bone.
For technic of application, the specific chapters below should
be consulted.
C O M B I N A T I O N OF SHORT W A V E S WITH O T H E R F O R M S
OF T R E A T M E N T
Short-wave diathermy alone may cure different affections,

but in many instances its combination with other therapeutic
agents will be particularly advantageous or even definitely
indicated. The therapeutic measures to be employed with short
waves may be grouped as follows:
(1) DRUGS
Specific treatment in syphilis or diabetes and the commonly

used pharmaceutical preparations, in accordance with the re-
quirements of the disease under treatment, may be used in
conjunction with short-wave treatment.
(2) SURGICAL MEASURES
These may be employed, as discussed in the preceding

sections, as required or indicated.
(3) PHYSIOTHERAPEUTIC MEASURES
Light, ultraviolet light, and similar forms of physiotherapy

may be advantageously combined with short-wave diathermy.
(4) MECHANOTHERAPEUTIC MEASURES
In certain cases mechanotherapy, in the form of massage,

for example, may prove a valuable adjuvant to short-wave
diathermy, hastening convalescence, especially in joint disease.
(5) IRRADIATION THERAPY
The question of combining irradiation by X-rays and radium

with short waves is still controversial, Loch and others main-

taining that short waves have a sensitizing effect upon deep
X-ray action, whereas Wittenbeck denies this.
(6) DIETS, OPOTHERAPHY AS R E Q U I R E D , ETC.
ELECTROPYREXIA
Heat treatment of disease is nothing new. It is only in the

method of inducing heat in the body that changes have taken
place. Hot-water baths were favored by the Egyptians, the
Romans and the Greeks. Hot air, hot water, steam, paraffine,
and mud baths, heated blankets, and sun-heated sand have
been employed at different stages in the development of thera-
peutic practices. In more recent times, fever for therapeutic
purposes has been induced by inoculation of benign tertian
malaria, rat-bite fever, relapsing fever, nonspecific proteins and
sulphur. The most recent development has taken place in the
field of electricity, the first ventures being with diathermy; but
when short waves appeared in the therapeutic field, their use in
the induction of fever seemed logical. Since Whitney observed
that there was an elevation of the body temperature of men
working in the field of short wave radio transmission, much
experimentation has been carried on in this field, in which
American scientists have obtained the most outstanding results.
In 1930 Carpenter and Boak constructed an electropyrexia
apparatus. This consisted of an insulated box, within which the
patient lay supine, with head outside, protruding through an
opening in one end. The two 50 by 80cm. condensers lay along
the two sides of the body. Two electric fans kept the air cir-
culating around the patient's body, preventing the accumulation
of sweat drops which might cause arcing of the current, with
consequent scorching of the skin. With their apparatus, the
greatest heating—rise of temperature—was obtained with the
use of a 30-meter wave. It was found on experimentation that
the 6, 15 and 18-meter wave lengths did not heat so effectively
owing probably to insufficient put put of the machine. During a
60 to 80-minute exposure, the patient's body temperature rose
to 105° F. In addition to an increase in pulse and respiratory
rate, a decrease of the systolic and diastolic blood pressures was
noticeable. Some patients developed headache and vomiting.
(The temperature in the box ranged between 122°-131° F.)
Bischoff and his coworkers also experimented with hyper-
thermia induced by high-frequency electric currents. Treatments
were continued from one and a half to three and a half hours,
and, in contrast to the other methods, only with very slow
temperature rises up to about 102.8° F. No difference in effect
between raising the body temperature by a high-frequency
electric current and doing the same by the external application
of heat, was discernible. Of fundamental importance was the
loss of carbon dioxide. The pH of the blood became more alka-
line. There was a shift of bases to the blood proteins. The hemo-
globin of venous blood was more exygenated. The phosphorus
content of the blood and the urine decreased.
Hinsie treated cases of progressive paralysis, with fever in-
duced by 6, 15, 18, and 30-meter waves. The patient was placed
between two large electrodes in a cellotex box, with the head
protruding through an opening. With treatments of from 60 to
80 minutes, the temperature of the patient rose to from 104° to
105° F. In one case it rose to 106.5° F. After the treatment, the
patient was wrapped in several blankets, so that loss of body
temperature occurred slowly, the heat lasting for from six to
seven hours. Ten treatments were administered, one on every
second day. The temperature thus induced, resembled in every
way that caused by malaria inoculation. There was a decrease
in the number of red blood cells and in hemoglobin, and an in-
crease in the polymorphonuclear cells. The lymphocytes were
decreased. There were no changes in the solid elements of the
blood nor of the blood chlorids.
In another series of nine cases of general paralysis, Hinsie
and Blalock investigated the effect on the white blood cells of
short-wave electropyrexia. There was a distinct rise—about 75
percent—in the leucocyte count. This count rises gradually>
reaching its maximum at the end of about the ninth hour and
regaining its normal level at the end of about the twentieth hour.
The increase in cell count often starts within the first fifteen
minutes. The total leucocyte count tends to be less pronounced
as the treatments progress. The leucocytosis is characterized by
an increase in the percentage of polymorphonuclear neutrophils,
at the expense chiefly of the lymphocytes. In induced leucocyto-
sis, there is an increase in the nonfilamentous (early) forms of the
polymorphonuclear neutrophile leucocytes.
Bierman used an ultra short-wave apparatus, capable of
raising the body temperature about 6° to 7° F. in from 40 to 90
minutes. The treatments generally started in the morning, as
they frequently lasted several hours. The patient was placed
supine upon a glass-covered litter bed, between the surfaces of
the two upright condenser plates—50 x 90 cm.—which were one
meter apart. The patient was not in contact with the current,
and was wrapped in towels, which were designed to absorb the
perspiration and to help the rise of temperature. The patient's
head was outside the cabinet. Before treatment, a cleansing
enema was given and the patient was allowed a liquid breakfast.
Oral and rectal temperature, pulse and respiration rate were
recorded. Then the current was turned on. Perspiration started
after fifteen minutes and the towels had to be changed to
prevent arcing of the current. It was found that individuals
respond differently to the treatment. Some have headache,
nausea, shortness of breath, palpitation, thirst, or numbness of
hands and feet. The face is flushed and the conjunctivae injected.
The lips may become pale. The temperature is taken every ten
or fifteen minutes by clinical thermometer, the current being
turned off meanwhile. An electrocardiophone might be used for
recording the work of the heart. When the desired temperature
is obtained, the patient is placed under another hood, with a
number of carbon filament lamps inside. In this way the temper-
ature is maintained. The patient loses as much as five pounds
through the violent sweating. At the end of the treatment, cool-
ing takes place gradually. The treatments are given every other
day, or according to the necessities of the disease.
Auclair, Dausset, Bierman and others found that ultra short
waves are helpful in neurologic conditions (paresis, tabes, multi-
ple sclerosis); polyradiculitis, postencephalitic Parkinsonism
and chorea; arthritis (infectious gonorrheal) particularly;
thrombo-angiitis obliterans (not always successful); skin dis-
eases (scleroderma, psoriasis; Kaposi skin sarcoma; mycosis
fungoides, with transient results only). One case of Raynaud's
disease was improved.
Tenney conducted experiments with artificial fever induced
with the 30-meter wave length. He also placed the patients in a
boxlike cabinet and exposed their whole body to the irradiation.
In 60 to 80 minutes of treatment, the temperature rose from
99.6° F. to 104° and 106°. On the basis of 1,000 treatments, he
concludes that the fever created by short waves is less hazardous
than that produced by intravenous injections. With short waves
the fever can be kept entirely under the control of the operator,
if kept below 107° F. Its application is simple and there is very
little discomfort to the patient. He believes that this method of
producing artificial fever is superior to other methods, and that
the therapeutic results obtained are better. Tenney used general-
ized short-wave diathermy in several varieties of lues, arthritis,
bursitis, myositis, and neuritis, generally with fair results.
Bierman classifies the different possibilities of short-wave
electropyrexia in combating various diseases. In some, high and
sustained temperatures will be necessary to accomplish a thermo-
lethal effect upon the invading organism, such, for example, as
the gonococcus. In others, a mild degree of temperature eleva-
tion will be found more desirable, for example, when aiming at
the dilatation of peripheral blood vessels in thrombo-angiitis
obliterans. When an increase in leucocytes or increased tissue
permeability is desired, a mild temperature elevation may be
sufficient. In still other cases, we may find it best to create a
mild degree of systemic temperature elevation with a high de-
gree of localized heat. Such an arrangement may correspond to
the condition existing when a localized area of infection occurs
in the body. Contraindications to the use of "radiothermy,"
that is, short-wave diathermy of the body as a whole, will
naturally vary with the degree of temperature elevation. Ele-
vation of temperature of one or two degrees will not throw so
much of a burden on the cardiovascular and other systems of the
body as would greater temperature elevations. Severe organic
lesions diminish the body's ability to respond to the additional
load placed upon it by a rise in temperature. By means of systemic
temperature elevation, the body increases its defense activities.
Experience indicates that we may vary the character of the hyper-
thermia produced, as we desire to secure one effect or another.
Bierman states that of the various methods available for
producing hyperpyrexia, the most effective appears to be that

of short-wave treatments.
The source of the curative effect of electropyrexia is still an
open question. Halphen and Auclair believe that it lies exclusively
in the thermal effect of the waves. Belot is of a different opinion.
He applied low-intensity waves with little energy output, which
created only a slight systemic temperature elevation, believing
that the exposure of the entire body to the electric effect of the
short waves, rather than their heat effect, to be of curative value.
Auclair supports his point of view by a report of a number of
cases of tabes, Parkinsonism, poliomyelitis and asthma, in
which the raising of the temperature above 104.5° F. proved
beneficial. A temperature elevation up to 102.2° F. is thought
to be satisfactory in rheumatism, polyarthritis and arthritis.
That the source of cure lies elsewhere than in a rise of tempera-
ture is emphasized by Wagner- Jauregg, who points out that the
belief that malaria therapy cures the paralysis exclusively
through hyperthermia is erroneous, as there were some success-
ful malaria treatments which were not accompanied by a rise in
temperature. Neither does tuberculin nor staphylococcus vac-
cine therapy create any considerable fever in the patient. Con-
sequently, the temperature rise is not necessarily the factor
that brings about the cure of progressive paralysis. Further re-
search will be needed to throw light on this problem, but aside
from the outcome of these investigations, it is not premature to
state that short waves hold, in the form of electropyrexia, an
important place in the therapeutic field. The literature contains
numerous reports on the use of short-wave electropyrexia
(those of Babin-Chevaye, Humphris, Cotton, Wilson and
Kellner, Binet, Laudat, Nagelschmidt, Bierman, and others). It
is suggested that electropyrexia be combined with other thera-
peutic measures. In the case of syphilis, for example, its com-
bination with specific drug therapy may accelerate the bene-
ficial results.
S H O R T - W A V E DIATHERMY AS COMPARED WITH D I A T H E R M Y
Since the advent of short-wave diathermy, its possible ad-

vantages over other physiotherapeutic methods, especially
diathermy, has been a much-agitated question.
A score of writers have expressed their views on the differ-
ences between short-wave diathermy and diathermy, emphasiz-
ing the field of each. A complete misunderstanding of the nature
of short-wave diathermy was shown by some authors. Stiebock,
in an article published in 1925, in the early days of the develop-
ment of this method, described his technic, which consisted of
placing bare electrodes (not insulated) directly on the skin, con-
cluding that in cases in which resorption of exudates must be
accomplished and in all cases in which deep hyperemia must be
created, there is no ground for the substitution of any other
measure for the very satisfactory diathermic procedure. Con-
sidering the method he employed, his evaluation is not one of
short-wave diathermy, but rather of the application of short
waves in a manner characteristic of diathermy.
Following these efforts came a radical change in technic and
with it a better understanding of the differences between
diathermy and short-wave diathermy, as it is used now. Noack
emphasized the even, internal heating achieved by short waves
and by no other form of physical therapy, which makes them
superior to diathermy in properly selected cases. Nagelschmidt,
in 1929, expressed the view that classical diathermy would not
be superseded by short-wave diathermy or, as he calls it,
"ultradiathermy," but that each would have its own sphere of
usefulness. He thinks that the introduction of short-wave
diathermy denotes a widening of the whole field of diathermy
and opens to therapeutics a sphere in which classical diathermy
has been of no value. Conversely, he believes, the new methods
are not suitable for the treatment of many clinical conditions in
which classical diathermy has been of the greatest possible use.
With the continued development of short-wave diathermy,
investigators come forward with more and more definite claims.
Hinsie, studying the application of short waves to produce
electropyrexia, believes that the great advantage in fever treat-
ment by short waves lies in the fact that the temperature can be
constantly kept under control. Rausch and others found in the
course of numerous experiments that short-wave diathermy is
simpler and less hazardous than diathermy and that burns are
very rare, or almost impossible. The heat generated is homogene-
ous in quality, and does not increase pain, which diathermy
sometimes does. Davis speaks favorably of the ease of appli-

cation of short-wave diathermy, as compared with the diffi-
culties in diathermy technic. Reiter states that the wave
lengths of from 12 to 35 meters can be used in all cases in which
diathermy has proved useful, and that the effects are greatly
improved by the deep and uniformly penetrating quality of the
waves. Furthermore, short waves can be used in acute inflam-
matory processes in which ordinary diathermy should not be
applied. Cases of rheumatism, all forms of arthritis, neuritis,
neuralgia, and sciatica are the main subjects for this powerful
form of heat application. Schweitzer, comparing diathermy and
short-wave diathermy, concludes that the latter requires a
simpler technic, is more easily regulated with precision, and is
more far-reaching in effect. This view is shared by K o b a k .
I t was found by experimentation that the heating of tissue
increased with the reduction of the wave length, that is, with
the increase of the frequency, together with the electric capacity
and conductivity. It was also found that a greater and more
uniform penetration of heat within the body took place with
short waves than by any other method.
We believe, with Mortimer and Osborne, that with the help
of phantom model experiments it is impossible with the present
technic to measure the amount of heat generated in the living
tissues. If we consider the reactions and the compensatory
mechanism of the organism, which is under the influence of a
complicated and incompletely understood nervous system, we
must realize that laboratory experiments, however desirable, are
sometimes futile.
Mortimer pointed out that the blood flow and the rapid
interchange in the living body may render the differences of
temperature in the tissues negligible for all practical purposes.
A much-emphasized quality of short waves, as McLennan,
Burton, Schliephake, Patzold, Reiter and others have shown,
is the selective thermal action on tissues. According to this
theory there would be for each wave length a maximum heating
effect in a given medium. If the selective heating effect were
known as the characteristic electrical constant of the substances
of the body, it would be possible to treat each separate part of
the organism without directly affecting the others. This may
appear feasible theoretically, but cannot as yet be applied in
practice. Selective thermal action, which exists in experiments
for different solutions and tissues, would necessitate further
observation in the living human organism. Coulter and Carter
have recently reported on such work. They were unable to find
that such selective thermal action is present in the human body.
Numerous model experiments have proved that in short-
wave diathermy, when properly applied, heat is generated
practically evenly in all layers of the experimental object. In
diathermy, on the other hand, the temperature within the ob-
ject rises much more slowly than that on the surface. The
diathermy current, acting by conduction, follows the line of
least resistance, and the energy will be transformed into heat,
according to Ohm's law. The skin, for instance, which has a
high resistance, absorbs a great part of the energy. Consequently
only a lesser portion of the total energy is left to heat the tissues
beneath the skin. The surface layers of fat again present a zone
of high resistance and absorb much of the remaining energy.
Bones offer the highest resistance of all, and the general state-
ment may be made that the current which reaches the bones
will flow around them without penetrating. It can be stated
that in bones no heat of therapeutic value is generated by
diathermy.
Short waves, on the other hand, present a different picture.
As pointed out above, in Chapters II-V inclusive, discussing
physics and experimental work, short-wave current acts on the
molecules of the substances under treatment, and consequently
can affect tissues, such as the inner substance of bone, where
diathermy would be less effective. Within the cranium, short
waves can generate considerable heat, which cannot be said of
diathermy. Gesenius made experimental observations with the
laparoscope within the abdominal cavity of animals, noting
vasodilatation. He found short waves superior for the purpose
to other, classical methods of heat application.
The main differences between diathermy and short waves in
therapy may be tabulated as follows:
Diathermy Short Waves
Frequency 500,000 one million/ 10-100 million/sec.

sec.
Wave length 600-300 meters 30-3 meters
Electrodes Direct contact with Air-spaced and dielec-
body tric-spaced
Heat generation By ohmic losses By ohmic losses, in
(Joule's heat) addition to dielec-
tric hysteresis
Heat generation in Uneven heat produc- More even heat pro-
tissues with best tion; deep heating duction in all tis-
conductivity difficult : sues; deep heating
possible more sim-
ply and evenly
Selectivity None Demonstrated experi-
mentally
Specificity None Demonstrated experi-
mentally
According to the focal-heat and the vibratory theories, short
waves generate heat in each cell by dielectric hysteresis and by
generation of Joule's heat, in this way attaining a thorough heat-
ing of each particle in the treated object. The diathermy cur-
rent, on the other hand, flows around the cells and penetrates
only to a limited extent, creating heat only according to Joule's
law. That this is of importance where living tissues are being
treated cannot be doubted.
DIFFERENCES IN APPLICATION
In diathermy the electrodes are in direct contact with the

body surface, whereas in short-wave diathermy the electrodes
do not touch the surface to be treated; furthermore, the action
of the waves can be regulated, as Schliephake has shown by
changing the distance between electrodes and skin. Burns
which may occur with short-wave diathermy are usually super-
ficial and heal without marked deformity, as mentioned in the
various clinical sections. But the burns consequent to diathermy
are, on the other hand, more serious.
Naturally, the results obtained by the hand of an expert
with classical diathermy may be superior, in certain conditions
in which this treatment may be definitely indicated, as com-
pared with the results achieved with short waves in the hands
of a beginner. There is no doubt of the necessity for properly
constructed and manufactured apparatus, in the hands of
especially skilled physicians, for use in properly selected cases.
Only by observing these essential qualifications will short-wave
diathermy achieve its greatest development and usefulness. Ac-
cording to Kovdcs, in some cases the clinical results are alike,
regardless of the method employed, the choice being guided by
convenience. Only further observations will determine the con-
ditions in which short-wave diathermy may be preferable.
VII
GENERAL AND MECHANICAL PRINCIPLES IN

SHORT-WAVE TECHNIC
THERE are two habits which the operator of a short-wave

machine should acquire until they become practically second
nature. One is to instruct every patient before treatment begins,
to inform the technician of any unusual sensation of heat, either
in the field under treatment or elsewhere on the body. The
second habit recommended is that of testing the skin sensitivity
of every patient who is to be subjected to this form of treatment.
If the skin sensitivity to heat shows evidence of being diminished
or absent, this will serve as a warning to the technician to exer-
cise particular care lest burns be produced on a patient in whom
the sensitivity to higher degrees of heat is lessened. The simplest
way to perform this test is by using test tubes of cold and warm
water.
While the technic of treatment of disease conditions is taken
up specifically below, Chapters VIII-XVI, a few general prin-
ciples may be noted here. In the matter of position, it is well to
bear in mind that if the patient is comfortable there will be less
tendency to shifting of position, either intentional or accidental,
during the course of treatment. If rigid electrodes on a stand are
used, such shifting of the patient may result in displacement of
condensers and misdirection of current, although with well-
insulated electrodes this danger is slight. A table with adjustable
ends, so as to raise the head or extremities and to facilitate placing
the condensers beneath the patient, is an invaluable aid to good
technic. Naturally, such a table should preferably be made of a
material which would not act as a conductor of electrical energy,
and for this reason also numerous metal parts and attachments
are undesirable. A pad should be upon the table, made of an in-
sulating material which is both easily cleaned and disinfected.
In certain cases it may be more convenient or desirable to
98 SHORT-WAVE TECHNIC
have the patient assume a sitting position, in which case the
electrodes are fixed with bands (rubber) or fixed between the
hands of a stand.
No general rule can be laid down concerning the distance
that condensers should be placed from the surface of the body,
each case presenting a problem in itself; also, the differences in
output of machines must be taken into account. Nevertheless,
the general principle should be borne in mind that the depth of
reach of the waves may depend upon the distance of the plates
from the body. Hence, in practice, the operator should be
thoroughly acquainted with the machine he is using, either
through experiments on models, or from clinical observation, so
as to be able to form an approximate idea as to individual
variation of that intensity which will create the best therapeutic
conditions without undesirable effects.
In case of a deep-seated focus of disease, the distance of the
condenser should be increased by means of intervening padding,
or withdrawal of rigid electrodes fixed on stands, while for a sur-
face lesion the active condenser will approach nearer the surface.
Electrodes, their variations and types, are discussed below,
while their physical aspects are dealt with in Chapter I I , " T h e
Physical Aspects of Short-Wave Diathermy." The comments
made here are purely elementary, and do not cover the many
contingencies or problems presented by the individual case. A
constant problem with which the technician is faced is, for
example, the absorption or deflection of energies by tissues inter-
vening between the focus of disease under treatment and the
condensers.
For generalized short-wave diathermy (electropyrexia),
larger electrodes are used, with the patient within a specially
constructed chamber, in order to prevent heat loss and to main-
tain the temperature at the desired high level.
B U R N S AND T H E I R P R E V E N T I O N
The problem of preventing accidents or unpleasant sequelae

of short-wave diathermy resolves itself into the prevention of
burns, which are, so far, the only deleterious effect to be antici-
pated. Claims have been made, during the past eight years of
SHORT-WAVE TECHNIC 99
its use, concerning the dangers of short-wave diathermy aside

from superficial burns, but none have been observed. If burns or
other accidents occur, the responsibility for them can definitely
be placed where it justly falls, that is, upon the lack of experience
of the operator or upon unsatisfactory machines or supplies.
Burns from short-wave treatment are usually superficial and
heal readily, leaving no residuals. Such superficial burns are ob-
served in cases in which much perspiration takes place. Sweat
promotes conduction and current concentration, which may,
through carelessness, result in first and second-degree burns.
As stated above, the responsibility rests squarely upon the
technician. For this reason it was suggested at the beginning of
this chapter that it should become a habit for the technician to
instruct every patient to report any sensation of heat that is too
great for comfort at any spot on the body, and to test the skin
sensitivity of the patient. Current concentration is especially apt
to occur if there is a prominent point in the field under treat-
ment, such as the tip of the nose, the ear and so on. The illustra-
tions below show how current concentration takes place on a
prominent point when the electrode is improperly applied, and
how current concentration is promoted when opposing skin sur-
faces are in contact, for example, the knees, the electrodes being
on the outer sides. Burns in the former case are prevented by
proper air-spacing and shaped electrodes, and in the latter by
insuring sufficient space between the contiguous surfaces so that
the current can pass evenly.
The photograph pictures (fig. 17) such a second-degree burn
taking place when the flexible electrode was applied directly
to the swollen joints, the current concentration occurring at the
illustrated points. These healed, however, within fourteen days,
without sequelae.
A point which should be noted and emphasized is that by
using high wattage-output machines, heating may be of such a de-
gree and so sudden as to cause heat coagulation, either super-
ficial, or deep, as in the case of relatively less vascularized
tissues (bone marrow), where the heat transported by the cir-
culation may be less than in other parts of the involved tissue.
If the operator is not cautious, taking into account the particu-
larities of his machine, this accident may occur without the
patient being conscious of more than a sensation of uncom-

fortable heat. Compression of the treated area, as well as per-
spiration, also predispose to burning.
In order to prevent such regrettable accidents, it is highly
important to use such high-output machines with extreme care,
and with full knowledge of the possibilities. There seems to be a
general tendency on the part of manufacturers to produce ma-
chines of very high output, but it has not yet been proved that
16. Proper and Improper Application of Electrodes: Knees

a, Improper Application, Causing Current Concentration; 6, Proper Application, Preventing
Current Concentration
for general use in short-wave diathermy such machines are to be

preferred. They are required only in the case of deep-seated
lesions, and most lesions met with in practice of medicine can be
adequately treated with machines of lower output.
Superficial burns may also occur if electrodes are improperly
insulated or poorly manufactured. For example, if the insulation
breaks or tears, there may be sparking which may cause burns.
Burns have also been observed where cables touch the body apart
from the area under treatment, resulting in higher concentration
at the points contacted. Here again enters the importance of
preliminary instruction of the patient, to report any uncom-
fortable sensation, no matter where located. Whenever this is
done, the technician should at once turn off the current, reapply
the electrodes to eliminate any possible error in technic, and
17. Superficial Skin Burns, Caused by Faulty Application of Electrodes
a. B u r n s , C a u s e d b y H e a t C o a g u l a t i o n on P r o m i n e n t P o i n t « ; 6, T h e S a m e Lesion«
Healed, w i t h o u t P e r m a n e n t S c a r F o r m a t i o n
make a thorough investigation for the cause of the reported heat
sensation. If cables touch the body, adequate padding placed
between them and the body will prevent accidents of this sort.
An unusual, one might say unique, accident was reported by
Kling and Berg in the Journal of the American Medical As-
sociation (June 1, 1935). This, a case of third-degree burn,
shows the disastrous results that may be brought about by an
irresponsible salesman demonstrating a machine of this kind
without clinical knowledge—bringing injury to the patient and
discrediting in the practitioner's eyes a new therapeutic measure
which is efficacious, providing the proper skill and knowledge
are brought to its exercise.
Heat coagulation of tissues to such a degree, in any normal
individual with normal sensibility, must be accompanied by
severe pain which would be a warning for immediate interrup-
tion of the current. The occurrence of such a severe accident
may be interpreted as due either to abnormal sensitivity of the
treated area, verging on the pathologic, or to faulty application
(compression) of the electrodes and to the extremely strong
intensity used.
It should be borne in mind that short waves are heat itself
and have analgesic properties, and the patient may not notice
that small burns have been produced. Therefore, since to date
there is no way of exactly measuring the necessary output for a
given condition, the dosage rests solely upon the personal ex-
perience and judgment of the operator. It may be said, never-
theless, in spite of the difficulties inherent in a measure which is
still in process of development, that short-wave diathermy may,
on the whole, be considered entirely safe, fewer accidents occur-
ring with this procedure than have occurred in the hands of
experienced practitioners employing diathermy. We have only
to recall the numerous accidents and disasters in the beginning
of the era of diathermy, and especially of X-ray therapy.
Summing up, it may be said that, aside from the proper
intensity of current furnished by a reliable apparatus, the im-
portant factors in the prevention of burns (which so far as we
know constitute practically the only danger) are proper air-
spacing and padding, and a dry skin.
E L E C T R O D E S FOR S H O R T - W A V E DIATHERMY
One of the greatest assets of short-wave diathermy is the fact

that action of these wave lengths can be regulated by manipula-
tion of the electrodes toward or away from the skin surface. The
factor of control is important, and increased latitude in using
the method is given by the use of one smaller and one larger
electrode, by placing one nearer and the other farther from the
body surface, and by the possibility of using the unipolar method.
Experiments have shown that within certain limits the greater
the air space between condenser plate and object, the more even
will be the heat generated in the various layers of the object
treated. If the plates are near, or very near the surface, then the
effect on the skin will be greater and the depth effect less. In
other words, the greater the distance of the plates from the
surface up to a certain point, the more uniform will be the heat-
ing action. By proper adjustment of electrodes, it is possible to
affect the deep structures as fully or more fully than the super-
ficial layers. If the body lies close to the plates with only a thin
dielectric between, and if the temperature of the body layers at
different levels is taken, a decided increase will be found in the
skin and subcutaneous fat, with diminishing temperature to-
ward the interior. If the plate on one side is moved away from
the surface about 2 or 5 cm., then much greater warmth is ob-
served on the other side where the plate contacts. If the plate
on the other side is then also moved away, homogenous warmth
is observed in all layers. This fact has many practical aspects. If,
for example, one wishes to treat one ear more intensively than
the other, or if the seat of disease is nearer the skin on one side
than on the other, then the condenser plates on that side should
be placed nearer the skin than on the opposite side. More
localized and concentrated heating may be obtained by a smaller-
sized electrode, placed nearer to the pathological area, in
opposition to a larger electrode with greater air space.
In the case of a protruding anatomical part or a curved sur-
face area within the condenser field, the concentration of energy
lines in the field might become very strong at certain points.
Small animals such as rats, when placed in the condenser field,
showed burns on the ears, which later became necrotic and
sloughed off. (See below, Chapter XVI, for a discussion of rats

in cancer research.)
In general, two electrodes are applied opposite each other.
This is called the bipolar system. Groag and Tomberg devised a
method requiring only one electrode, designated as the unipolar
system. As Figures 18-19 show, the short wave field in this
18. Current Dispersion by the Unipolar Method
19. Current Dispersion by the Bipolar Method

system is concentrated near the body surface and the energy

lines are more dispersed, the farther away they are from the
electrode. This system centers the effect of the short waves near
the surface, and therefore it is particularly suited for the treat-
ment of diseases in which the pathological area is near the skin.
Thus success with the unipolar system has been reported by
Groag and Tomberg in furuncles, gangrene, crural ulcer, arth-
ritides, neuritis, neuralgia, thrombo-angiitis obliterans, lum-
bago, muscular rheumatism, and so on.
Another method of treatment is that employing the solenoid,
or inductotherm (fig. 20). In this country John R. Merriman,
H. F. Holmquest, and S. L. Osborne, and in Vienna, F. Kowar-
schik, recommended the use of a coil around the part of the body
to be treated. In the United States, 25-meter waves, and by
Kowarschik the 4.8-meter wave, were used and it was evident
that merely by placing a few turns of insulated cable around
or about the parts to be treated, an electromagnetic field was
created, similar to that obtained between the two electrodes of
20. Inductotherm
short-wave apparatus. This method would be especially useful

in the case of the extremities, but general application could be
achieved by special devices. According to Merriman et al., its
heating characteristics are such that maximal heat is produced
more readily in the more conductive (vascular) tissues than in
the less conductive (adipose) tissue. These investigators believe
that this method would meet the requirements of medical
diathermy, including the production of hyperpyrexia. Kowar-
schik's conclusion is that solenoid application may prove to be
satisfactory in conditions as yet undefined, especially those of
the extremities. To date, however, the solenoid has not super-
seded the condenser plate in the application of short-wave
diathermy, on account of the rapidly decreasing field strength
in certain condition. Further experimentation and clinical ob-
servation will determine its exact use and its particular field.
The bipolar system is used in practically all cases today be-
cause, by using electrodes of differing sizes, a smaller on one side
and a larger on the other, placing one nearer and the other
farther from the surface, one can satisfactorily concentrate the
energy near the surface, and can consequently treat all affec-
tions for which the unipolar system is suited.
In general, two types of electrodes are used: the rigid and
the flexible.
RIGID E L E C T R O D E S
The first application of short waves was based on experi-

mental work which resulted in the conclusion that the metal
electrodes should not touch the body surface directly, lest the
undue concentration on the skin result in burns. All electrodes
must be insulated. Schliephake used glass as insulating material,
in the form of a glass disk, which at the same time fixes the elec-
trode in the proper position and allows for the regulation of its
distance from the skin surface. These disks are the so-called
glass shoes, and the electrodes equipped with them are the glass-
shoe electrodes (fig. 21). The electrode is enclosed in the
glass shoe, and by means of a screw it may be pushed forward
toward the skin or withdrawn from it. This device allows for
the required air space and can easily be kept clean. It also has
the advantage that the electric field created by it is constant,
and not altered by movement of the patient, for example in
respiration. From a theoretical point of view, such movement
on the part of the patient would allow more concentration, in-
creasing the electric field during expiration and lessening it
during inspiration. From a practical point of view, however,

this seems to be of little importance.
The glass shoes are usually so constructed as to be larger
than the metal electrode which they enclose. This more easily
eliminates the so-called " e d g e " effect.
B y the use of electrodes properly constructed, it is possible
to treat organs or diseased areas which ordinarily would not be
reached by the electrodes used on the outside of the body. B y
the use of such special electrodes, the body cavities—for ex-
a b
21. Glass-Shoe Electrodes
ample, the mouth, vagina, rectum and so on—may be pene-

trated and treated by the waves. In adnexal affections an elec-
trode, as shown in Figure 22a, can be inserted into the vagina,
and one of the usual flat electrodes applied on the outside of the
abdomen. The metal parts are naturally enclosed in some in-
sulating material. Such electrodes should be employed chiefly
if direct local heat effect is desired, but in practice they have
rarely been used and are recommended only for the specialist.
F L E X I B L E ELECTRODES
They consist of a metal plate, sheet or gauze, and are encased

in some insulating material such as sponge rubber, felt or some-
thing similar. This type of electrode is made in different sizes,
and can be properly and easily fitted or adjusted to the area to
be treated. Flexible electrodes give a fairly even distribution of
the electric field, with the least loss of electric energy, and facili-
tate the nearest approach to the surface when this is desired.
22. Special Electrodes
a, Vaginal; 6, Breaat; c and d. Sinus and Tonsil
Raab and others do not favor rubber-insulated electrodes,
claiming that under certain circumstances they may be heated
by the short-wave currents. Because of the high dielectric heat
losses, they absorb a great part of the energy. This might easily
cause burns, especially if the electrode were placed directly upon
the skin. The ideal insulation for an electrode seems to be some
nonconducting material which would be durable, withstanding
the wear and tear of constant use; which would not absorb
moisture; and which would have a dielectric constant of one,
that is, it would not become heated and would not offer re-
sistance to short waves.
Raab recommended a glass pearl net as insulating material,
claiming that it would give the proper flexibility, serve as a good
insulator, and would not obstruct the evaporation of perspi-
ration.
The advantages inherent in flexible electrodes may be best
observed in the treatment of various pathological conditions of
the head and extremities. Such uses are illustrated below.
As can be readily seen, flexible electrodes are satisfactory
from the practical point of view (fig. 23).
SIZE OF THE ELECTRODES
The size of the electrodes is of primary importance in achiev-

ing a cure. The electrodes should be interchangeable, and their
size depends upon that of the object to be treated, or upon the
surface of the area to be treated. It is self-evident that a smaller
electrode should be used in the treatment of a furuncle than
would be employed in the case of electropyrexia.
One principle of the technic of application is the use of elec-
trodes which are somewhat larger than the focus to be treated.
Should the latter be more extensive than the available elec-
trode, the diseased part may be divided into areas, to which
treatment may be applied in consecutive order for the proper
length of time.
SHAPE OF THE ELECTRODES
A great variety of forms and shapes of electrodes are designed

which, from a practical point of view, are not of the importance
which is often attached to them. They are most frequently
round, but they may be angular, or a combination of both

shapes. With several pairs of different sizes, square, rectangular
or other shape, most requirements will be satisfactorily met.
It doubtless facilitates treatment if a larger number of elec-
trodes of various shapes are at the disposition of the thera-
peutist. Such special shapes are recommended for sinuses,
tonsils, axillary diseases, breast conditions and for the diseases
of the genital tract. Some of these are shown in the accompany-
23. Flexible Electrodes
ing illustrations, and in other sections of this book. See Figure

22a, b, c, d.
TECHNIC OF APPLICATION
The electrodes must be placed near to or in contact with the

body. In order to assure the proper distance between the elec-
trodes and the skin, a Turkish towel is first laid on the surface
to be treated (if flexible electrodes are used). The flexible elec-
trodes are put on top of the towel and, if necessary, fixed to the
body by the proper means (rubber bands, adhesive tape, etc.).
If the patient lies prone and the electrode will remain fixed by
its weight, such aids to fixation may be omitted. In general,
however, fixation by weight cannot be recommended, as skin
burns may occur through the compression or because of ac-
cumulation of sweat. The number of Turkish towels varies ac-
c o r d i n g t o t h e case, a n d b y m e a n s of t h e m it is possible t o v a r y
t h e d i s t a n c e b e t w e e n skin and electrode f r o m 0.5 t o approxi-
m a t e l y 5 c m . T h e a d v a n t a g e of t h e rigid glass e l e c t r o d e is t h a t
it l e a v e s t h e area to be treated visible.
A l t h o u g h it is possible t o g i v e s h o r t - w a v e t r e a t m e n t t h r o u g h
c l o t h i n g , t h i s is not r e c o m m e n d e d for h y g i e n i c reasons (sweat),
a n d s h o u l d be resorted t o o n l y if t h e p a t i e n t h a s difficulty in
r e m o v i n g his clothes or in dressing himself.
I n general, observation of the following rules will guard
a g a i n s t m i s a d v e n t u r e : (1) B e sure t h a t y o u r p a t i e n t is n o t under-
s t a t i n g t h e f a c t w h e n he or she reports t o y o u t h a t t h e s e n s a t i o n
of heat felt is l u k e w a r m or w a r m ; it s h o u l d n o t e x c e e d this.
(2) T a k e i n t o account those b o n y protrusions w h i c h lie close t o
t h e skin. (3) K e e p t h e treated b o d y s e c t i o n dry, a n d free of
interfering obstacles. A v o i d s w e a t i n g , a n d r e m o v e adhesives.
(4) W a t c h o u t for m e t a l parts, lest t h e y get i n t o t h e field of
t r e a t m e n t . Rings, s a f e t y pins, and so on, s h o u l d be r e m o v e d .
One c a n n o t d o better t h a n t o s t u d y the t w e n t y - f i v e rules q u o t e d
b y K o b a k for t h e a d m i n i s t r a t i o n of s h o r t - w a v e d i a t h e r m y .
T h e s e are cited in full as follows:
Principles of application.—1. Considering that in radiathermy (short-
wave diathermy), the sensitivity of the patient to warmth is the sole
reliable guide to the regulation of dosage, it is essential to examine each
patient for normal sensitivity to heat and cold, to exclude the presence
of affections of the nervous system, which are characterized by loss of
sensitivity and to avoid the danger of producing burns.
2. Each patient should be advised that the treatment must produce
only moderate and pleasant warmth, and that the moment sensation of
intense heat of a painful nature is experienced, he or she should report it
to allow adjustments.
3. All metallic substances and objects within the field of treatment
must be removed before treatment, to avoid intense localized heating
and burns. Watches, keys, pocket knives, and the like must be removed
from the clothing. It is not at all impossible that metallic foreign bodies
imbedded in the tissues, as for example, old broken needles, bullets,
and the like, may seriously interfere with the administration of radia-
thermy to that region. On the other hand metallic fillings of teeth do not
appear to have given rise to any unpleasant effects.
4. Care must be taken when treating regions in which the bones
lie close under the skin. Here the patients may complain of painful
sensations instead of experiencing the pleasant warmth essential for
success with radiathermy. This is known as periosteal pain. It is essential
at once to switch off the apparatus and to await complete cessation of
the unpleasant phenomena, after which treatment may be resumed with
moderate dosage.
5. Chairs and tables on which patients are placed for treatment
must be free of metal parts for the reasons given under Rule 3.
6. Oilcloth, art leather, old rubber mats, and any moist substance,
all of which are so-called semiconductors, should not be employed as
pads under any circumstances, not even with covering of nonconducting
material. The principal reason is that semiconducting materials may be-
come overheated and deviate energy, which in turn would nullify the
effects of treatment.
7. All connecting wires and other metallic appliances to secure the
electrodes should be thoroughly insulated and kept at a considerable
distance from the patients for obvious reasons. Interposition of felts in
incomplete insulation suffices.
8. To secure the proper depth effects the distance between the
electrodes and the skin should be not less than one and not more than
five centimeters, the variation depending on the size of the electrodes
and the make of apparatus. As a rule the larger the electrode the greater
should be its distance from the skin.
9. All felt pads used to produce separation of electrodes from the
skin must be absolutely dry not only before but throughout the treat-
ment. To prevent these pads from becoming moistened by the patient's
perspiration, blotting paper, some cellular material, linen or similar
stuff must be interposed between the skin and the felt pad.
10. When it is desired to obtain the maximum effect in treating the
chest or the abdomen the following rules should be followed: (a) Set the
short-wave apparatus for maximum dosage by the proper skin-electrode
distance, subsequent adjustment of dosage being made with the regu-
lating devices of the apparatus, (b) Maximum heat effect will be ob-
tained with an apparatus having the greatest power, with the smallest
intrinsic heating of electrodes and the intervening materials (e.g., felt-
pads) employed to secure skin-electrode distances.
11. Glass electrodes (Schliephake) have a superior depth and effect
are therefore particularly indicated when one has to treat thick body
parts such as the trunk, deeply located bones, and the like. For glass
electrodes, too, cellular material, blotting paper or linen should be inter-
posed to prevent the formation of sweat and resulting sparks, intense
heating and burns.
12. Remove clothing in all cases where a maximum effect is aimed
at and considerable perspiration may be anticipated, as when one makes
use of large electrodes.
13. When short-wave treatment is given for superficial (skin)
effects, medium depth effects are essential; for this reason skin-electrode
distance must be maintained. It Bhould also be noted that with small
electrodes the distribution of heat on the skin is not uniform, which be-
comes especially noticeable at uneven parts of the treated skin.
14. Unipolar treatment having a lesser depth effect is applicable
when deep effects are not desired, e.g., when the head is to be treated and
flooding of the brain is to be avoided; or in treating superficial lesions in
close proximity to bones, in which case the skin-electrode distance should
not exceed 20 mm.
15. Longitudinal treatments of extremities should always be given
through the patient's clothing.
16. For the longitudinal treatment of extremities and when other-
wise a maximum depth effect is either not desired or unattainable, one
may make use of moldable electrodes for greater convenience.
17. All electrodes should be larger in area than the diseased part to
be treated, in order to stimulate the lymph current of the adjacent struc-
tures.
18. During administration of treatments the physician should
frequently ascertain by interrogating the patients whether the heat is
felt at the proper place and pleasantly. As the resonance indicator of
the apparatus, unlike the ammeter on a diathermy apparatus, is not a
reliable guide to dosage and as patients frequently become dulled in
sensitivity to intense heat after prolonged application, the physician
must place his hand to the patient's skin from time to time to ascertain
the degree of heating. Use of any regulating appliances must never be
entrusted to the patient.
19. Whenever it is desirable to concentrate the short-wave treat-
ment toward one (active) electrode for the purpose of affecting super-
ficial wounds, infections or other lesions, the skin distance of the active
electrode should be somewhat less than that of the inactive electrode.
20. As burns are more likely to appear where osseous structures lie
close to the skin or where irregularities of contour occur, such as prom-
inences and articulations, one should in all such places insure against
such an accident by increasing the skin-electrode distance. Similarly one
should not increase without control the dosage, simply because patients
state they no longer feel warmth. As was pointed out in Rule 18, patients
become dulled to the sense of heat and unnecessary increase of dosage
may lead to burns. In all such cases the resonance indicator is of relative
value as a guide.
21. With apparatus providing currents of different wave lengths,
it is excellent practice to select shorter lengths for depth effect or when
one has to treat suppurative processes. Longer wave lengths are best
adapted to more superficial lesions, especially those without suppuration.
22. In the application of shorter wave lengths, the physician should
exercise special control and watchfulness, as one cannot rely solely on
the sensitivity of the skin to heat. Impairment of sensitivity even to a
slight degree is always to be considered. Undesirable complications are
avoidable by care.
23. In all cases affecting the head, especially when involving also
the brain, individual reactions must be observed. Not infrequently
patients complain of headache, dizziness, or other nervous phenomena,
which dictate the usual precautions.
24. In application of radiathermy to patients suffering from heart
disease the same precautions must be taken as with any form of heart
therapy, including diathermy. Watching the pulse will guard against
mishaps.
25. It is recommended that a Neon light in working order be always
at hand when administering radiathermy. Occassionally it may become
necessary to determine proper reasonance, to check the proper function
of the apparatus, or to correct some mechanical defect.
It is very unfortunate that some irresponsible manufacturers
and salesmen insist that the application of short-wave diathermy
is very simple, that it carries no dangers, and above all, that its
technic may be acquired by anyone, regardless of the operator's
general intelligence or knowledge of medicine. Such unethical
propaganda in the interests of sales is only too apt to cast upon
this relatively new and, in its proper place efficient, therapeutic
agent the onus of quackery.
Short-wave diathermy is not a cure-all and it most certainly
should not be used without discrimination for every disease that
crops up in medical practice. Short-wave diathermy should not
be applied unless the pathological condition is clear beyond the
possible limit of doubt. Due consideration should be given the
question as to whether short-wave diathermy will give better
results in a given condition than other forms of treatment,
medical or surgical. After such consideration, if the choice falls
upon short-wave diathermy, there should also be coupled with
its application either the experience of the operator or of other
creditable observers, the measure being employed with the
utmost care. Ideally, of course, the specialist, familiar with the
various therapeutic agents, would employ short-wave diathermy
only where it is definitely indicated. It is recommended that the
physiotherapeutist seek the advice or guidance of the speoialist.
Such an arrangement would prevent the abuse of a good meas-
ure—for example, the employment of short-wave diathermy in a
condition in which, for the patient's sake, surgery would be
better. Similarly, there may be occasions when short-wave

diathermy would lead to better results if it were supported by
medication or specific therapy.
It cannot be too often or too emphatically stated that short-
wave diathermy is not magic. It is simply a new agent derived
from a form of electric energy, which promises in the future to
be enrolled with credit in the armamentarium of the physician.
PART V
THE CLINICAL APPLICATIONS OF
VIII
INFECTIOUS, ALLERGIC AND METABOLIC DISEASES
G E N E R A L CONSIDERATIONS
THERE is a definite place for short-wave diathermy among

modern therapeutic methods. Although, in the eyes of those
unfamiliar with the procedure, it may appear open to question,
there is no doubt from the clinical evidence presented that there
is much in favor of its use, provided the operator is aware of its
physiological, pathological and therapeutic action, and is skilled
in its employment. From the practical point of view, its effect is
chiefly adjuvant, increasing the resistance of the patient against
the invading organism. That its action may be more specific and
complex is probable, though as yet this is not specifically known.
The statement can be made, however, that during the eight
years since its first employment, experimental or clinical, upon
the human organism, no permanently damaging effects have
been observed. It is true that minor accidents have occurred
which were attributable either to the variation in the machines
on the market, there being no uniformity in those brought out
by the different manufacturers, or to lack of knowledge and skill
in the operator. It stands to reason that only those thoroughly
cognizant of the physical properties of the measures employed,
as well as possessing skill and general medical training, should
apply short-wave diathermy in human disease. Unfortunately,
there are always some who are not qualified to use newer
therapeutic procedures, as yet on trial; and even in the case of
skilled use, those uncertain effects, good or bad, which ac-
company a procedure which is still in course of development,
are only to be expected.
The results reported in the literature are not always com-
parable, owing to lack of technical uniformity and absence of
full records. This unevenness will be eliminated with further
120 INFECTIONS
development of the speciality. Both negative and positive re-
ports increase our knowledge and furnish a basis for continued
experimentation in those diseases which may reasonably be ex-
pected to be benefited by this form of treatment, but in which
as yet the results are insufficiently checked or the work in-
adequately controlled. There is another sphere in which short-
wave diathermy may be of great use, and that is as an adjunct
to classical methods of treatment.
It is my hope that the present contribution to the literature,
though in many ways necessarily incomplete, may give a general
view of the field, both experimental and therapeutic, in which
results, good, bad or indifferent, have been obtained with this
new medium of treatment, and that it will encourage further
research and constructive, critical work.
At the same time, it may not be amiss to voice again the re-
minder that, just as there are many roads to Rome, so there are
also many therapeutic measures, and that short-wave diathermy,
for the sake of its own future, should not be considered in the
light of a cure-all. The patient should be given the benefit of
good judgment in the choice of treatment to which he is sub-
jected. Upon the conscience and experience of the physician
rests the welfare of the patient.
INFECTIOUS DISEASES
T H E COMMON COLD
The usual forms of treatment of acute rhinitis—exercise, hot

baths, fluids—which aim at relief of nasal congestion through
peripheral dilatation, can be advantageously superseded by
short-wave diathermy. Since this form of treatment comfortably
and effectively increases vagotonic and decreases sympathico-
tonic effects, and results in an intense hyperemia, it fulfills the
therapeutic requirements. Symptomatic relief in uncomplicated
cases is obtained after from one to.three treatments. The stuffi-
ness in the nose decreases after the first treatment, the air
passages become free of obstruction, the headaches subside, and
the nasal discharge quickly diminishes. Although the uncom-
plicated common cold usually runs a short course without treat-
ment, it is so quickly and effectively banished by short-wave
diathermy that recourse to this measure cannot be too highly
recommended, if only for the sake of the patient's comfort.
INFECTIONS 121
Technic of treatment.—Because of the anatomical position of

the nose as a prominent surface organ, a special electrode may
be used, not only in order to obtain the best results, but also to
prevent undesirable after effects, such as burns. An electrode of
this type is shown in Fig. 22c. Such a special electrode aids in
the application of the current, as it can be adapted to individual
anatomical requirements; and, in combination with the special
tonsil electrode (Fig. 22d.) or rigid electrodes, it also greatly
facilitates short-wave diathermy. Flat electrodes may result in
current concentration, with the danger of overheating of promi-
nent parts, as discussed in Chapter VII, "General and Mechani-
cal Principles in Short-Wave Technic." Special electrodes require
only the usual routine attention for use. Electrodes constructed
with air spaces are used to advantage.
The duration of treatment depends upon the severity of the
infection, the usual time being from 10 to 25 minutes. The first
treatment should not exceed 10 to 15 minutes, since the head-
aches which accompany the infection may be intensified by too
long a treatment in the beginning. Subjectively, the patient
should be conscious of agreeable warmth during the treatment.
Treatments are daily at first, for from 10 to 20 minutes each,
and are then continued every second or third day. It must be
noted, however, that as yet no "specific" wave length has been
determined for the clinical varieties of the common cold.
PNEUMONIA
Tronside reported 27 cases of pneumonia, treated with short
waves, without a fatality. It would be an important achieve-
ment were it possible to check the progress of pneumonic proc-
esses, and thereby the mortality, by this means.
Schittelheim observed a more rapid resolution of the pneu-
monic infiltration after short-wave diathermy. Reiter favorably
influenced suppurative pneumonia.
Laqueur and Remzi successfully treated one case of broncho-
pneumonia after the acute stage had subsided. Hayer empha-
sized the especially beneficial effects of short waves in the
chronic cases in which resolution is protracted.
In milder cases of pneumonia in children, Votz used short-
wave diathermy with good results. For details of technic in
122 INFECTIONS
pulmonary disease, see Chapter I X , "Diseases of the Respira-
tory Tract."
PULMONARY TUBERCULOSIS
The aim of treatment of this disease is arrest oí the tubercu-

lous process and cicatrization of the disease area, thus achieving
cure. To this end medical and surgical means have hitherto
been employed. Since the advent of short waves as a new
therapeutic agent, Schliephake and Liebesny have directed their
attention to its use in tuberculosis. Although their results are as
yet inconclusive, since the number of patients treated is too
small to be conclusive, the results so far obtained, they believe,
justify further investigation.
Schliephake describes- variable nonconclusive results in 10
cases. He apparently succeeded in arresting the disease process
in some of his other cases, with concurrent improvement in the
general condition and with gain in weight.
In the exudative form, Raab, and Hancken, noted absorption
of the pleuritic effusion. The action is apparently the same as in
cases of pleurisy with effusion; the short waves increase the
resorptive power of the pleura (fig. 24a). After a few treatments
the chest fluid is absorbed. Raab had a case of severe long-
standing cavernous tuberculosis of the lung, complicated by
serous effusion. This effusion was completely reabsorbed after
six treatments with short waves within one month (fig. 24b).
These authors failed to relieve cases of tuberculous empyema,
especially when complicated by fistula. Schedtler also failed in
tuberculous empyema (3 cases), but noted local and sympto-
matic improvement in 4 cases of tuberculous peritonitis. His re-
sults in pleuritis are noted below, in Chapter I X , "Diseases of
the Respiratory Tract."
In mixed infection, the reported results are both good and
bad, Lob reporting failure.
In surveying the results of investigators, it must be stated
that in the field of tuberculous disease of the lung, short-wave
diathermy to date has not proved so successful as in the case of
lung abscess and gangrene. Nevertheless, it would seem to be
worth while to continue investigations in this field.
For principles of technic of application, see Chapter I X .
INFECTIONS 123
ERYSIPELAS
While the usual form of treatment leads to quick resolution,

in many cases of erysipelas short-wave diathermy has proved to
be remarkably efficacious addition to the physician's weapons
against it. If it is diagnosed in the early stages and if no ulcera-
tions are present, cure may be obtained after one or two treat-
ments (Schliephake, Raab, Pflomm, Schweitzer). The grave
gangrenous form is also greatly benefited, and a quickly favor-
24. Roentgenograms, Showing Tuberculous Exudate of Six Months' Dura-

tion, in a Grave Case of Pulmonary Tuberculosis
a, Before Short-Wave D i a t h e r m y ; 6, After 6 Short-Wave Treatment« within 4 Weeks
able outcome may result. The severity of the infection deter-

mines the number of treatments, and in severe cases two sessions
may be instituted daily.
Nevertheless, Lob emphasizes the fact that this form of
treatment may not be entirely harmless, and that under im-
proper dosage the local and general symptoms may be aggra-
vated. Insufficient dosage may favor the process, or the results
achieved may be no better than those following X-ray or ultra-
violet-light therapy.
In a septic case with temperature, Weissenberg effected a
cure in three weeks. This was the case of a physician who had
injured his finger in the course of his duties, followed two days
124 INFECTIONS
later by diffuse edema of the entire arm, accompanied by intense
pain. Daily treatments were administered for thirty minutes
each at different areas on the diseased arm. The infection became
localized and an abscess formed in the axilla, where it drained.
According to Weissenberg, the impression was gained that the
application of short-wave diathermy prevents the development
of general sepsis, and favors a satisfactory outcome.
In the general infections—septic conditions—Liebesny recom-
mended short-wave diathermy directed to the liver and spleen,
on the assumption that thereby the patient's general condition
might be favorably influenced. He bases this idea on his clinical
observations.
ERYSIPELOID
Infective dermatitis, resembling erysipelas, appears usually

on the hands and responds readily to various therapeutic agents.
Lob observed the disappearance of symptoms within 3 or 4 days
after a few treatments by short waves; this was followed by a
cure. Failures were also noted.
Technic of treatment.—The preferred wave lengths are those
of the short range—4, 6, 8 meters—with a duration of from 15
to 35 minutes per treatment. On the whole, the employment of
short-wave diathermy in the pyogenic infections of the skin is
justified, and the results of this conservative form of treatment
are promising.
With improper technic, superficial burns are sometimes,
though rarely, observed. These can easily be avoided by in-
structing the patient properly and by giving attention to ap-
propriate air-spacing with electrodes. The principal cause of
burns is perspiration. Hence the patient who perspires markedly
should be treated with care.
ACTINOMYCOSIS
This chronic infectious disease of cattle, transmissible to

man, caused by the parasitic fungus Actinomyces bovis and
commonly called "lumpy jaw," may develop in the soft tissues
of the lower jaw, with involvement of the neighboring bone.
This localization of actinomycosis may be amenable for short-
wave treatment. There are no available records that actinomy-
INFECTIONS 125
cosis elsewhere in the organism has been treated successfully.

Liebesny succeeded in curing several cases of actinomycosis of
the j a w with the 4-meter wave length, giving a t r e a t m e n t daily,
15 to 2 0 minutes being required to achieve results. H e observed
t h a t the pain often stops after the first t r e a t m e n t , t h e infiltrated
area becomes soft and breaks down, t h e abscesses formed being
evacuated b y c o a g u l o t o m y * . Resolution is gradual, to complete
healing and return t o normal conditions. I t is considered wise t o
continue the short-wave t r e a t m e n t s at longer intervals, a f t e r
healing has apparently taken place, in order t o prevent re-
currence. Vaccines, preferably autovaccines, described b y
Neuber, in conjunction with short-wave diathermy, are favored.
Wessely considers short-wave diathermy the t r e a t m e n t t o be
preferred in actinomycotic infections. Liebesny claims t h a t
cures can be effected only with the shorter wave lengths, around
4 meters, and also states t h a t t r e a t m e n t with the 14-meter
wave length aggravated the condition. Groag and T o m b e r g
could not confirm Liebesny's beneficial results. According to
L o b , after unsuccessful short-wave t r e a t m e n t even severe cases
m a y be cured b y electrosurgery.
Weissenberg cured 5 cases of actinomycosis in a period of
from 3 to 10 weeks. Some of the cases were complicated b y large
fistulas. As he obtained uniformly satisfactory results with
different wave lengths, this would seem t o speak against the
specificity of the 4-meter wave, as claimed b y Liebesny. Never-
theless, it would seem t h a t the lower range—4, 6 meters—is the
most effective if equal intensity is used.
T h e involved area should be placed well within the electric field.
If larger areas are diseased, different sections may be treated daily.
ALLERGIC DISEASES
T h e r e are reports of symptomatic relief, observed in numer-

ous cases of hay fever.
BRONCHIAL ASTHMA
Beneficial results were obtained b y Schaffler and R6zsa, and

the present author. T h e antispasmodic and the anti-inflam-
m a t o r y effect of short waves is the basis of their application in
•High-frequency electric incision with coagulation.
126 INFECTIONS
this affection. Laqueur compared the action of diathermy with
that of short waves, and found that treatment with the latter
resulted in a higher percentage of cures. The respiration became
freer and easier from the beginning of the treatment, according
to Raab and Rollin. It may be that the unduced hyperemia in-
creases bronchial secretion, facilitating expectoration. Gruchella
mentions a case in which improvement was obtained after 15
treatments. Osborne, using short waves in bronchial asthma,
reported 14 cures, 10 cases improved, 4 failures, and 2 cases lost
track of. Laqueur and Remzi had 2 failures and 10 successes.
The number of cases reported is as yet very small and con-
clusions are not justified. We believe that in this complex field of
medicine, short-wave diathermy should be used only in as-
sociation with customary specific treatment, under the super-
vision of the specialist.
D I S E A S E S OF M E T A B O L I S M AND OF THE D U C T L E S S G L A N D S
GOUT
According to Raab, the gouty arthritides react well to short-

wave diathermy, though Réchou and Babin-Chevaye believe
that chronic form presents the best field. They used the treat-
ment only very cautiously in the acute stage. Raab observed in
many of his cases that the painful deposit softened after a few
treatments, diminishing in size in direct proportion to the de-
crease in pain. Naturally, short-wave diathermy can be con-
sidered a means of achieving symptomatic relief only. Its action
lies in the profound local hyperemia induced and the attendant
extreme increase in blood and lymph locally. These bring about
the dissolution of the tophi, with alleviation of pain. Frequently
the blood cholesterin, also, is diminished.
Since short-wave diathermy gives symptomatic relief, t
should be administered in conjunction with other therapeutic
measures, such as diet, drugs, and so on.
The electrodes are so placed as to include the diseased area
within the electric field.
OBESITY
It has been argued that by inducing abundant sweating and

increased metabolism, short-wave diathermy should be as effec-
INFECTIONS 127
tive in weight reduction as other physiotherapeutic measures,

such as hot air, paraffin, Turkish baths, light treatment, and so
on. This is advocated chiefly by the French school. It may be
best applied in the form of electropyrexia, especially in the
obesity of endocrine imbalance, as for example, in adiposo-
genital dystrophy. Dausset claims to have obtained lasting re-
sults (six months) in a case of Frohlich's disease after fifteen
treatments of generalized short-wave diathermy (electropyrexia).
This observation may possibly rest upon an improvement in the
balance of the internal secretions.
DIABETES MELLITUS
There may be a possibility of stimulating the blood supply to

the pancreas through short-wave diathermy, and thereby
exercising a rejuvenating effect upon the damaged tissue. The
idea that the damaged islands may be regenerated though short-
wave treatments is purely theoretical, and in order to attempt
experiments in this direction it is naturally of first importance
that the cells should not be so far degenerated as to be beyond
hope of regeneration. In the latter event, Raab states that short-
wave diathermy could have no beneficial effects. Therefore, he
believes that short-wave diathermy would be of use only in early
cases in which the pathological changes have not advanced too
far, and that even then, if no actual regeneration could be in-
duced, would only hold the degenerative process in abeyance.
Schliephake, working on dogs, found a temporary decrease in
the blood sugar after short-wave treatments.
Dausset treated a diabetic child of ten years, in whom the
diabetes developed following influenza. He claimed to have ob-
tained a normal condition of the urine after ten treatments. One
year later the symptoms recurred and the short-wave treatment
was repeated again with temporary success. No exact data as
to blood chemistry, which might serve as a practical check on
results, are given in the literature.
DISORDERS OF T H E ENDOCRINE FUNCTION
The following observations are reported for the sole purpose

of completing a survey of the work being done with short waves.
I t must be stated, however, that the results in endocrinology to
128 INFECTIONS
date need confirmation, and careful and intensive scientific
study is necessary to give any estimate of the effect of such
treatment in endocrine disorders. So far all is primarily theory,
or cases unscientifically observed and reported.
In thyrotoxicosis the results are contradictory, an occasional
observer reporting improvement in symptoms and another stat-
ing that the measure is contraindicated.
Weissenberg treated 12 cases of thyrotoxicosis with improve-
ment in all, using weak doses, and marked gain in some. If the
question arises as to whether or not short-wave diathermy might
not be employed as a preoperative measure, its possible contra-
indication should not be lost sight of, in view of the increased
hyperemia which it induces.
Dausset and Babin-Chevaye state that they are able to
influence thyroid diseases, changes in the pituitary, and ovarian
disturbances. Dausset and Dognon think that at times smaller
doses give better results, and may be effective in various endo-
crine disorders, adiposogenital dystrophy for one. It is of interest
to speculate upon the possible effect of short-wave treatment on
the hormones influencing growth, and the possible results to
those unfortunate patients in whom developmental disturbances
have established abnormal body proportions.
French authors, led by Dausset, believe that one effect of
short-wave treatment may be to accomplish descent of the
ectopic testicles and to promote their growth on an endocrine
secretory basis. Similarly, in treating the pituitary in amenor-
rhea, one may succeed in reestablishing normal menstruation.
According to Dausset, it should also be possible, by such treat-
ment of the pituitary, to control uterine hemorrhage, to relieve
patients suffering from uterine congestion, and to arrest the
growth of fibroid tumors. The effect of short waves on the
thyroid is evidenced in diminution in size of the gland and
especially in decrease in the metabolic rate, with gain in body
weight. Tremor, tachycardia and exophthalmos are favorably
influenced. On the other hand, hypothyroidism should respond
to the invigorating effect of a stimulated blood circulation,
through this treatment.
Weissenberg states that parenchymatous goiter regressed
after 25 treatments, using strong dosages. There was a decrease
INFECTIONS 129
of 1} inches in the size of the neck. This manifestation of im-

provement was observed in other cases also.
Dausset sums up his observations in the comment that short-
wave treatment may affect the endocrines either directly, or
by stimulating antagonistic hormone secretion. Obviously this is
all, so far, pure theory.
Jorns and Last experimented on rabbits, and found no in-
jurious effects histologically after short-wave treatment (4
meters) of the thyroid gland, though its function was reduced.
From the fact that generalized short-wave treatment of the
scalp arrested falling hair and seborrheic conditions, Dausset
and Auclair assume that the endocrine function had been im-
proved.
There are as yet insufficient observations on the effect of
short waves in hyper or hypofunction of the pituitary. It is,
however, Weissenberg's belief that the function of the gland may
be influenced by such treatment. In 2 cases of amenorrhea, the
reappearance of the function occurred, in one after 10 treat-
ments and in the other after 3. He had also noted that in other
patients treated for a variety of disorders, the menstrual period
recurred earlier than customary. Such observations require
confirmation. It would be equally futile to attempt an explana-
tion of the claims that sexual powers at least temporarily are
increased after treatment not only of the testes but also of other
parts of the body. This is a matter that requires scientific ob-
servation and accurate and extensive investigation, and should
be viewed with skepticism for the time being.
IX
D I S E A S E S OF T H E R E S P I R A T O R Y T R A C T
O W I N G to our limited experience in the field of pulmonary

disease, we are not, as yet, in a position to pass final judgment
upon the usefulness here of short-wave diathermy. Only by
summing up the findings of practitioners, some of whom have
devoted much of their attention to such cases, can some con-
ception be gained of results in this field. To judge by these re-
ports, it would seem that short-wave diathermy might be de-
veloped into a highly effective measure, provided continued
study is applied. A good deal depends upon perfecting the
technic and upon a clarification of the question of the dosage
calculated to give the best results. Naturally, standardization of
machines holds an important place here. Such continued study
is highly desirable. It is very possible that this form of treatment
will serve to reduce both the mortality and the period of con-
valescence, when used by physicians with adequate experience
and knowledge of lung pathology. If no emergency impends,
short-wave diathermy may always be tried before surgical
intervention is resorted to.
Schliephake believed from the beginning that pulmonary
disease presented a field for short-wave diathermy. The air in
the alveoli and bronci lowers the dielectric constant. Any marked
increase of heat is prevented by the quick removal of heat,
through vigorous circulation of the blood. Moreover, heat may
also be given off in the expired air. This favorable situation is
altered, however, when consolidation is present. In such a case
the dielectric constant is high and the electrical field is cor-
respondingly dense, or, so to speak, "drowned" within the lesion.
Since abscesses and tuberculous tissue are devoid of vessels, the
heat can be dissipated only in part, and these masses therefore
become heated to a high degree. We see from experiments with
bacteria that their activities are retarded by short waves at a
higher temperature.
THE RESPIRATORY TRACT 131
This intensive local heat production in the pathological area,

with its concomitant hyperemia—increased phagocytosis and so
on—favors the destruction of bacteria and operates as an aid to
the defensive mechanism of the organism against the spread of
infection. B y some therapeutic action as yet unexplained, the
infection becomes localized, its toxic effects are reduced, and the
organism is able to overcome and resolve the pathological
process.
The indications for short-wave diathermy in thoracic condi-
tions seem to embrace, aside from the specific infections, mainly
the nonspecific inflammations and infections of the pleura and
lungs.
LARYNGITIS
Satisfactory results are reported in acute laryngitis, by

specialists who claim that in the majority of cases one treatment
is sufficient to cause improvement. In severe cases a number of
treatments may be required for cure.
It has also been reported, and this coincides with our own
observation, that the hoarseness of singers after prolonged sing-
ing, which is due to a slight inflammation of the vocal cords,
can be remedied with one or two treatments.
In chronic conditions, it is questionable whether beneficial or
permanent results can be obtained.
BRONCHITIS
Short-wave diathermy seems to be of benefit in bronchitis

(Ginsberg). Laqueur and Remzi were able to improve 2 out of 3
cases of chronic bronchitis. Berry treated a woman, 4 9 years of
age, whose ailment was diagnosed as "chronic bronchial ca-
t a r r h . " Her chief symptoms were a constant cough, worse in
winter and upon lying down, which proved very disturbing to
rest. For two months she received short-wave diathermy, be-
ginning with daily doses of 15 minutes and gradually increasing
to 20. As the treatment proceeded, the length of exposure in-
creased, together with the intervals between treatments; in the
last weeks, the treatments were 30 minutes in length, and twice
a week. When last seen, 4 months after cessation of treatment,
she had been free of cough, in spite of the inclement weather.
132 THE RESPIRATORY TRACT
Peters and Tegethoff found short-wave diathermy beneficial in

chronic bronchitis, with results better than those following
diathermy.
We noted improvement after 3 treatments, in one of our
patients who suffered from chronic bronchitis, but there was a
recurrence after the patient contracted a new cold. In 2 cases
the improvement was permanent.
BRONCHIECTASIS
Surgical intervention in bronchiectasis all too often dis-

appoints. It is well, therefore, to employ conservative measures
first, and among these short-wave diathermy may be included.
Schliephake, and Raab, state that in all cases of bronchiectasis
treated by short waves, the expectoration is diminished. The
former treated a case of bronchiectasis of the right lower lobe in
a youth of 16. The patient had previously been treated by
diathermy and other measures, and repeated pneumothorax did
not improve his condition. He was given 25 treatments, at first
daily with the 7-meter wave length; later with the 16-meter
wave length, at first daily and later twice a week. In four weeks
the patient improved to such an extent that he could be dis-
charged from the hospital, and in four months he was entirely
symptom-free, and following his occupation of gardening.
Further cases are also reported by Schliephake, and Schedtler.
I t is possible that short-wave diathermy decreases the secre-
tion, thus favoring evacuation by the contraction of the vitalized
bronchial muscles, providing the histologic changes are not too
far advanced. Restitution of normal conditions may result,
especially if the bronchiectasis is intrabronchial. Even if only
the foul expectoration is reduced or rendered odorless by this
form of treatment, this alone constitutes a great relief to the
patients. I t seems to us that short-wave diathermy is worthy
of trial in this field.
EMPHYSEMA
The dyspnea of the patient with emphysema may be re-

lieved by weak doses of short-wave treatment. This was the
finding of Weissenberg, who studied a large number of cases.
After such repeated treatment, with the patient aware of a

sensation of mild warmth for about 10 minutes, he is relieved
and expectoration is easier.
This observer also succeeded in eliminating the irritative
cough of infants, by a few weak treatments with short waves.
PLEURISY
The observations of Schweitzer, Liebesny and Finaly,

Laqueur, Wolfrum, Votz, Schittelheim, and others, would seem
to show that short waves are indicated both in dry pleurisy and
in pleurisy with effusion. Hayer states that of all pulmonary
diseases, pleurisy reacts quickest and most favorably to short-
wave diathermy. Absorption of the effusion takes place rapidly
and the adhesions and their symptoms are favorably influenced.
The regression of the fluid may be observed after the first treat-
ment, and is usually cleared in from 3 to 16 treatments, depend-
ing upon the severity of the condition. In 14 cases of dry pleurisy
with fever, pain and respiratory disturbance, the results were
uniformly good. In 6 of 8 cases of pleurisy with exudate, resolu-
tion took place following short-wave diathermy (up to 40 treat-
ments in some), and 2 remained unimproved. These cases were
observed by Schedtler who noted that different wave lengths
had a similar action. He recommended that puncture always be
performed before the treatment.
The action of short-wave diathermy is chiefly that of an
active hyperemia, increasing the absorbing power of the pleura.
In the case of long-standing pleurisy with adhesions, short
waves act favorably from a symptomatic point of view, but
naturally there are many failures. Laqueur and Lambrecht state
that the short waves are less effective in the old adhesive pleurisy
than in cases of more recent development.
EMPYEMA
Schliephake, Liebesny, Raab, Reiter and others, using short-

wave diathermy alone in empyema, report very satisfactory re-
sults in the majority of their cases, without surgical intervention,
and attribute this favorable outcome to the increase in resorp-
tive power of the pleura, which is stimulated by short-wave
diathermy and which favors the absorption of the purulent
exudate.
In postpneumonic empyema, Schliephake repeatedly ob-
served complete absorption within from 3 to 6 weeks. In 2 cases
the condition of the patient was so critical that the surgeon
hesitated to perform a rib resection. In both patients, the first
2 treatments were followed by marked symptomatic improve-
ment and after further treatment the temperature gradually
fell, in the course of from 5 to 6 days, to normal and remained
so. The sedimentation time of the red blood cells was greatly
decreased, and the subsidence of the effusion could be followed
step by step. Within 3 weeks following pleural puncture which
before treatment had brought up a thick purulent exudate, an-
other puncture proved negative. Both patients were discharged
as cured in 4 weeks.
Pleural empyema is absorbed in a short time. Schliephake
treated a woman with extensive postpneumonic empyema. I t
was decided not to perform a rib resection, as the patient was
not likely to withstand such an operation. After 5 daily short-
wave treatments, the patient was free from fever and without
pain. In the following 2 days the X - r a y shadow cleared up and
after three weeks only a pleural thickening remained. The
patient gained in weight and was discharged after 4 weeks.
Similar improvement has also been shown in interlobar
empyema, in which surgery is often difficult. In the case of a
14-year old girl, suffering from chronic right inter-lobar empyema
following influenza of pneumococcic origin, short-wave dia-
thermy was instituted by Schliephake as a last resort. The
temperature had been continuously high, but fell to normal after
4 days of treatment. Gradual improvement and increase of
weight followed, with complete recovery in 5 weeks.
Schliephake reports further cases of extensive postpneu-
monic and interlobar empyema, in which complete resorption of
the pus was effected in from 4 to 5 weeks without puncturing
or opening the pleural cavity. Adhesions cannot always be
avoided, but on the whole are considered fewer than is observed
after rib resection. A striking feature is the rapid subsidence of
the fever, patients usually being apyretic after from 3 to 5
treatments. The general condition frequently improves after the
first treatment and insomnia in particular is greatly relieved.

This admirable by-effect is evidenced in practically all patients.
In 2 of his cases, the empyema was a sequel of Malta fever;
the outcome was complete cure.
Tuberculous exudates are also absorbed through short-wave
diathermy, though a longer period of treatment—one to 2
months—is required. For reports of short-wave diathermy in
a b
25. Roentgenograms, Showing Gangrenous Interlobar Empyema

a, The Grose Sire of the Lesion and Its Position, before Short-Wave Treatment; b. Seven
Weeks after Short-Wave Diathermy. (The Lesion Is Barely Distinguishable and the Patient
Has Been Discharged from the Hospital)
tuberculous empyema, see Chapter V I I I , section on "Pulmonary

tuberculosis."
With the exception of Lob, Schittelheim and Hayer, who
claimed to have observed no benefit from short-wave diathermy,
all investigators reporting their results in the literature are
enthusiastic, advocating without reservation the use of this
therapeutic agent in empyema (Neumann). The only contraindi-
cation is cardiac decompensation. Short-wave diathermy would
appear to be of particular benefit in the encysted form of
empyema.
ABSCESS OF THE L U N G
Abscess of the lung, either single or multiple, is of relatively

infrequent incidence. It may be acute or chronic and, if the
abscesses are multiple, the customary treatment is incision and
drainage. The mortality is as high as from 60 to 85 percent under
medical treatment, but this is reduced to about 40 percent by
surgery.
According to Schliephake, Liebesny, Raab and others, short-
wave diathermy improved to an almost unbelievable degree the
results in this serious infection.
The duration of treatment, using Schliephake's method
(larger air-spacing between electrodes and surface, in order to
secure more homogeneous, deep action with high energies) was
from 3 to 6 weeks. Operation is usually not undertaken at all
until such preliminary course of treatments by short waves has
been given that it may be possible to avoid surgical intervention.
This is desirable, as postoperative convalescence is apt to be
very long, and in addition postoperative mutilations and ad-
hesions are frequent.
Cure through short-wave diathermy is brought about not
only through expectoration, but also by absorption, through the
reduction of the infiltrative inflammation around the abscess.
This can be clearly followed by serial roentgenograms, which
will show a gradual clearing of the shadows. In the final stage
only a faint shadow is visible around the abscess in the roent-
genogram, but the level of the effusion remains to the last.
When the abscess cavity finally begins to shrink, the effusion
also disappears.
Schliephake reported the largest number of cases of lung
abscess (40), in which the progress made was checked simul-
taneously by roentgenograms and laboratory examinations.
Liebesny, who was not successful in treating lung abscess in the
beginning, owing to faulty technic, then adopted Schliephake's
technic (noted above) and treated 6 cases without failure.
Schliephake employed short-wave diathermy in 40 cases of
lung abscess, many of them postpneumonic, postinfluenzal, one
embolic, and one an aspiration abscess after tonsillectomy.
Approximately one-half were accompanied by gangrene. The
sputum contained a variety of bacteria, among them being the

Streptococcus viridans, hemolytic streptococci, Staphylococcus
albus and Staphylococcus pyogenes. All but 2 recovered without
operation. In only one case was aspiration necessary.
An embolic abscess in a man 31 years of age originated from a
thrombosed varicose vein in the leg. He had high fever and foul
purulent expectoration. The odor disappeared after two treat-
ments with 12-meter waves. After 7 treatments, the patient no
longer complained of pain. Roentgenograms demonstrated t h a t
a b
26. Roentgenograms, Showing Absorption of Lung Abscess
a, A Fluid Level Is Distinguishable below the Clavicle in the Right Upper, Indicating a Large
Abecess in the Apex of the Upper Lobe; b. After 3 Weeks of Short-Wave Treatment, the Lesion
Has Practically Cleared Up
the abscess had disappeared and had left only a negligibly small
shadow in its place. One abscess the size of a fist disappeared
after a course of treatments extending over 8 days. In the
second roentgenogram only a few faint shadows appeared where
the abscess had been. The circumstance should not be over-
looked t h a t such an abscess may break through into a bronchus
and its contents be coughed up so that a spontaneous cure takes
place. But on reexamination of the patient reported, this was
seen to be impossible; the amount of the discharge diminished
perceptibly immediately after the first treatment.
Among 6 cases reported by Liebesny, one was t h a t of a man
29 years of age. The abscess was the size of a hand, situated
beneath the right clavicle and characterized by foul expecto-
ration of elastic tissue. The temperature and the amount of
expectoration increased after 2 treatments, but after 4 the
temperature fell and expectoration decreased. Roentgenograms
showed decreased opacity, and the expectoration became odor-
less. After 16 treatments, the expectoration ceased, but further
treatment was given as the roentgenograms still showed disease.
After 29 treatments, the patient was entirely symptom-free.
In cases of lung abscess reported by different authors and
collected from the literature, Raab found 90 percent cured after
short-wave diathermy.
It is to be noted that the rapid discharge of the foul ex-
pectoration and the fall of temperature, among other symptoms,
indicate that the correct technic is being used and point to con-
tinued improvement. Hemorrhage, as an untoward effect follow-
ing short-wave diathermy, may be avoided by care in treatment
(Bauer).
Short-wave diathermy in abscess of the lung behaves as in
other inflammatory processes, influencing favorably the de-
fensive mechanism of the organism against the pathological
process. In healing, the abscess cavity becomes filled with
granulation tissue, followed by scar-tissue formation. It seems
that in cases of multiple-abscess formation which are not suitable
for surgery, short-wave diathermy would be especially indicated,
even for those who are conservatively cautious. The astonishingly
beneficial results reported in lung abscess are corroborated by
X-ray reports, controlled, affirmed and followed up. Further
observations may bear out the reports of clinical results of short-
wave diathermy, which may be of special benefit for those
patients suffering from this highly fatal disease. Judging by
these successes, short-wave diathermy may become one of the
most valuable of our conservative curative agents.
PULMONARY GANGRENE
Gangrene may follow lobar pneumonia in debilitated sub-

jects. The disease is not limited, as in the case of lung abscess,
but spreads. The foul expectoration is characteristic. The
prognosis is very poor. The treatment, if possible, is surgical.
Nevertheless, a favorable outcome has been reported by Schlie-
phake in the case of a boy 9 years of age, with bilateral suppura-
tive pneumonia, in whom complete healing took place in 5 weeks.

Liebesny treated gangrene of the left lower lobe in a man
39 years of age. Roentgenograms demonstrated a fist-sized
abscess in the left lower area. Expectoration increased and the
temperature rose after two treatments, but decreased after the
third. After the seventh treatment, the expectoration amounted
to 100 cc., as against 350 cc. before treatment started and 500 cc.
after the first two treatments. In all, 40 treatments were given
of from 20 to 60 minutes each, until improvement. In the other
cases improvement was noted after the fourth treatment, as
shown by physical examination and roentgenograms. When 15-
meter wave lengths were used, convalescence was longer than
when the 8-meter wave was employed. In the latter case, cure
eventuated after 17 treatments.
T E C H N I C OF T R E A T M E N T
T h e position of the patient during treatment does not ap-

pear to be of special importance in the case of pulmonary
disease. T h e recumbent position or the lateral may be selected,
according to individual requirement and in the judgment of the
operator, while if necessary the patient may be seated. T h e
important thing is to bring the diseased area well within the
condensor field. The electrodes should be large enough to create
an adequate electric field and should be placed at a distance of
several centimeters from the skin, in order to secure homogene-
ous, deep action at the desired level (Schliephake method). For
this purpose it is recommended that the electrodes be placed
anteroposteriorly and, in order to avoid improper concentration,
the electrodes may be flexible, shaping easily and adequately to
the chest wall. Larger rigid electrodes are used for concentration
at greater depth.
F r o m Schliephake's laboratory and clinical experiments, we
know that a special technic is required to secure homogenous,
deep action with short waves. T o this end it is necessary to em-
ploy an apparatus with a wattage sufficient to give such deep
effect (above 300 watts).
T h e recommended wave lengths are around 6 meters and the
treatments daily from 10 to 20 or to 30 minutes in duration.
According to Raab, greater energies are not necessary, as the

short waves easily penetrate the chest wall and the air-contain-
ing lung tissue. It seems reasonable, however, to favor higher-
powered apparatus in treating cases of more extensive patho-
logical processes with more infiltration.
The dosage is not yet exactly determined, and the treatment
is guided by the patient's subjective sensations and by the
experience of the physician. I t is individual in each case, depend-
ing upon the reaction on the part of the patient and on the
pathological condition. No rule can be given at present, and
perhaps not in the immediate future. The treatment depends
upon the symptoms.
The subjective feeling of the patient should be carefully
noted. Any complaint not attributable to the pathological con-
dition may require modification of the technic used, such, for
example, as less intensity. The intensity should be so regulated
that the patient will feel agreeable warmth in the depth of the
chest. The duration of the first treatment should not exceed
10 or 15 minutes. Then, if the patient has shown no additional
symptoms, the time may be increased to 15 or 20 minutes. After
longer sessions patients sometimes complain of a sensation of
light pressure and dyspnea, beginning two or three hours after
the treatment and lasting a few hours. This is attributable
(Schliephake) to the intense hyperemia of the tissue. Where
these complaints occur, the intensity and the time of treatment
should not be raised further. The dosage may be increased until
a sensation of pressure in the chest follows the treatment, but
this should not be uncomfortable for the patient.
Another symptom complained of, especially in the case of
pleurisy treated by short waves, is pricking—mild stabbing—pain
in the chest, but this is transitory and of no significance. If the
cough increases, the intensity should be decreased in the follow-
ing treatment.
An increase of temperature of 1° or 2° F . is frequently ob-
served after treatment, but this usually falls within one or 2
hours. The rise in temperature is attributed not only to the
internal heat generated by short waves, but also to the increased
local metabolism. Schliephake observed a rise of about 1° F . in
the evening temperature, after treating productive cirrhotic
tuberculosis of the lungs. In this case the patient did not have
an evening rise of temperature before short-wave treatment.
Observations on blood pressure showed a fall, with a return
to the earlier level after a few hours.
Investigators concur in their observations that in no case
treated did the patient exhibit symptoms, either during or after
any treatment, which would necessitate termination of the
therapy during the course of the illness. In every case of fatal
outcome, death could not be attributed to short-wave diathermy.
Proper dosage, as determined from experience and numerous
observations, gives only beneficial results. It is to be hoped that
in the future there will be standardized apparatus put out by the
manufacturers, and that the measurement of short-wave ener-
gies will be brought to a degree of exactness which will facilitate
accurate dosage.
X
D I S E A S E S OF T H E G A S T R O - I N T E S T I N A L T R A C T
THE ORAL CAVITY
SHORT-WAVE diathermy may be employed with benefit in the

various pyogenic infections and inflammations of the mouth.
Ulceration of the soft parts may be favorably influenced. Wagner
believes that the more acute the infection, the more rapid is the
response. It should be stated emphatically that any chronic
ulcer or any lesion in the mouth that shows no tendency to heal
should be considered cancerous until proved otherwise by biopsy.
There is as yet inadequate data on tuberculosis and syphilitic
lesions of the oral cavity.
Weissenberg observed improvement of subjective symptoms
in cases of aphthous infection.
Fiandaca treated a young patient who developed noma dur-
ing convalescence from typhoid fever. The process was arrested
after 9 treatments, given daily for from 10 to 15 minutes. The
report is illustrated with photographs.
T H E D E N T A L STRUCTURES
Short-wave diathermy has proved to be of benefit in the

numerous infectious processes of the dental structures. A number
of investigators, among them Schliephake, Raab, v. Kohler,
Liebesny, Schweitzer, Weinmann and Weissenberg, have re-
ported cures in the treatment of gingivitis, periodontitis, puru-
lent infection of the teeth, dental sinuses and granulomas. Ac-
cording to Schliephake, painful dental abscesses react quickly
and favorably to short-wave diathermy. In one of his cases
exhibiting a dental abscess of 14 days' duration, there was
cessation of pain after the first treatment and complete healing
after two subsequent applications. Fistulas react equally well.
Employing short-wave diathermy, Schliephake succeeded in
144 THE GASTRO-INTESTINAL TRACT
closing a long-standing dental fistula in three days. In our clinic
we have observed, in the case of a patient treated for sinusitis,
the diminution of the purulent secretion, coinciding with im-
provement of the subjective symptoms of the dental fistula but
not such dramatic cures were obtained. Dental abscesses, ac-
cording to Sparkenberg, can be cured by short-wave diathermy
alone.
Dental granulomas, which may act as foci of infection, fre-
quently occur on teeth which support a crown or bridge and
which, if extracted, would be greatly missed. According to
Wagner, Reiter and Last, such granulomas can be cured by
short-wave diathermy. In the course of treating several patients
for chronic muscular rheumatism, Schliephake noted the com-
plete amelioration of dental granulomas.
Parodontitis may be cured, or in any case improved, by this
form of therapy. In 4 cases reported by Schliephake, all the
teeth were affected, the duration having been of 3 months and
one, 2 and 10 years respectively. Cure took place in 3 of the
cases after 4, 8 and 14 treatments respectively, over a period
ranging from 4 to 14 days. The 14-meter wave length was used.
In a severe case, discharging pus from numerous abscesses, cure
was achieved only after 82 treatments in 80 days, with the 14-
meter wave length.
R a a b claims that bone atrophy may be arrested by the
action of short waves and, conversely, that bone production can
be promoted by these wave lengths, through their stimulating
action on the local metabolic processes and by the elimination of
infection.
Periodontitis has been reported cured in 2 or 3 treatments,
granulomas in about 6 treatments, using the 16-meter wave
length. Lux, however, could not obtain such results, which may
possibly be accounted for by the differences in technic and
apparatus.
Technic of treatment.—The electrodes are placed on the
cheeks, including the affected area and in such a way as to cover
the upper and lower mandibles. The electrode on the affected
side may be nearer to the lesion. The treatment should be from
10 to 30 minutes daily at first, and then on every second or
third day. T h e wave lengths employed varied in the hands of
THE GASTRO-INTESTINAL TRACT 145
different investigators, Reiter employing the 30-meter wave

length and Schliephake favoring 4 to 14-meter wave lengths.
TONSILLITIS
Short-wave diathermy opens a new field for the eradication

of focal infection. In cases of subacute and acute tonsillitis, in
which tonsillectomy is contraindicated because of the unfavor-
able condition of the patient, short-wave treatments can be given
28. Roentgenograms, Showing Dental Granuloma

a. Before Short-Wave T r e a t m e n t ; b. After 6 Short-Wave
Treatments
before the proposed operation and may even render it unneces-

sary. Weissenberg believes that such preliminary treatment will
prevent possible complications such as sepsis, metastatic ab-
scesses, and so on.
Stiebôck employed short-wave diathermy in diseased condi-
tions of the tonsils in which surgery was contraindicated be-
cause of old age, hemophilia or cardiac or nervous disorders. He
reported satisfactory results, and later used the same treatment
with equal benefit in Vincent's angina. Weissenberg also re-
ported a high percentage of favorable results, obtained in a short
time through the use of this measure. Groag states that angina
should be treated with short waves for the purpose of preventing
the complication which may originate from tonsillitis. This
condition may be cured at most within three days.
In acute septic tonsillitis, short-wave diathermy is con-
sidered of value by Reiter, Schaffler and Rôzsa, and in several
cases of acute tonsillitis we observed a spontaneous fall of
temperature with improvement of the objective and subjective
symptoms. In one case of proved streptococcus tonsillitis of two
days' duration and showing a temperature of 102° F., the patient
had immediate relief from pain and was able to swallow after
one treatment each with 6 and 12-meter wave length for 10
minutes. Six hours later the temperature had fallen.
Our impression coincides with that of other observers, that
short-wave diathermy is indicated in tonsillitis. Nevertheless,
further observations are necessary, in order to establish the basis
of its specific curative value. It is a very difficult task to evaluate
any one specific therapeutic agent in diseases of the mouth and
throat, principally because of the great variety of disorders and
because of the individual pathological history presented by each
patient. It seems to us that in badly infected tonsils short-wave
diathermy may be used as preoperative treatment, and that in
cases in which surgical removal of the tonsils is contraindicated,
short-wave diathermy would be an especially valuable method
of treatment.
Technic of treatment.—Rigid or special electrodes are recom-
mended for the treatment of tonsillitis (fig. 22d). The diseased
area is placed between the electrodes and a current is employed
which will give the patient a sensation of agreeable warmth.
The treatments should be given daily or every second day, for
from 15 to 25 minutes. It is best to combine short-wave dia-
thermy with other routine treatments.
SPASM OF T H E E S O P H A G U S
Weissenberg reported the case of a man of 70 who gave a

history of spasm of the esophagus of many years' duration. He
improved after the first 2 treatments with short waves to the
extent of being able to swallow fluids. He was symptom-free
after 6 months of treatments, comprising 10 consecutive treat-
ments with weak dosage. The recurrences were improved with
further treatments with weak dosage. Weissenberg states that
functional spastic conditions of the esophagus, as well as of the
cardia and pylorus, respond favorably to the antispasmodic
action of short waves.
THE STOMACH
GASTRITIS
A number of investigators, among them Hancken, Griibel,

Noack, Schweitzer, and Wolfrum, according to Raab, found
that short-wave diathermy in gastritis relieved the thirst, heart-

burn, and vomiting. These few observations, however, do not
permit the drawing of definite conclusions.
PEPTIC ULCER
Concerning the effect of heat on the secretory activity of the

stomach, Miiller, and independently Bogendorfer, say that heat
applications would result in decrease of the secretion and of the
hydrochloric acid. Cold, on the other hand, would increase the
secretion and thereby also the hydrochloric-acid content.
Bogendorfer and Sell attributed this to reflex action through
termic irritation. The pneumogastric stimulates, the sympa-
thetic inhibits, the secretory activity of the stomach. The action
of short waves, therefore, would seem to be stimulating to the
pneumogastric and inhibiting to the sympathetic. On these
grounds it was logical to introduce short-wave diathermy as a
corrective of impaired secretory function of the digestive tract
(Schliephake).
Mahlo has done considerable research work in this field,
principally by serial experiments on fasting men. Where in-
sufficient secretion was present, he used for his research work
300 cc. of a 5-percent alcohol solution, making certain that no
saliva was swallowed with it. This was removed after the treat-
ment. According to him, short-wave treatment of the cardia
would produce a different result from that which follows ap-
plication to the pylorus.
That the action of short waves cannot be explained as being
solely the effect of heat is evidenced by the fact that a decrease
in leucocytes occurs ten minutes after the start of the treat-
ment, as noted by Schliephake, von Oettingen and Schultze-
Rhonhof. This temporary leucopenia changes to a leucocytosis,
lasting from 9 to 24 hours. Mahlo believes that this may be
secondary to short-wave treatment of the spleen.
The action of short waves is not uniform. Mahlo examined 25
cases roentgenographically, and invariably found that increased
peristalsis (confirmed by Bauer) was induced by short-wave
diathermy, stopping at once with the interruption of the current.
Secretion was also increased to such a degree that it was neces-
sary to remove 25 cc. of clear fluid every 10 minutes. This effect
lasted 40 or 50 minutes, descreasing thereafter, though treat-
ment continued. The longest period of increased secretion was
70 minutes, but the degree of acidity diminished, which is in
line with observations of the effect of other forms of heat therapy.
Mahlo believes that in the majority of chronic ulcers, short-
wave diathermy may create conditions favorable to healing. In
most of the cases, acidity decreased, to anacidity in some. This
diminution of hydrochloric acid is not constant, however. In a
number of cases motility is increased, as observed roentgeno-
graphically, and this may be so pronounced that no secretion
can be obtained. The analgesic effect of short-wave diathermy
is no small factor in the symptomatic improvement. From his
work, Mahlo draws the conclusion that short-wave diathermy
can be a valuable adjuvant in the management of peptic ulcer.
Schliephake agrees with Raab that no conclusions can as yet
be drawn as to the ultimate effect of short-wave diathermy of
peptic ulcer, since the cases treated are as yet too few. Hancken
and Schütz found that even long-standing ulcers can be im-
proved by short-wave diathermy, their opinion being based on
roentgenographic control of those treated.
Among our cases was one of marginal recurrent ulcer. T.
McM., male, 29 years old, had had a gastric resection for peptic
ulcer a year previous. He came now with symptoms of recurrence.
Roentgenograms revealed the typical crater of a marginal ulcer
at the stoma. Short-wave treatment was started with the 12-
meter wave length, and given in daily sessions for from 10 to 15
minutes. Definite symptomatic improvement was evident after
the first 4, after which the treatments were given every second
day, with further improvement. Following the twelfth treat-
ment, the patient again complained of slight pain and vomited
about one ounce of dark red blood. Treatment was suspended
for 4 days, and then continued. Within a month, 15 treatments
were given, at the end of which roentgenograms showed no signs
of ulcer. The patient felt entirely relieved, except for occasional
nocturnal pain which was relieved by alkalines or milk. The only
dietary restriction was that he was kept to soft food. The patient
returned to work 2 weeks after treatment was started, and
roentgenograms 2 months later were negative. Five months
after treatment he had gained 35 pounds and felt much improved.

It was again necessary to operate upon him a year later.
Although this is but a single case, it would seem that short-
wave diathermy has possibilities as a therapeutic agent in peptic
ulcer, especially of the marginal type. From Mahlo's research it
is clear that acidity may diminish, and even change to the
alkaline side. This effect, coupled with the analgesic action of
short waves, may create conditions definitely favorable to heal-
29. Roentgenograms, Showing Recurrent Postoperative Marginal Ulcer

a. Ail Arrow Indicates a Sharply Defined Niche of Marginal Ulcer; b. Following a Course of
Short-Wave Diathermy, the Niche Is No Longer Discernible
ing. On the other hand, we observed that intensive dosage and

too frequent application may occasion hemorrhage, which
complicated the picture.
The results obtained do not permit an accurate evaluation of
the possible effect on organic lesions of the stomach and duo-
denum. We know that chronic ulcers, especially in persons of
advanced age, become carcinomatous in from 2 to 10 percent,
according to different authors, for which reason surgery should,
if possible, be resorted to. There may, however, be cases of re-
current marginal ulcer following operation. It is in such cases
that short-wave diathermy, combined with proper medical
treatment, may give favorable results. To substantiate this im-
pression, however, larger series of cases so managed and care-
fully observed, are necessary in the future. Weissenberg achieved
150 T H E GASTRO-INTESTINAL TRACT
symptomatic improvement after short-wave diathermy with

weak doses, in several of his cases presenting hyperacidity with
or without peptic ulcer.
In ulcer with callus and in long-standing ulcers showing no
tendency to heal and holding the threat of malignant degener-
ation, surgery is indicated.
GASTRIC NEUROSES
A favorable effect of short-wave diathermy is shown in gastric

neuroses. Peterson's observations are based on 130 such cases.
He found that in cases with pyloric hypertrophy in which tender-
ness is present in the pyloric region, the symptoms subside after
from 4 to 5 short-wave treatments. This beneficial effect lasts for
several months, as verified by follow-up examinations. He be-
lieves, therefore, that regeneration of diseased ganglia and nerve
substance of the sympathetic nervous system may be induced by
short-wave diathermy. Weissenberg states that the irritable
stomach may be cured by a single treatment with weak doses.
He bases this assertion on his personal experience.
T H E INTESTINES
Observations and case reports are scattered, a variety of

diseases having been treated, but by and large no extensive
series were studied and too often no details were given. This
dearth of accurate analysis impairs the value of any conclusions
that may have been arrived at.
Rollin succeeded in improving a case of tuberculous colitis,
with bleeding and discharge, in 12 treatments. Schedtler was
successful in 3 cases. Kobak treated spastic colitis, and stated
that short-wave diathermy proved beneficial. Without mention-
ing details, Babin-Chevaye, Hancken and others reported
favorable results. In spastic conditions, for example spastic
constipation, short-wave diathermy may be of benefit.
R6chou, Laqueur, Remzi, Schliephake and Schweitzer re-
ported improvement in chronic appendicitis and abdominal ad-
hesions, especially those formed after operation.
Schliephake obtained improvement in cases of perityphlitis
and peritonitis and in inflammatory adhesions, and this was con-
firmed by Halphen and Auclair.
In generalized peritonitis, Lob described treatment pro-

longed to 10 hours with favorable outcome. This observation is
very interesting, as no damaging effects were observed after so
long a period of treatment. This author also observed the bene-
ficial effects of the measure in tuberculous peritonitis.
In the case of gonorrheal infections of the rectum, short-
wave diathermy may be beneficially applied, it is believed, but
this remains to be substantiated.
The inflammatory conditions and infections of the rectum
and anal region should prove no exception to the benefit exer-
cised in such pathological states by short-wave diathermy. Anal
fistulas, perirectal abscesses and inflamed hemorrhoids may
properly be treated with short waves. At least, its application
may be tried preoperatively.
We had a case, a young girl, who came in with a painful re-
current incomplete anal fistula of long standing, with periodic
purulent discharge and infiltration. Three consecutive daily
treatments resulted in absorption of the infiltration and reduc-
tion of the purulent to a slight serous discharge. This disappeared
within 3 days without further treatment. A follow-up examina-
tion 6 months later showed the lesion to be completely healed.
This one observation also needs confirmation by other studies.
Weissenberg achieved beneficial results with short-wave
diathermy in chronic nonspecific rectal disease and rectal
tenesmus.
T H E B I L I A R Y PASSAGES
Experience with short-wave diathermy in inflammations of

the biliary tract is as yet insufficient to justify a conclusive dis-
cussion of the subject. More extensive observations, with careful
checking by follow-up examinations, are necessary to sub-
stantiate the claims made for it in this field, as compared with
other forms of therapy. It is possible, therefore, only to report
the literature to date. It would seem that acute and chronic
uncomplicated inflammations of the biliary passages are
amenable to short-wave diathermy. As an adjunct to surgery in
cases of cholecystitis with stones, this form of treatment is of
possible value, since it reduces inflammation preparatory to
surgical intervention, which may then be undertaken with less
risk. Raab warns us, however, that in such cases the treatment
should be milder in degree, in order to avoid the precipitation of
attacks of colic resulting from the irritation of intensive treat-
ment.
Dietrich reported favorable results after a few sessions, in 14
cases of chronic cholecystitis; and Wolfrum, Leopolde, Drews,
and others consider short-wave diathermy positively indicated
in this condition. Kobak found that the gall-bladder symptoms
were relieved after a few treatments, though this observation
leaves the question of cure or continued progress unanswered.
Raab sent a questionnaire to 20 physicians, and of these
only 2 reported unfavorable results from this form of therapy.
One case of chronic cholangitis following dysentery, reacted in
attacks of colic. The other, a case of chronic cholecystitis, failed
to show any improvement after short-wave diathermy.
Weise subjected himself to this form of treatment in his third
relapse, accompanied by violent pain, and obtained lasting
beneficial results. Lambrecht reported 16 cases of cholecystitis
with cure in 10, improvement in 5 and failure in one, after an
average of from 8 to 10 sessions.
Laqueur and Remzi obtained satisfactory results in their 4
cases of cholecystitis and one of cirrhosis of the liver. Schweitzer
proved the subsidence of inflammation by using the duodenal
tube as a control. Hancken reported a case of proved typhoid
cholecystitis. He succeeded in reducing the patient's symptoms
in 6 treatments, and after the cure typhoid bacilli could no longer
be demonstrated.
In a case of cholangitis with stubborn jaundice which proved
resistant to other measures, Walter reported success after 3
sessions with short-wave diathermy. Peemoller, R6chou and
Babin-Chevaye reported favorable results in hepatitis, cholecyst-
itis, and cirrhosis.
On the basis of a study of a large number of cases, Wolf ad-
vises the use of short-wave diathermy in cases of subacute and
subchronic cholecystitis. These respond readily to this treat-
ment, as a rule, and the period needed for cure is shortened.
Those, however, who do not respond readily should then be
treated by the classic methods. Acute cases, with definite peri-
toneal symptoms, are surgical problems to begin with.
T H E GASTRO-INTESTINAL TRACT 153
According to his experience, patients feel relieved after the

first treatment, which is directed toward the upper abdomen.
This amelioration may be due to increased blood circulation
(hyperemia), and diminished edema, which reduces pain. After
2 or 3 treatments, with improvement of subjective symptoms,
the temperature falls, the icterus diminishes and bile disappears
from the urine. In cases of subacute, subfebrile cholecystitis,
with moderate icterus, in which other therapy had failed, short-
wave diathermy was surprisingly effective. In those with marked
icterus, duodenal lavage with a 5 percent solution of magnesium
sulphate is advised, in combination with short-wave diathermy.
Patients with recurrent attacks of colic are not suitable subjects
for short-wave diathermy and, if other conservative measures
fail, operation must be resorted to.
Haas and Lob made the interesting observation that pan-
creatitis may be successfully treated with short waves.
In treating intra-abdominal disease with short waves, the

patient is, if possible, placed in the lateral position, either right
or left. This avoids current concentration by compression or by
accumulated perspiration, should the patient be lying upon the
electrode, which might result in skin burns. In gall-bladder
disease, it is preferable to have the patient lying upon the left
side. The electrodes are selected according to the action de-
sired. If a localized process is to be treated, a small electrode is
placed on the abdominal site and a larger one upon the back.
The distance between electrode and skin surface may also be
altered, according to requirement of concentration at a given
level. Weak doses are recommended, especially in ulcers and
spastic conditions. Weissenberg observed that in one of his
cases the condition became worse after strong doses (sensation
of intense heat), and improved again when weaker doses were
again resorted to (slight sensation of heat). Bearing in mind
the observations of McLellan, Burton and Schliephake that
liver heats more readily than other tissue, the intensity used in
this region should be less than that employed in other intra-
abdominal inflammations.
Wave lengths of from 6 to 15 meters were used. In the
154 THE GASTROINTESTINAL TRACT
neuroses the duration of treatments may be from 10 to 20
minutes, but in ulcer a mild current for from 5 to 15 minutes
should be employed as a precautionary technic, to avoid possible
hemorrhage. The danger of bleeding in cases of ulcer treated by
short waves cannot be emphasized too strongly. This may be
the result of a marked hyperemia induced by this treatment,
and may take place easily if the blood vessels in the diseased
area are impaired, when overdistention of the vessels may re-
sult in rupture. Although hemorrhages were observed by Mahlo
and by us, it must be said that they were not of serious import,
although in the long run they may be so.
In treating subacute and subchronic cholecystitis, Wolf
suggested beginning with from 3 to 5 minutes' exposure daily,
increasing the time gradually to from 10 to 20 minutes over a
period ranging from 3 to 22 days, and using the 15-meter wave.
XI
DISEASES OF T H E GENITO-URINARY TRACT
T H E URINARY T R A C T
CYSTITIS
Heymann was able to cure a case of tuberculous cystitis

with short waves, after the tuberculous kidney had been
removed.
PYELITIS
According to Raab, short-wave diathermy is especially indi-

cated in this infection. In one of his patients pyelitis recurred at
short intervals, with high temperature and much purulent dis-
charge. Medical treatment with pelvic lavage was unsuccessful.
After two short-wave treatments the patient's condition was
improved, and the temperature was normal; and after several
succeeding treatments, pus and bacteria were eliminated from
the picture. The leucocytosis disappeared, and when seen several
months later the patient was free of symptoms.
Rollin, Walter and Dietrich confirmed this observation
with their own results. Schweitzer, however, observed in one
case increased pain without improvement after the treatment.
Schliephake also failed in his cases. Votz believes that pyelitis in
children can be favorably influenced by short-wave diathermy.
The studies of Fabian and Graham showed that longer wave
lengths, 20 to 40 meters, stimulate the growth of Bacillus coli.
It would seem logical, therefore, to employ greater intensities
and short-wave lengths—6 to 8 meters—in Bacillus coli pyelitis.
Short-wave diathermy may be of benefit in stubborn chronic
infections and in acute infections in which tumors, calculi and
tuberculosis have been eliminated. Nevertheless, before credit-
ing short-wave diathermy with the place claimed for it by Raab,
further accurate observations are necessary.
156 THE GENITO-URINARY TRACT
Whether pyelitis or pyelonephritis should preferably be
treated with short waves, remains to be demonstrated by further
experimentation.
NEPHRITIS
Short-wave diathermy may be of benefit in uremia, by in-

creasing the functional activity of the kidney and by lowering
the blood pressure.
The effect of short waves on blood pressure was shown by
Rausch and others, who demonstrated that the blood pressure
decreased 15 to 30 mm. Hg after short-wave diathermy. Follow-
treatment, the decrease in blood pressure persisted for a period
(of days or weeks), as described also in the discussion of essential
hypertension. The degree of permanent benefit in hypertension
depends upon the anatomical changes that have taken place in
the kidney and arteries. The best results are obtained in the
early stages, when the blood pressure is characterized by a great
lability. By repeated treatments, one may secure in such
patients a condition that will be satisfactory for years. In the
type in which advanced arteriosclerosis is present, the results
are only transitory. Short-wave diathermy is, therefore, im-
portant only from the point of view of symptomatic therapy.
Rausch also expressed the view that in the presence of
parenchymatous changes, acute or chronic, short waves exert a
more favorable influence than diathermy on the functional
activity of the kidney. Votz believes that acute nephritis in
children may be favorably influenced by short waves. Hellfors
observed, in 2 of his cases of subacute nephritis, decided im-
provement after from 5 to 10 treatments. The albumin in the
urine during the period of short-wave diathermy decreased from
2.5 to 1.5 percent.
Rausch treated 14 cases of nephritis. The treatment lasted as
a rule from 30 minutes to one hour. After the first treatment,
the blood pressure dropped 15 to 30 mm. Hg, and this reduction
was sustained, owing to the continued treatments. After from
4 to 5 sessions, the patients improved. Rausch suggests that
further treatments of shorter duration, administered at longer
intervals, would be effective in maintaining the improved con-
dition of these patients.
THE GENITO-URINARY TRACT 157
Dietrich saw improvement in 11 of his cases of nephritis,

particularly marked in anuria, when the kidney region was
exposed to treatment twice daily for one or 2 hours. After 3 or 4
days, secretion of urine was resumed.
Schliephake claims to have obtained satisfactory results,
manifested mainly in symptomatic improvement, in cases of
nephritis.
The observations reported are as yet inconclusive but there
are indications that disordered kidney function may be benefited
to some extent by short-wave diathermy. This applies in
particular to the acute nephritides, for example, glomerulo-
nephritis. Weissenberg observed cessation of headache follow-
ing one short-wave treatment in chronic nephritis.
It is recommended that the blood pressure be measured
during and after treatment, as a control on the fall produced, as
well as every half hour following treatment. The blood pressure
falls rather quickly during treatment, arriving at its minimum
usually toward the end, and remaining at that level for half an
hour after treatment. By continued treatment the blood pres-
sure falls slowly to lower figures. At these later sessions, the fall
will not be more than 5 or 10 mm. Hg during treatment, the
greatest fall occurring during the first treatment.
PERIRENAL ABSCESS
Schliephake informs us that perinephritic abscesses may be

treated successfully by short-wave diathermy, with or without
surgery, and that when combined with surgery, convalescence is
shortened. In a boy 8 years of age, perinephritic abscess followed
rupture of the kidney after suture. A fistula formed, accompanied
by high temperature. Short-wave diathermy cured the condition
in 4 weeks.
In a man 72 years old, Mahlo treated a metastatic peri-
nephritic abscess which had originated from a furuncle of the
nose. Before the short-wave diathermy was started, the patient
had had, over a period of several weeks, high fever, malaise,
loss of weight, pain in the left renal region radiating to the left
thigh, with other symptoms. Improvement followed 3 treat-
ments, and after 10 the patient was symptom-free.
It is possible that short-wave diathermy may simplify the
treatment of this infection, but no conclusions as to its value

can be drawn as yet, in spite of the isolated reports of results
obtained.
Hutter and Liebesny treated sinuses after nephrectomy with
short-wave diathermy, and were successful. One patient had
undergone 4 operations in 6| months, with diathermic treatment
at the same time. Continuous treatment with short waves was
instituted, with fall in temperature and progressive improve-
ment to practically normal, in 17 treatments; but no mention is
made of definite cure.
In our own case of sinus following nephrectomy, the patient
received twelve short-wave treatments, but the discharge,
though less purulent, persisted, and the sinus did not close for
two months.
Hutter and Liebesny found decided improvement after short-
wave diathermy in 2 cases of tuberculous fistula following
nephrectomy, which had proved refractory to ultraviolet and
roentgenotherapy.
Technic of treatment.—The condensor field is created in the
region affected. The electrodes, large enough to cover the whole
area, are applied, one on the corresponding lumbar region and
the other to the hypochondrium. Greater intensities should be
used for from 20 to 30 minutes daily, to achieve the desired
therapeutic effect with lower-range wave lengths. In order to
assure adequate penetration of the short waves, the distance of
the electrode from the skin may be increased to from 1.5 to 5 cm.
T H E FEMALE GENITAL TRACT

PELVIC INFLAMMATION AND INFECTIONS
Judging from the literature and from our own limited ex-
perience, it would seem that short-wave diathermy has a definite
place in the treatment of inflammatory affections within the
female pelvis. Adnexal tumors, according to Dalchau, Laqueur
and Remzi, in particular are quickly eliminated, with or without
insignificant sequelae, within several weeks. Short-wave dia-
thermy is beneficial in functional disorders, such as dysmenor-
rhea. As an aid in surgery, it is of definite use in controlling acute
inflammation, as a preparation for operation.
The heat effect and the supposed specific effect of short
waves differ from that of other physiotherapeutic agents, for

example, diathermy. With adequate intensity and proper
technic, short waves penetrate more readily the thick muscular
and bony walls of the pelvis and are thus able better to exert
their effects. Nevertheless, some difficulties are presented by the
anatomical position of the pelvic organs, they being placed be-
tween the intestines and the surrounding, relatively extensive,
soft parts.
The work of Raab, Schliephake, Bierman and Schwarz-
schild, Horowitz el al, and others, indicate that with the rise of
local temperature, producing hyperemia, the organism is sup-
ported in its fight against the inflammatory and infectious proc-
esses encountered in gynecological diseases.
Results are uniformly satisfactory. Hackemann treated 350
cases of pelvic inflammation and emphasized the fact that the
best results are secured in the acute forms. In older, chronic
cases, improvement is slow. In such cases he recommend ones or
two courses of short-wave diathermy yearly. In his series he ob-
served almost 90 percent improvement, with 80 percent cures.
Dietrich reported the same percentage, after treating 120
patients, including cases in which hot air, diathermy and other
measures had failed. Laqueur and Remzi treated 32 cases of
adnexitis, pyosalpingitis and parametritis, with 28 beneficial re-
sults and 4 failures. Schliephake's results were doubtful in
pyosalpingitis. Hackemann achieved permanent improvement
in 2 cases of old adnexal tuberculosis.
Acute infections
Acute salpingitis.—The brief history of one of our cases of
acute gonorrheal peritonitis and salpingitis is given herewith.
A. N. had been treated for 2 months by local antiseptics for
gonococcal vulvovaginitis. She developed sudden pain, muscular
rigidity in the lower abdomen and a temperature of 103° F.
When short-wave diathermy was started, her fever was 102° F.
During the first treatment, the patient had a sensation of com-
fortable heat, but experienced increased pain after the second
treatment, and the temperature rose to 105° F. During this high
fever short-wave diathermy was again administered. The
temperature fell the following day. After the fifth treatment pain
decreased, and tenderness to pressure diminished. She slept
well, usually after two treatments. There was gradual improve-
ment, with less discharge. After the tenth treatment there was
an intermission for 2 menstrual periods, and a few days later
pain and fever recurred. Short-wave diathermy was again
started and brought relief after 3 treatments, but the fever rose
periodically to 100° F., with increased discharge. After 26 treat-
ments in 6 weeks, the patient felt well but still had a discharge,
negative for gonococci; but a mixed infection was present,
which was also controlled in a short time. Lohrig and Wit ten-
beck had similar cases in which the treatment was suspended
during the patient's menstrual period, and in which apparently
the infection flared up again. It would seem advisable to con-
tinue the treatment without interruption. Raab emphasizes the
importance of not interrupting the course of treatment during
menstruation; he observed that after the cessation of the menses,
there may be a recurrence of symptoms.
In 5 cases of pyosalpingitis, Dalchau was able to operate
without danger after the acute inflammatory process had sub-
sided and become localized under short-wave diathermy.
Adnexitis.—Wittenbeck, Vogt, and Dalchau found that
their patients usually were free from pain after 4 or 5 treatments,
in the case of adnexal and pelvic inflamamtion. Diminution of
adnexal tumors also occured during further treatments. This is
what may be expected. After symptomatic relief is achieved,
the inflammatory products are gradually eliminated. In 12 cases
of peritonitis and adnexal infiltration, Vogt observed rapid
lessening of the pain and a relatively short recovery. Dalchau,
in his 16 cases, noted improvement in subjective symptoms,
with fall in temperature after 2 or 3 treatments. Following 2 to
15 treatments, the inflammatory process localized, and this
was followed by gradual improvement and recovery. In most of
those cases in which adnexal tumor had formed, the symptoms
subsided after a further 10 to 15 treatments. Sometimes symp-
tomless plum-sized infiltrations remained. In gonococcal ad-
nexitis with infiltration (8 cases), Dalchau combined specific
treatment with short-wave diathermy, and observed improve-
ment in subjective symptoms and temperature.
The acute adnexal swelling, caused by mixed infection after
miscarriage or pregnancy, was healed comparatively rapidly by

Vogt with short-wave diathermy.
Wittenbeck first reported a lack of success with the 15-
meter wave length, and concluded that short-wave diathermy
was not as effective as diathermy. But after purchasing a machine
which gave greater intensities and different wave lengths, he
was able to confirm the results reported by other investigators.
He found that in general the subjective symptoms improved
first, and then disappeared with a gradual subsidence of .the
physical signs. Usually the two proceed in a parallel course.
Sedimentation tests may be used as a control on progress. In
acute and subacute inflammation, in which diathermy has
proved disastrous, favorable results may be obtained, he believes,
and markedly so in acute conditions. There were cases however,
in which short-wave diathermy had no effect. He concluded that
the 12-meter wavelength is perhaps more active than the 15-
meter wave length, but wave lengths and intensities remain to
be definitely determined in the future. Pordes, however, could
not observe any advantage of short-wave diathermy in pelvic
diseases. This negative report may have the origin similar to that
of Wittenbeck's first lack of success. Proust, Moricard and
Pulsford cured a variety of inflammatory processes of the
adnexa with short waves, in cases which had not responded to
diathermy.
Chronic infections
Chronic adnexitis.—The long-standing inflammation of
chronic disease sometimes induces extensive adhesion formation,
which may present quite a surgical problem. According to Raab,
one must differentiate between the degree of inflammation and
the extent of adhesion when considering the employment of
short-wave diathermy. One may be masked by the other, but
to be able to judge the effectiveness of short-wave diathermy,
these components have to be considered. The inflammation is
readily influenced by the treatment, but to resolve scarifying
adhesions is possible but rarely by this means. If such adhesions
are present, operation is indicated.
Vogt observed that in chronic adnexal infiltrations which
resist the usual forms of treatment, short-wave diathermy is
without danger of complications and is beneficial. In obstinate
gonorrheal adnexal tumors, he was able to relieve the patient of
pain and of her subjective complaints. Such a case occurred in
a woman 28 years of age, with a history of gonococcic infection
of four years' duration. She had been treated with diathermy
(18 sessions), with only temporary benefit and with no change in
her condition. A right adnexal tumor, the size of a large plum,
was present, painful, soft and fixed. There was a purulent cervi-
cal discharge. Short-wave diathermy with the 12-meter wave
length and for 15 minutes was given daily. For the first 3 treat-
ments, a vaginal electrode was used. The measured vaginal
temperature before treatment was 100.2° F., and after treat-
ment 104.5° F. as the average. The patient's condition remained
unchanged. Pain was somewhat increased in the diseased area.
For the fourth and fifth treatment external electrodes were
used, with the 12-meter wave length, for from 15 to 20 minutes.
After this, pain was less and there was decided improvement in
the patient's condition. After the sixth treatment pain and dis-
charge ceased, and she had no subjective symptoms. Control
examination eight days later was negative. She was instructed
to return if symptoms recurred, but in the six months since her
discharge she has not been seen.
Gesenius reported results in 180 cases of adnexal disease. In
65 the improvement was definite, and verified by gynecological
examination. In 113 there was symptomatic improvement.
Vogt states that about 80 percent of the chronic adnexal
conglomerates can be cured conservatively by short-wave
diathermy. Peemoller also reports favorable results in adnexal
disease. Loiseleur reported a case of chronic salpingitis compli-
cating pregnancy, which he treated with short-wave diathermy
without deleterious effects on the pregnancy. Dalchau eliminated
the symptoms of sciatica in 14 short-wave treatments of a preg-
nant woman in the seventh month.
Paladini effectively employed short waves as a stimulating
agent in uterine inertia following labor, in those cases that had
failed to respond to medication.
Metritis.—Ten cases of parametritis with abscess in Douglas'
cul-de-sac, were treated by Dalchau with short-wave dia-
thermy. Extensive infiltration was present. Abscess formation
took place after a few treatments, and the abscess was incised
and drained. The remaining infiltrations were resolved after

continued short-wave treatment. In 4 cases of metroendometritis,
Dalchau found that 4 treatments arrested the progress of the
disease, as manifested by diminished discharge from the uterus,
with cure accomplished after 12 treatments. In cases of endo-
metritis Schumacher obtained variable results.
a b
30. Bartholin's Gland Abscess

a, Before T r e a t m e n t by Short-Wave Diathermy; 6, After T r e a t m e n t by Short-Wave Diathermy
Bartholin's gland abscess.—Beneficial results of short-wave

diathermy in cases of abscess of Bartholin's gland were reported
by Dausset. We also treated 2 such cases, with prompt subsi-
dence of the process. One was a young woman 26 years of age,
who complained of severe pain of 6 days' duration, in the genital
region. She could not walk nor sit. Her temperature was 102° F.
Inspection revealed an elevated, firm, slightly fluctuating area,
about 5 cm. in diameter, at the lower third of the right vulvar
region, the inflammation covering an area 3 inches in diameter.
The right vulva was red, edematous and swollen to 4 times
normal size. Short-wave diathermy was started, with the 12-
meter wave length, 15 minutes daily, with some improvement
after the second treatment. After the third, the process became
localized and ruptured spontaneously during the following night,
discharging about 10 cc. of sanguineous-purulent material. There
was no further pain. After the fourth treatment, discharge
ceased and infiltration disappeared. The lesion was slightly
bluish-red, surrounded by limited edema. The next examination,
5 days after treatment was started, was wholly negative, and
the patient was discharged as cured (fig. 30 a, b).
DYSMENORRHEA
Weissenberg and Hackemann observed marked improve-

ment, and in some instances cure, in cases of dysmenorrhea.
The latter believes that a psychic factor may enter and support
the effect of short-wave diathermy. Dalchau, in 3 cases, after
dilatation and curettage had given a negative pathological re-
port, observed that 6 treatments with short-wave diathermy
were sufficient to eliminate pain, and that the succeeding
menstrual period was normal and painless. Several investigators,
including the author, express the view that dysmenorrhea can be
beneficially influenced by short-wave diathermy. In one of our
own cases in which dysmenorrhea was severe, the menstrual
period became entirely painless after 2 treatments, given one
day before the onset and on the first day. The relief was con-
spicuous. It is suggested that treatments in dysmenorrhea be
giv^n as above, one on the day before the onset of the period
and one on the first day, each for about 10 or 15 minutes, with a
moderate intensity.
Technic of treatment.—Two methods of application are avail-
able for the treatment of pelvic inflammation in the female, that
is, the customary external mode and treatment by the vaginal
route. The latter demands a great deal of attention during the
treatment, and requires the constant presence of the operator.
The accumulation of vaginal secretion or uterine discharge
creates different dielectric constants, with the result that an
electric energy which in the beginning created for the patient a
sensation of comfortable warmth may quickly become too hot,
owing to the greater concentration of the current.
THE GENITOURINARY TRACT 165
When using the vaginal electrodes, it is vitally important to

be certain that the electrodes are perfectly insulated. The elec-
trode should be covered with one continuous piece of insulating
material, to avoid direct conductivity of the electric current
with resulting sparking and burns. It is therefore wise to use
double insulation. We have observed small burns caused by
faulty insulation of these electrodes, fortunately without serious
consequences.
This electrode is indicated in pathological processes in the
cervical or paracervical region, unilateral parametrial inflam-
mations, and wherever it seems to be more advantageous to
have more extensive local heat. A vaginal electrode of ap-
propriate size is lubricated and introduced into the vagina and
fixed in a comfortable position. The other electrode is so placed
that it will create the electromagnetic field in the diseased area.
Owing to the possibility of frequent burns attributable to the
physical conditions created in the vagina by the discharge, this
method is not recommended for extended use.
The most widely used method is the extravaginal, for trans-
pelvic short-wave diathermy. Large electrodes are recom-
mended for treatment of the pelvic contents. If a flexible elec-
trode is employed, it is important that it be 8 by 12 inches in
size, to cover the pelvis. By this means the "uneconomic" air-
spacing of the rigid electrode is avoided (Eckert). This applies also
to treatment of diseases of the chest. If a small electrode is used,
air spacing must be increased and a higher wattage employed.
Application of the electrodes may be determined by the
pathological area; for example, if the right adnexa is affected, a
large electrode is placed in the lumbosacral region, a smaller one
in the right inguinal region. The distance of the electrode from
the skin surface should be greater at the back—about 2-3 cm.—
than on the abdomen—1-2 cm.—if the inflammatory processes
are localized rather more toward the abdominal surface.
Preferably the patient lies on the healthy side, as this brings
the diseased vagina between soft parts so far as possible, thereby
creating anatomical relationships that are favorable to short-
wave diathermy. By such precautions, symptoms of compression
and heat stasis can be avoided, which would not be the case
were the patient lying prone upon the electrode. Naturally
where the patient's condition prohibits this position, she must
lie on her back and on the electrode, but in such a case the inter-
position of a sufficient number of dry towels, preferably Turkish
toweling, is required to assure an even heat effect.
In case of intense perspiration, this nonconducting material
must be changed during the treatment, as soon as the patient
complains of greater heat concentration at a definite point. In
our practice Turkish towels or pieces of thick felt seem to be
most satisfactory for this purpose, when flexible electrodes are
used. Rigid electrodes (with a special table if available) are
more easily handled, the diseased part being placed between
the condenser plates.
The duration of each application should be from 20 to 30
minutes, beginning, however, with from 10 to 20 minutes, and
increasing daily by 5 minutes. It is unanimously agreed among
investigators that treatments should be daily in the beginning.
Raab advises treatments daily of from 25 to 30 minutes' dura-
tion for the first 10 days, continued every second day there-
after until the desired effect has been achieved. Wittenbeck
treated his patient every day in the beginning from 10 to 30
minutes, later every second day, employing the 12-meter wave
length. Hackemann stopped for a period of observation after
5 or 6 treatments, and gave further treatment when definite
improvement was observed. Staehler obtained better results with
wave lengths of from 4 to 6 meters than with longer wave lengths.
Schumacher warns against overdosage, which may eventuate in
perforation of the pyosalpinx and may lead to peritonitis. There-
fore, in adnexal infiltration he recommends a 3-minute period to
begin with, increasing in a week to from 10 to 30 minutes.
In gynecological practice, the heat produced may be meas-
ured and used as a basis for dosage. For this purpose the benzol
thermometer recommended by Patzold and Korb, proves the
most accurate. Mercury thermometers are not suitable for the
purpose, as they concentrate the electric field.
T H E M A L E GENITO-URINARY TRACT
GONORRHEAL URETHRITIS
In bacteriological experiments it was found that the gonococ-

cus is relatively easily destroyed by heat. Hence various phy-
siotherapeutic methods producing heat have been used in the

treatment of this common infection. But as is not uncommonly
the case, the experimental results could not be duplicated in
clinical practice. In chronic infections, the outlook seems to be
more favorable from a therapeutic point of view, but in the acute
infections nothing can as yet take the place of the classic treat-
ment.
An attempt has been made to use short-wave diathermy in
acute gonorrhea in the male, but Schliephake, Nagell, and Berg-
green could observe no noticeable curative influence. Liebesny
believes that short-wave diathermy should not be used in acute
uncomplicated gonorrheal disease, as it involves much time and
expense without adequate compensating benefit.
Gumpert used the 15-meter wave length for from 10 to 15
minutes in chronic gonorrhea in the male. Although he treated
only 8 cases, he reports enthusiastically the quick results ob-
tained after a few treatments. Gonococci could not be found
after from 3 to 8 days, and the urine was clear.
This bears out the observation of other investigators that in
chronic gonorrhea of the so-called infiltrative type, short-wave
diathermy may be of benefit. R a a b mentions a case of gonorrheal
infiltration of the penis in which, after 3 treatments, the purulent
discharge stopped, the infiltration disappearing entirely after 10
treatments.
Last failed to cure acute and chronic gonorrheal urethritis.
Schliephake, on the other hand, met with success in 2 out of 3
cases of long-standing paraurethral abscess, with fistula and
positive bacteriological findings. Daily treatments of 30 minutes
each cured one in 14 days; in the other gonococci persisted for
4 weeks, though the fistula had closed. Protargol injections were
then started, in combination with short-wave diathermy, and
within 2 days bacteriological findings were negative, from which
the impression was gained that short-wave diathermy sensitized
the action of protargol. The third case could be only partially
improved, in spite of prolonged treatment. Most of the reports
deal with negative results in treating gonorrheal infection in the
male, with favorable results obtained in epididymitis.
DISEASES OF THE PROSTATE
Acute and chronic inflammations of the prostate, and even

those changes due to prostatic hypertrophy, seem to react
favorably to short-wave diathermy. Last reported beneficial re-
sults in acute and subacute prostatitis. Hancken, however,
states that chronic disease of the prostate would respond less
favorably to short-wave diathermy. Liebesny states definitely
that only genuine inflammations should be treated with short
waves, believing that in prostatic hypertrophy short waves
should not be used, as no shrinking of the hypertrophied tissue
can be achieved by the treatment. On the other hand, the treat-
ment has a permanent effect in dilating the vessels, with the re-
sult that in aged patients the prostatic plexus becomes varicose,
and further treatment increases the possibility of hemorrhage.
Neither should new growths of the prostate, whether benign or
malignant, be treated with short waves. Weissenberg failed to
induce improvement in 2 cases of chronic long-standing hyper-
trophy of the prostate.
MISCELLANEOUS DISEASES
Raab claims to have been able to cure acute epididymitis in a

few treatments. He mentions a case of 3 months' duration,
characterized by severe pain, in which one treatment accomp-
lished marked decrease of pain and swelling. Six treatments
proved sufficient for cure. These observations were confirmed by
Gleissner, Mahlo, Last, Dorst, Halle, and Liebesny. Halle and
Hancken also report curative results in stubborn chronic
epididymitis. It may be mentioned here that a temporary
Steinach effect, as a secondary result of short-wave diathermy,
was observed by some investigators.
The present writer inclines to the view that in cases of
phlegmonous inflammation of the scrotum, of streptococcic or
staphylococcic origin, short-wave diathermy is definitely indi-
cated, as it may lead to rapid cure without surgical intervention.
It is, however, recommended that the pus be drained, after the
infection has been localized by short-wave treatment. An illus-
trative case in the writer's practice was that of a man 67 years
of age, who had been operated upon for rectal carcinoma 5 years
before. An extensive local recurrence was removed by electro-
coagulation by the writer. Following recovery, he underwent

operation for a left hydrocele. Uneventful healing took place
and the patient was discharged with slightly swollen but not
tender scrotum. Four weeks after the operation, he returned
with edema and enormous swelling of the scrotum and penis, to
the size of a baby's head. Redness was mostly on the left side,
and there was slight fluctuation and excessive tenderness to
touch. The lesion was diagnosed as a diffuse infection, due
probably to a secondarily infected postoperative hematoma.
The patient was given short-wave treatment before he was
taken to the hospital for incision and drainage. On January 23,
1935, the first treatment of 15 minutes' duration, with the 6-
meter wave length, was given. The following day, January 24,
another treatment was given; pain and inflammation seemed to
be localized at the left side, below the incision. Edema decreased.
Two days later, following a third treatment, pain had subsided
entirely, the lesion was half its original size, and about 5 cc.
sanguineous-purulent material was discharged from a sinus
formed spontaneously in the scar of the previous operation.
Edema of the penis subsided and infiltration was present only at
the left scrotum. Two days later (4 days after the treatment
commenced) inflammation was greatly diminished and there
was no further fluctuation or discharge. A last treatment was
given 2 days after this, after which the patient felt well; in-
filtration covered an area about 1.5 inches in diameter, and
there was a light reddish discoloration but no tenderness. The
infiltration was gradually resolved, and 11 days after the
beginning of short-wave diathermy, the patient was discharged
as cured. He was well when last seen, 26 months later.
Liebesny reported a case of erysipelas of the scrotum which,
like erysipelas elsewhere, reacted well to short-wave diathermy
Two treatments effected a cure.
Kronfeld was able to effect a cure with short-wave diathermy
in one of his cases of plastic induration of the penis.
The gonorrheal affections of joints accompanying genital
infection are taken up below in Chapter XIII, "Diseases of the
Locomotor System."
Tuberculous disease of the testicles, bladder and kidney
should react well to short-wave diathermy, if the experiments of
Liebesny can be duplicated in clinical practice. Weissenberg re-

ported a case of tuberculous epididymitis accompanied by in-
tense pain, in which the short-wave treatment repeatedly ameli-
orated the pain for a period of hours, but no mention is made as
to the outcome of the pathological process. Heymann claims to
have effected a cure in a case of tuberculous epididymitis with
fistula.
On the whole, no attempt can be made to evaluate short-
wave diathermy in urology, as experience in this field is still too
limited. In human beings, no damage to the germinal centers in
the male or female has been observed. There are, apparently, no
contraindications, then, from this aspect, and with proper care
and consideration of all factors in an individual case, short-
wave diathermy may always be tried. In the laboratory animal,
the injuries observed in the testes were due to heat coagulation,
caused by the relatively high intensities employed.
TECHNIC OF TREATMENT
Liebesny warns us that in urological practice a special

technic of treatment is necessary, as deep layers of tissue must
be reached with the short waves. He believes that great intensi-
ties must be used and that the condensor plates must be 10 to 15
cm. distant from the body surface. In treating the scrotum, less
intensity should be used.
According to the usual technic employed, the male organs
are placed between two electrodes so as to concentrate the
electric field upon the pathologic site. The patient may also be
placed in the "stonecutter" position, with the penis and scrotum
reflected upon the symphysis, and one electrode placed above
the genitalia and the other on the perineum.
In treating the prostate, one electrode is placed in the anal
region and the other over the bladder. Intensity is varied ac-
cording to the depth of the lesion, greater intensity with greater
depth. Length of treatment should be from 15 to 25 minutes
daily, or every other day. Shorter wave lengths are recommended
for the deeper lesions; usually the 6-meter wave lengths were
used.
XII
D I S E A S E S OF T H E C I R C U L A T O R Y S Y S T E M
AND THE LYMPH GLANDS
T H E CIRCULATORY SYSTEM
I T C A N N O T be too emphatically stated that so far all observations

dealing with short-wave diathermy in the cardiovascular field
are inconclusive. What has been done in the way of investi-
gation is reported here for the sake of completeness, and no
attempt is made to prove a point. The problem invites the serious
student; there is ample opportunity for intensive study and
scientific investigation. Short-wave diathermy in cardiovascular
disease has still to prove itself.
Kowarschik is of the opinion that the condenser field can be
used for interesting diagnostic purposes in heart conditions.
When placed between the two condenser plates, the human
heart produces changes in the current by its varying size while
in action. This variation of current flow can be registered
graphically, and a curve, a so-called dielectrogram, can be ob-
tained. This curve is typical in the normal heart, and shows
characteristic differences in certain cardiac diseases (Atzler).
THE HEART
Dognon and Piffault conducted animal experiments in a

study of the effects of short waves on the heart. They observed
that after prolonged treatment, there was a reduction in the
cardiac rate, with a diminution of the amplitude of the systoles,
until the heart stopped in diastole; but when the treatment
ceased the heart resumed its action.
This is of course, an extreme, and naturally not observed in
human beings under treatment with physiological doses of short
waves. The observation serves, nevertheless, as a warning that
172 CIRCULATORY SYSTEM
treatment should be discontinued should the heart action slow
down.
On the whole, observations in the field of cardiac pathology
have been too few and too inconclusive, and either too carelessly
made or too carelessly reported, to justify definite statements as
to the place of short-wave diathermy in heart disease. It is,
however, the general impression that caution should be exer-
cised in its use, and that it is wise to abstain from prolonged
treatment of the heart, particularly in the presence of marked
organic disease of that organ.
Some investigators believe that short-wave diathermy may
be of benefit in functional disorders of the heart and in the
cardiac neuroses. Rausch, reporting from the Kordnyi clinic in
Budapest, made an extensive study of the effects of short waves
in circulatory diseases, and came to the conclusion that the
effects are mainly analgesic and antispasmodic. The effect of
these wave lengths on blood pressure is mentioned above. In
comparing diathermy and short-wave diathermy in heart dis-
ease, Rausch expresses the opinion that the latter has a distinct
advantage over diathermy, this advantage being inherent in the
homogenous warmth which it effects and which may favorably
influence the cardiac pathology without increasing pain, such as
is sometimes to be observed under diathermy.
Angina pectoris.—Rausch states that short-wave diathermy
is only of symptomatic effect in this disorder. In those cases in
which the best results were obtained, the severe pain subsided
immediately after the treatment. The subsequent attacks were
milder and reduced in number. Meyer was probably the first to
recommend this form of treatment in angina pectoris, and he
spaced the sessions farther apart and at lower than the usual
intensities. One of his cases improved after 6 treatments; a
second after 3. One patient died within a short time in an attack,
but his death could not be attributed to the treatment em-
ployed. Liebesny reported 5 cases so treated, in which the at-
tacks stopped in a relatively short time. Among the improved
cases was one in which a diagnosis of coronary thrombosis was
established by electrocardiogram. Liebesny is of the opinion that
the lowering of the blood pressure by short waves may be re-
sponsible for the good effect. Among those reporting favorable
CIRCULATORY SYSTEM 173
results from this therapy in angina pectoris are Hellfors, Hempe
and Lambrecht. They replaced diathermy with short-wave
diathermy. Improvement was also reported by Babin-Chevaye
and Peemoller.
Siegen and Hempe report results on 220 cases treated with
short waves in conjunction with other measures. They found
symptoms entirely alleviated in 43 percent, improved in 54
percent, and unimproved in 3 percent. They used the 8 to 15-
meter waves for from 8 to 20 minutes. They insist, however,
that this form of treatment should be confined to the specialist.
Short-wave treatments result mainly in vasodilatation, and
even when small doses, with low intensity are employed,
temporary palsy of the sympathetic system follows, as was
shown by Pflomm's experiments. In angina pectoris, where
insufficient blood supply, through narrowing of the nutritive
blood vessels, causes pain, this form of therapy could be em-
ployed with great benefit. As we can obtain only temporary
vasodilatation with the nitrites, the lasting vasodilatory effects
of short waves—as was shown by Pflomm's experiments-
would indicate their use, but only under the supervision of a
cardiologist. Results of short-wave diathermy are especially
favorable in those cases of angina pectoris in which the patients
continue in their usual occupations, and in which there are
relatively mild organic changes. These patients become symp-
tom-free for a longer period. Weissenberg reports numerous
cases benefited by short-wave diathermy, among which we find
the case of an obese 50-year-old housewife, who had precordial
pain with radiations to the left arm, accompanied by anxiety,
especially when walking. Her symptoms could be promptly
controlled by nitroglycerin. After the first short-wave treatment,
the precordial pressure disappeared and after 10 applications of
weak dosage, she was sufficiently improved to resume her
normal occupation; after 20 treatments she was able to perform
heavy work and to take longer walks—sometimes lasting 3 hours
—without attacks, and dispensed entirely with the use of
nitroglycerin.
Functional disorders.—According to Rausch, the so-called
irritable heart, characterized by fatigue, dyspnea, precordial
pain and palpitation, may be improved by short-wave dia-
thermy. The improvement is only symptomatic. "Heart-pains"
(aortalgia) require more prolonged treatment before improve-
ment takes place, and in the case of functional pain there m a y
be as many failures as favorable results.
Organic diseases.—In addition to the symptomatic effect,
Rausch observed that the heart action increased also, with
concomitant improvement in the circulation, even in the case
of organic disease.
In spite of the preceding observation of Rausch, Raab
warns us against the use of short-wave diathermy in organic
disease of the heart, and Rahnenfiihrer and Maier observed new
symptoms and evident deleterious effects after this treatment.
The treatment of the arteriosclerotic heart muscle distinguished
by pain is unsuccessful, according to Mann. Schliephake claimed
to have improved the symptoms of syphilitic mesaortitis.
Inflammation of the heart muscle.—Judging from the results
obtained by short-wave diathermy in inflammations of serous
cavities, the assumption has been made that favorable results
m a y also be obtained in the different forms of myocarditis.
In myocarditis, Schliephake claims to have obtained satis-
factory results, evidenced symptomatically and b y electro-
cardiogram. Rausch, however, voices the caution that in the
case of heart disease one can never speak of final results, but
only of periodic improvement.
Schliephake described the case of a 19-year-old girl, critically
ill with endocarditis. Her heart was decompensated, she was
dyspneic and anemic, and examination revealed albuminuria
and enlargement of the spleen. Blood culture was negative. After
5 sessions with short waves directed to the heart and spleen, the
temperature fell and her general condition improved. In 20 days
she was able to leave her bed. A few treatments over the kidney
region stopped the albuminuria. The patient was discharged
from the hospital in 5 weeks.
Nevertheless, extreme care should be observed when ventur-
ing to treat such a serious condition as endocarditis with
short waves.
Technic of treatment.—Rausch and other investigators recom-
mend treatments daily or every other day not to exceed ten
minutes at one time. Only rarely is the period extended to fifteen
or twenty minutes at subsequent treatments. A moderate in-

tensity is used and controlled by the patient's subjective sen-
sation of agreeable warmth. The 12- to 30-meter wave-lengths
are recommended in preference to shorter lengths. There are no
records concerning the use of shorter wave lengths. In inflam-
matory conditions shorter waves, from 4 to 6 meter may be
preferred.
T H E VASCULAR SYSTEM
Essential hypertension.—Short waves may have a sedative

effect in essential hypertension, if we may judge by the observa-
tions of investigators (Chapter VI, "Short-Wave and Other
Treatments," section on "Electropyrexia")- Every application
of short waves, of any wave length, results in a diminution of the
systolic and the diastolic blood pressures. This is more marked
in hypertension.
Rausch demonstrated that the hypertonic blood pressure de-
creases from 15 to 30 mm. Hg after the first exposure to the
30-meter wave length, and on subsequent exposures the fall was
from 5 to 10 mm. Hg. With Dr. Watson's work we also ob-
served this phenomenon, though to a lesser degree, with the
wave length of 6-15 m.
The subjective complaints subsided, or at least lessened,
practically always after the first treatment, even with persisting
high blood pressure. T h e blood pressure may be reduced gradu-
ally to a certain level. The fall is greatest in the beginning, and
more marked, the higher the blood pressure, becoming less with
each succeeding treatment until a certain level is reached. B y
repeated treatments, however, one may maintain a condition
that will be satisfactory for years (Rausch, Apel).
In advanced arteriosclerosis, the effect on the blood pressure
is only transitory, though short-wave diathermy may be an
important aid in symptomatic therapy.
In one case of essential hypertension observed by us with
Dr. Watson, the blood pressure of 195 systolic and 115 diastolic
dropped to 165 systolic and 86 diastolic after the first treatment,
and resulted in improvement of the subjective symptoms after
8 treatments of the head, with the 15-meter wave length, of
from 10 to 15 minutes daily. We obtained a reduction of 150
systolic and 85 diastolic as the average, over a period of 3 months.

End results, however, are open to question, as no follow-up
observations for longer periods were made.
The peripheral circulatory system.—Discussion in this section
will be limited to those affections in which short-wave diathermy
has been employed and in which positive or negative results
have been reported in the literature, and will include our own
limited experience.
Short-wave diathermy is used in functional disturbances of
the blood vessels mainly because it indirectly supports the action
of the heart and attempts to reestablish the normal circulation.
It is indicated mainly in angiospastic conditions.
Halpert and Fedoroff found that in the trophoneurotic dis-
eases of the vessels, there is a spastic condition of the capillaries
of such a degree that the erythrocytes are not able to pass. They
found that hot baths did not always result in dilatation. On the
contrary, sometimes contraction of the capillaries followed.
Heat therapy aims at dilatation of the vessels. The research of
Pflomm showed that short waves inhibit the sympathetic
nervous system and have a tonic effect on the pneumogastric
nerve, the differences in the extent of action depending upon the
wave lengths employed.*
A marked dilatation of the blood vessels is the principal
indication or evidence of the effect of short-wave treatment.
This is especially true where angiospasm is present, though it is
also noted in arteriosclerosis and endarteritis obliterans. The
hyperemia induced by short waves differs from that resulting
from ordinary heat. The vasodilatation following short-wave
diathermy, which lasts for hours, cannot be influenced by
adrenalin (Pflomm, Weissenberg). There follows a pronounced
migration of leucocytes to the parts treated, thus raising to a
considerable degree the phagocytic index. The vessel may dilate
from 3 to 8 times its physiological size, and may remain so under
the administration of small doses for 2 or 3 days if the small
doses are repeated, and for 14 days if longer application and
greater intensities are employed (Pflomm).
These experiments appear to be supported by results in the
*Weiasenberg made a similar observation, noting that the same wave lengths
may differ in action in different cases, and even in the same case at different times.
This may be due to a difference in the technic employed.
clinical field. In the case of severe pain, the analgesic effect of the
short waves helped to improve the subjective symptoms.
Weissenberg observed immediate symptomatic improvement in
acroparesthesia and Raynaud's disease under short-wave dia-
thermy. On the other hand, in some of the cases of endarteritis
obliterans and severe forms of gangrene, pain was intensified
during exposure, but lessened after the treatment was finished.
Hd observed only 2 cases out of his 900 patients, which showed
motor nerve irritation. Most of the patients reported a sensation
of warmth after the treatments, but a few stated that they felt
cold.
Decidedly satisfactory results were noted during the cold
months. The patients seemed to bear cold weather for a longer
period of time without angiospastic phenomena. Accompanying
the improvement in the subjective symptoms was the healing of
the ulcer. Weissenberg not only treated the diseased extremity,
but also applied short-wave diathermy to the higher sympa-
thetic centers along the cervical, dorsal or lumbar spine or mid-
brain. In one case of Raynaud's disease of the hand, the patient
improved during the treatment, with immediate return of the
symptoms after the treatment was over. Following 3 treatments
of the mid-brain, definite improvement was noticed, and after 7
consecutive sessions the patient was entirely free of symptoms.
A curious by-effect was the recurrence of the menstrual periods
at earlier dates in all classes. This was attributed to treatments
of the pituitary gland. In a series of 38 cases of peripheral
vascular disease including arteriosclerosis, diabetic gangrene and
Raynaud's disease, Liebesny was able to cure 9, improve 13,
but failed to alter in any way the condition of 16. Last and
RSchou reported satisfactory results in cases of Raynaud's dis-
ease. Liebesny was able to cure 2 out of 4 such cases, after 30
and 35 treatments. One improved and the fourth remained un-
changed. Saidman reported favorable results in 3 cases.
One case of acroparesthesia treated by Saidman, improved
after 6 treatments, as evidenced by complete subsidence of pain.
The patient could sleep again and also resumed her occupation.
Marked improvement was obtained in cases of acrocyanosis by
Dausset, but Laqueur and Remzi met with total lack of success
in treating this condition.
Last, Ruete and Weissenberg treated chilblains with benefit.
Biirkmann treated 10 cases of chilblains, in sessions lasting from
15 to 20 minutes each, sometimes increased to 25 minutes, with
beneficial results. One case with vesicles on the hands improved
after 3 treatments, with decrease in pain and without develop-
ment of necrosis. A frostbitten small toe was cured after 5 treat-
ments and a nose improved after 7 treatments.
In 22 cases of intermittent claudication without gangrene,
short-wave diathermy cured 9, improved 5 and left 8 unchanged
(Liebesny). Lob and Stiebock, and others treated this disorder
with beneficial results, whereas Shaffler and R6zsa report a lack
of definite success in this condition and in syphilitic endarteritis.
In the case of intermittent claudication, an average of 30 treat-
ments were given.
It seems that short-wave diathermy does not influence ad-
vanced arteriosclerotic changes, though beneficial results are
obtained in the earlier stages of angiospastic conditions. This
holds for intermittent claudication, which, according to Liebesny
and Last, does not react to short waves if the condition is far
advanced. There may be regenerative changes in moderately
affected cases, according to Schliephake, Dausset and Delherm.
Babin-Chevaye was able to report a cure of senile gangrene
after treatment lasting 3 months. In a case of moist gangrene,
the gangrene was first changed to dry and then cured after 71
treatments (Liebesny).
Results were by no means uniform in the treatment of
endarteritis obliterans. Stiebock, Weissenberg, Hayer and
Kobak, giving long series of treatments of varying lower and
higher intensities, secured some satisfactory results and some
failures. Hayer found that short-wave diathermy favorably in-
fluences endarteritis obliterans and gangrene, but that no
permanent improvement resulted. It follows that this form of
treatment could be most effectively administered according to
the requirements of the pathological process, but the angio-
spastic condition from the therapeutic point of view becomes an
individual problem.
Of 29 cases of thrombo-angiitis obliterans with gangrene,
Liebesny was able to cure 12 and to improve 5. One case con-
sidered cured, recurred after 2 months, and 11 cases remained

unchanged.
Diabetes is not a contraindicant to short-wave diathermy,
provided that the blood sugar is under control. In fact, 2 cases
of diabetic gangrene were treated with favorable results. During
short-wave diathermy the diabetic condition must also be
treated.*
It cannot be definitely stated whether the lesion itself or the
regional sympathetic centers should be subjected to treatment,
or whether one treatment should embrace both. The highest
percentage of cures with short waves as shown by adequate
follow-up examinations, should be diligently reported in the
literature, so that more accurate statistics may be obtained, on
which to base a comparison of results. At the present time short-
wave diathermy in this field seems to cure approximately 30
percent, improve 30 percent, and fail in 40 percent. Aside from
temporary aggravation of subjective symptoms (during treat-
ment) described in a few cases, no aggravation of the pathologi-
cal process has been observed. Consequently, as there is nothing
to lose and everything to gain, this method of treatment should
be widely employed. One may even suggest a combination of
short-wave diathermy and the Pavax treatment as a possible
solution in these difficult disorders.
From our own clinical material, we wish to report a case of
thrombo-angiitis obliterans in which a favorable lasting result
was achieved in a comparatively short time. The patient, male,
60 years of age, had been suffering from intermittent claudication
for 4 years. Recently the pain increased and redness, with a
black spot, appeared on the left great toe. Examination showed
the great toe and the second to be bluish-red, with areas of
erythema extending toward the dorsum of the foot. Pulsation
of the dorsalis pedis artery was hardly perceptible. The extrem-
ity was extremely painful to the touch and to pressure; the
patient was unable to wear a shoe, and walked with the aid of
crutch and cane. He had in the past been treated with infra red,
ultraviolet radiation and diathermy, rest in bed, with oc-
casional relief but no permanent benefit. He was advised to
*See also an account of the control of a case of diabetic infection in Chapter XV
below, "Miscellaneous Conditions," section on "Phlegmon."
have his foot amputated. As a last resort, short-wave diathermy

was tried. His condition remained unchanged for the first 4
treatments. H e received morphine every night and amytal dur-
ing the day. After the sixth treatment, intensification of color
was manifest in the great toe, but some symptomatic improve-
ment was also noted. On the twentieth day acetylcholine in-
jections were started,in conjunction with short-wave diathermy.
Altogether, the patient received 15 injections. After the thirty-
sixth day definite improvement was noticed: pain was less, but
the patient still had to take pantopon at night. The discoloration
of the great toe was limited to the first phalanx. Continued
treatments for 13 days resulted in further improvement, and
drugs could be dispensed with. The great and second toes re-
sumed a normal color and pain was entirely gone. The course of
26 short-wave treatments extended over 43 days and resulted in
complete subsidence of subjective and objective symptoms.
When last seen, 6 months later, he had no complaints, attended
normally to his occupation, and enjoyed normal function in his
foot. In this case short-wave diathermy, combined with acetyl-
choline injections, saved the limb. T w o other cases of thrombo-
angiitis obliterans were treated with distinct symptomatic
improvement, but the results were less favorable than in the
case described above.
Because of its antispasmodic (vasodilatory) and analgesic
action, short-wave diathermy may become a valuable addition
to the therapeutic measures employed by the cardiologist.
Much more needs to be done, however, in the matter of research
and scientific control, to establish it on a sound basis.
Technic of treatment.—The affected part of the extremity is
placed between two electrodes, which should be opposite each
other. Strong doses may aggravate the complaint. Treatment,
therefore, should be with weak doses, and given daily, provided
the patient does not react in a manner to contraindicate this.
In such an event, the treatment may be given every other day,
with gradual increase of the intensity, in order to obtain the
maximum effect. The intensity at first should be lower, increas-
ing gradually. The treatment should not last longer than 10
minutes in the beginning, being raised to 20 and 30 minutes with
increasing tolerance on the part of the patient. As there is as
yet no accurate method of measurement, we must, for practical

purposes, rely on the patient's subjective sensation of agreeable
warmth as a guide in choosing the proper dosage. So far the
wave lengths between 12 and 15 meters have been found most
effective. In order to treat the regional sympathetic center, the
electric field is created by placing two electrodes in such a
position that they include the sympathetic ganglions—the
cervical, dorsal or lumbar ganglions, depending upon the area
involved.
In the case of an ulcer, Schliephake advises covering not only
the lesion but also the surrounding tissue with a large electrode.
T H E L Y M P H GLANDS
T U B E R C U L O U S ADENITIS
Among our cases was a man 25 years of age, with a history of

having had an operation three years previous, which left a
fistula at the manubrium sterni. He developed a slightly painful
swelling in the right axilla, which gave the impression of being a
tuberculous lymphadenitis. Ten treatments with the 16-meter
wave length, for from 10 to 20 minutes each, were given in 12
days. The patient felt weaker after the course of treatment, had
definitely less pain, but showed no clinical improvement. An
operation was performed and aside from the usual picture of
tuberculous changes, histologic examination showed nothing
but vascular engorgement.
Lob and E . A. Woods had no positive results in their cases of
tuberculous adenitis. I t is our impression that in tuberculous
adenitis no definite benefit accrues from the employment of
short-wave treatment, except possibly when secondary infection
is also present. In any event, the customary conservative or
surgical treatment should be employed.
MIKULICZ' DISEASE
The experiments by Von Oettingen and Schultze-Ronhof on

guinea pigs showed that after short-wave treatment the number
of leucocytes diminished. This was followed by an increase,
within 3 hours, with a decrease in the number of lymphocytes.
Pflomm met with the same result, and attributes this de-
crease to the destruction of leucocytes. I t might also be that
they are fixed in the peripheral area which was the immediate
focus of the treatment.
Groag described a case of Mikulicz' disease presenting an
atypical leucemic lymphomatosis, with aleucemic blood findings.
Short-wave diathemy, directed to the diseased parotid gland,
resulted in definite improvement in the blood picture, with per-
sisting tumor which was cured by roentgenotherapy.
As a means of checking his results with short-wave diathermy,
Groag treated a normal girl and then examined the blood.
The result was negative, from which he concludes that his find-
ings in Mikulicz' disease are sustained and substantiated.
NONCONTAGIOUS PAROTITIS
Short-wave diathermy may be used with success in non-

contagious parotitis. We treated such a case, which developed
metastatically in a patient with empyema. For 4 days there had
been severe bilateral swelling and pain and purulent discharge into
the mouth. Culture showed a streptococcus. The skin in the pa-
rotid region was reddened, and on the left side marked tender infil-
tration and slight fluctuation were noted. Using the 12-meter
wave length for from 10 to 20 minutes, short-wave treatment
was given, and after 3 treatments the jaw movements were freer
and less painful. With 2 further treatments, the swelling was
decidedly diminished and there was less purulent discharge from
the ducts. In the course of the treatment, the patient was
operated upon for the coincident empyema, with satisfactory re-
sult. No attempt was made to cure the empyema with short-
wave diathermy. Altogether, 6 treatments in daily sessions accom-
plished a cure of the parotitis, and the patient gradually re-
covered from the surgically treated empyema.
Raab states that chronic parotitis responds to short-wave
diathermy, with rapid resolution of the inflammation. The treat-
ment also prevents abscess formation, or promotes it if it has
already begun. In the latter case, a lancet incision may be made
if indicated.
In the technical application, an electrode of a size sufficient
to cover the parotid region is used, and in acute cases treat-
ments are given daily, while in chronic cases they are spaced to
every 2 or 3 days.
Hoeffler claims that local infections such as parotitis, mastitis,

and so on, can be as effectively treated with short waves in
children as in adults, the duration of the treatment naturally
being shorter—from 3 to 5 minutes daily. We obtained cures in
3 cases of cervical lymphadenitis of infectious origin in children
after from 3 to 8 treatments.
XIII
D I S E A S E S OF T H E LOCOMOTOR SYSTEM
T H E MUSCULAR SYSTEM
S H O R T - W A V E diathermy has been employed in a variety of

affections of the muscles—myalgia, lumbago, spastic contrac-
tures, rheumatism, and so on. Rahlwes, Bardenheuer and Peter-
son reported 76 cases in which short-wave diathermy resulted in
quick improvement and cure. Lob and Schliephake found that
lumbago reacts at once to short-wave diathermy. Our own ob-
servations confirm these findings. Sometimes the pain is re-
lieved immediately, and the case can be cured in one or two
treatments. In other cases of subacute muscle rheumatism,
symptomatic cure was obtained in from 3 to 6 treatments. The
eradication of foci of infection at the same time is advocated.
The myalgias and spastic torticollis respond quickly and
favorably.
In contrast to other investigators, Schweitzer and Turrell be-
lieve that diseases of the muscles are less amenable to short-
wave diathermy.
As a rule, longer wave lengths—8 to 14 meters—were used
for a duration of from 20 to 30 minutes, at an intensity that
gives the patient an agreeable feeling of warmth. The electrodes
should be placed so as to include the diseased area.
TENDOVAGINITIS
This disorder, which is the source of an incalculable amount

of pain to the sufferer, appears at any time of the year, is ob-
stinate to the usual forms of treatment, and is the most com-
monly misdiagnosed of conditions. It is not at all unusual to
find it miscalled neuritis or acute arthritis, particularly in the
case of the shoulder or hip. The inflammation within the synovial
structure produces friction, which explains the pain.
THE LOCOMOTOR SYSTEM 185
I t is worth while to emphasize this condition and the dis-

comfort and pain it causes, because it is so readily amenable to
short-wave diathermy. Furthermore, as the treatment can do
no harm it should always be tried when other measures fail, and
in fact should be employed from the start if available.
Lob reported beneficial results with short-wave diathermy in
acute tendovaginitis and in cases in which exudation had taken
place. Davis described a case of tendovaginitis in which de-
cided improvement took place with the first treatment, and in
which 6 treatments were sufficient to cure, clearing up the
crepitation. Our own 4 cases were cured after from 2 to 4 treat-
ments, in spite of the fact that other physiotherapeutic measures
—ultra red light—had failed.
Dr. W. G., of New York City, was kind enough to submit
his personal case, in which his tendovaginitis of the dorsoflexor
tendons of the wrist was cured with short-wave diathermy. Ten
days before treatment was begun, pain was felt following a
strain of the wrist while cutting a heavy plaster spica. T h e pain
was felt along the dorsoflexor tendons of the right wrist. Four
days after onset, the patient had acute pharyngitis and was con-
fined to bed. There was slight elevation of temperature for one
day. On the following day the wrist became acutely painful in
all motions, and there was swelling over the dorsoflexor tendons.
A plaster splint was applied to fix the wrist in dorsoflexion.
Thirty grains of sodium salicylate were given intravenously, but
there was no relief. Pain increased with increase in swelling, so
that motion of the fingers was limited by pain. The thumb was
not involved. On the following day the splint was molded, in an
attempt to secure more support for the fingers. T h e salicylate
administration was repeated, and aspirin was given every 4
hours in 4-grain doses. The salicylates were continued, but when
after the third day there was still no relief from pain, short-
wave diathermy was resorted to. During the first treatment
there was a sensation of mild warmth throughout the wrist and
hand and a slight increase of pain. The splint was reapplied but
all medication was discontinued. Four hours after the treatment,
the patient reported a sensation of pleasant warmth in the wrist
and hand, accompanied by distinct diminution of pain, and
definite increase of the surface temperature. This reaction lasted
186 THE LOCOMOTOR SYSTEM
for 8 hours, at which time the surface elevation of temperature
subsided. Pain was definitely diminished and finger motion more
free and less painful.
Following the second treatment, the phenomenon noted
above recurred within several hours and lasted for about 5 or 6
hours. The following day the swelling over the dorsum of the
wrist was 50 percent less. The wrist was painful only when the
fingers were moved. After the third treatment the same mani-
festations recurred, but to a lesser degree and for a shorter time.
The splint was discarded and normal use of the hand was pos-
sible. On the afternoon on which this treatment was given, the
patient was able to reduce a fractured shoulder and to apply a
plaster spica. No pain was present when the fourth and last
treatment was given; a very slight temperature reaction followed
this treatment. Within 5 days the wrist was entirely normal. In
the subsequent examinations, there was no pain and no limita-
tion of motion.
Technic of treatment.—The wave lengths around 6 meters are
recommended. In the main, the technic is as described in the
general discussion of technic (Chapter VII, "General and Me-
chanical Principles in Short-Wave Technic") and consists in
placing the affected area in the condensor field for from 10 to 25
minutes daily.
BURSITIS
Subacromial bursitis, which is characterized by the deposi-
tion of lime salts, is benefited by short-wave diathermy much in
the same way that it is improved by diathermy or roentgeno-
therapy. The increased blood circulation and the invigorating
local effect induced by the treatment, cause the improvement.
We had 7 cases in which symptomatic relief was obtained after
from 4 to 8 treatments. In one, roentgenograms showed a di-
minution of the calcium deposit. Naturally, one cannot expect
complete resorption of the calcium deposit if the process is far
advanced. Davis, and Kobak also observed beneficial results in
subdeltoid bursitis.
Technic of treatment. The electrodes are applied opposite each
other in such a way as to create an active electric field in the
diseased area. We found the 6 to 12-meter waves satisfactory.
The daily treatments should be from 15 to 20 minutes in duration.
THE BONES
Bone is a poor conductor of electricity. For this reason, be-

fore short-wave diathermy was developed, electrotherapy
proved less effective in treating diseases of the osseous structures
than in treating those of the soft parts. We know now, from
work reviewed elsewhere in this book, that shorter waves gener-
ate heat evenly when introduced into the bones. This fact, in
addition to other physiological attributes, has opened a rich
field for their therapeutic use.
Bone, from a clinical point of view, consists of calcified tissue,
of periosteum and of medullary tissue. These are intimately
connected. Hence inflammatory states usually affect the entire
structure.
The diseases of the osseous structure in which short-wave
diathermy has proved to be most efficacious will be discussed
below.
PERIOSTITIS
Turrell found that periostitis of the dorsal aspect of the

tarsus, ineffectually treated with diathermy, was completely
relieved after the first treatment with short-wave diathermy,
and when seen after six months the patient showed no evidence
of relapse. In the traumatic form of periostitis, improvement of
the subjective symptoms took place quickly after institution of
short-wave diathermy, with regression of local pathology
(Hancken, Hellfors, Lux, Rollin and others).
OSTEOMYELITIS
Our knowledge of the real value of short-wave diathermy in

acute osteomyelitis is still so limited that much further study
will be necessary to afford a proper evaluation. If employed in
acute osteomyelitis, it should be used with care, and where no
immediate danger presents itself. In extreme cases, with severe
toxemia, surgical measures should be used conservatively. If no
definite involvement of the periosteum is found, an incision
should be made and short-wave diathermy started. If this does
not improve the condition within a few days, a further operation
should be performed.
In subacute and chronic cases in which no sequestration can
be shown, results are remarkably satisfactory, although the
number of reported cases is limited. Where sequestration is tak-
ing place, short-wave diathermy may promote demarcation be-
fore surgical removal of the sequestrum.
Schliephake states that where no roentgenographic changes
are demonstrable, the condition can be cured by short-wave
diathermy. He believes that the patients are best treated in the
early stage, when no grave changes are evident roentgeno-
logically. It is also favorable to cases of long standing, especially
those in which sequestration can be hastened. The bone sub-
stance around the sedt of the disease becomes more strongly
calcified and sharp demarcation takes place. The sequestra are
sometimes ejected spontaneously through the fistulas, or they
can easily be removed. This sharp demarcation is a characteristic
evidence of short-wave effect. In one of Schliephake's cases
sequestration commenced under short-wave diathermy and in
from 4 to 8 weeks the sequestra were spontaneously discharged
through the fistula and others were removed by sequestrotomy.
This patient had been in the hospital for 4 years. According to
Weissenberg, one may expect the spontaneous discharge of
larger sequestra, but in the cases of smaller sequestra the
fistulas persist until they are removed by surgery.
In Liebesny's series of 15 cases, 4 were acute and 11 chronic.
He cured all his acute cases in from 12 to 20 treatments. One
case of osteomyelitis of the femoral head was symptom-free
after 9 treatments. Of the 11 chronic cases, 3 were cured in from
17 to 23 treatments, 7 were greatly improved after from 7 to 48
treatments, and one was unaffected.
Laqueur and Remzi obtained favorable results in 3 cases.
Ammon and Raab failed in one case of acute osteomyelitis.
We report the following 2 cases from our clinical material,
as being of interest.
T. P., a girl 12 years of age, gave a history of osteomyelitis
of the left leg, under treatment for 7 months. When seen, there
was a painful swelling of 8 days' duration, discharging pus. It
was tender, red, and infiltrated for an area about 2.5 inches in
diameter. Seropurulent discharge issued from an opening about
2 cm. in diameter. Roentgenograms showed no sequestration,
but atrophy of the lower end of the femur. Before operation
was undertaken, a request was made for short-wave diathermy.
After the third treatment, the patient had no more pain, the
local condition was decidedly improved, the discharge was only
slightly bloody, and serous, and there was no induration or
tenderness. The wound was granulating. One more treatment
was given, after which the wound was clean and covered with a
scab. There was no discharge. The patient was discharged cured
from the hospital 5 days after the first treatment.
The second case was that of a lad 6 years of age, who had
had osteomyelitis in different parts of the body at different
times and had been operated upon 4 times. When seen, there
was swelling, with redness and pain, on the arm just above the
left wrist. Roentgenograms showed a periosteal abscess of the
radius, without bone sequestration. Pain was increased on pres-
sure. The temperature was 101° F. Short-wave diathermy for
15 minutes, with the 10-meter wave length, was given twice,
after which pain was much less and pus and serum were dis-
charging. T w o further treatments were given with the 6-meter
wave length for 15 minutes, after which the lesion was much
improved and the patient was discharged very much improved
as to his condition. A follow-up examination 5 months later
showed the child to be cured and attending school regularly.
Short-wave diathermy is especially indicated, frequently in
combination with surgery, in those cases in which it is desired
to hasten elimination of the inflammatory processes and se-
questra.
Technic of treatment.—The diseased area is brought into the
electric field by placing the electrodes opposite each other, one
on either side of the lesion. The electrodes should be larger than
the lesion, to ensure the proper effect. It must be repeated here
emphatically that the electrodes should not be placed side by
side, as it is done in diathermy, but that they must be placed
opposite each other, with the lesion between them, in order to
create the strongest electric field, thus ensuring penetration
of bone.
The lower range of wave lengths (4 to 6 meters) is recom-
mended if the lesion is deep-seated. If large bones are involved,
stronger power must be used. The treatment is daily, for from
190 T H E LOCOMOTOR SYSTEM
15 to 25 minutes. Every second day, in chronic cases, is the

recommended procedure after the first 5 or 10 treatments.
T H E JOINTS
Inflammation, traumatic lesions, infections and the changes

caused by these, fall within the range of short-wave diathermy.
From a pathological point of view, the structure of the joints
differs from that of other tissues. One deals, here, with the
capsule, the inner synovial lining, and the bones, which give
varying manifestations of the different processes. For example,
in inflammation an excess of fluid is formed, which fills the joints
and results in fluctuation and effusion. This effusion may be
bloody, as a result of trauma; serous, as in chronic or neuro-
pathic conditions; or purulent, through infection with pyogenic
organisms either directly or through the circulation.
It is a well-known fact that in the different forms of arthritis,
acute or chronic, physiotherapy had always been of primary
importance. To create heat and hyperemia is the guiding prin-
ciple in treatment. Short-wave diathermy enables us to promote
both heat and hyperemia in a relatively simple way. The heat
that is generated is homogeneous, that is to say, it penetrates
evenly through all the tissues of the joint and even the bone.
As Pflomm's experiments have shown, it creates a lasting
hyperemia with the proper analgesic effect. From the experi-
ments of Jorns, Miiller and Lauber, we know that fluid ab-
sorption is markedly accelerated and cannot be brought about
by other physiotherapeutic methods, as for example, dia-
thermy, to the same degree. By its analgesic action, also, short-
wave diathermy facilites physiotherapy of traumatic conditions.
Investigators agree that short-wave diathermy gives the
best results in the acute and subacute inflammations of the
joints, in which diathermy can be used only with extreme
caution and even then with the danger of undesirable reactions.
ARTHRITIS
Schliephake treated the different types of inflammatory

arthritis with satisfactory results. Davis reports a case of in-
fectious arthritis of both hands, treated 3 times a week for 6
weeks. At the end of the course of treatment, pain and stiffness

were entirely gone and the patient was beginning to use her
hands in her household duties.
Weigel treated a case of postpneumonic arthritis of the wrist,
thereby not only preventing the necessity of surgical interven-
tion but achieving cure after a relatively short time, with ex-
cellent ultimate functional result.
Gonorrheal arthritis.—Schliephake, Schittelheim, Davis,
a b
31. Roentgenograms, Showing a Case of Gonorrheal Arthritis
a. Before Treatment by Short-Wave Diathermy; b. After 2 Months' Treat-
ment by Short-Wave Diathermy
Nagell and Berggreen, Kobak and others, report favorably on

short-wave diathermy in gonorrheal arthritis. Pain subsided
quickly, sometimes after the first treatment. This we also noted.
Considering the severity of the pain in this condition, the
alleviation of its severity alone is of great value. The swelling
and inflammation also subside in a relatively short time.
Pflomm treated a gonorrheal arthritis of the wrist in which
the roentgenogram showed distinct changes of the articular
surfaces, and these became entirely normal, with free motion of
the hand, after the course of short-wave diathermy. Especially
conspicuous was the healing of a very serious case of gonorrheal
arthritis of the knee, reported by Vogt, in which function of the
joint was completely restored. Weissenberg reported 2 cases of
gonorrheal arthritis cured by short-wave diathermy: one, with
only a slight swelling of one of the joints of the foot, was cured
in 5 treatments; the other, with arthritis of the right shoulder,
required 40 treatments over a period of 2 months. Motion in the
latter was reacquired only very slowly, but to the full extent.
Weissenberg used the 12 to 15-meter wave lengths.
Graf published an account of 9 cases of gonorrheal arthritis
treated with 14 to 19-meter wave lengths. The ankle joints were
cured after 29 treatments of from 20 to 30 minutes' duration.
He noticed that the foot was swollen after large doses. He suc-
ceeded in curing an elbow-joint infection in 13 treatments and
that of the knee joint in 43 applications.
We also noted swelling of the leg and ankle after prolonged
treatment, of from 25 to 30 minutes, with the 15-meter wave
length, of a gonorrheal arthritis of the knee. This subsided, how-
ever, after further treatments in which the period of exposure
was reduced to 15 minutes.
Laqueur and Remzi obtained improvement in symptoms, or
cure, in 23 cases after a relatively short period of treatment.
In only one case did short-wave diathermy fail to give the usual
favorable result.
A case of gonorrheal infection of the shoulder joint is reported
by Du Bois-Reymond. The arm was fixed in abduction without
active motion and with painful passive motion. Pain on pressure
was very marked. After the first treatment the pain diminished,
and in 20 treatments, in the course of 6 weeks, it resolved com-
pletely. Massage and exercise were soon started, which are also
recommended by Laqueur. This careful and gradual therapeutic
procedure resulted in complete cure, with free motion.
It is obvious from this résumé of reported cases that in
gonorrheal arthritis short-wave diathermy may well be the
therapeutic method of choice. The results are uniformly satis-
factory.
Traumatic arthritis.—According to Lob, quick resorption of
the exudate takes place under short-wave diathermy. Paschetta
believes that short-wave diathermy gives remarkable results in
traumatic arthritis, and that these are the better, the sooner
after the injury the treatment is instituted. He reported 8 cases,
among them contusions, treated at once, which were cured in
from 2 to 3 treatments; his chronic cases were discharged after
from 6 to 12 treatments.
Among our 47 cases of arthritis of varying etiology, we had
3 of traumatic origin with negative roentgenograph^ findings.

All responded promptly to short-wave diathermy, one in 5
treatments and 2 after 4 treatments.
R a a b reports on the impressive results obtained by Noack,
Mannes, Wolf and Schors. Dausset and Delherm were successful
with patients in whom other measures had failed. Among these
were 5 cases of post-traumatic arthritis, with one cured and 4
showing improvement.
Atrophic arthritis.—The author believes that in atrophic
arthritis success is not so general. Nevertheless, improvement
can be achieved, providing the morbid changes are not of too
long standing. Exudative forms are more amenable from the
symptomatic point of view. In cases of atrophic arthritis with
effusion into the joints, Schliephake found that short-wave
diathermy completely relieved the pain after 3 or 4 treatments,
and that motion was greatly facilitated by resolution of the
swelling. Removal of foci of infection was combined with the
short-wave treatment. Last improved a case of atrophic (rheu-
matic) polyarthritis, after 29 treatments of the tonsils. Equally
satisfactory results were reported by Turrell, Schaffler, Herzum,
Dausset, R6chou, Halphen and Auclair.
One of the cases of atrophic arthritis treated by us was as
follows: M . M ., female, 66 years of age, was admitted to the
hospital with impaired function of both knees, accompanied by
pain. She had received a variety of treatments, including
typhoid toxin injections, and diathermy. Her condition, growing
worse, required extension casts, and when no improvement re-
sulted, but rather the contrary, the question arose as to whether
she should be sent to a hospital or home for incurables. After a
5-months' stay in the hospital, short-wave diathermy was given.
The first treatment for 10 minutes, with the 15-meter wave
length, was followed by immediate subjective improvement.
This improvement continued during the course of 6 daily treat-
ments for 25 minutes, with moderate energy. She was then able
to walk with help, remaining on her feet for 20 minutes at a
time. Further improvement with continued treatment, with
stronger doses, took place, and she was able to leave the hospital
after 15 treatments in 17 days, walking without assistance and
with practically no complaints. This remarkable improvement
had been maintained, at the time of writing, for one year. She
has not been taking medication of any kind.
Raab believes that the improvement in subjective symptoms
and in motion is made possible by the resorption of the effusion,
which in turn decreases pressure within the joint, bringing about
greater freedom of motion. Peemoller made a similar observation.
Hypertrophic arthritis.—Although marked improvement
takes place in these cases, it is logically too much to expect that
short-wave diathermy will bring about anatomical changes. The
pain frequently disappears after a few treatments, though oc-
casionally it may be increased after the first treatments, sub-
siding in the course of succeeding sessions.
Davis mentions among his cases one of chronic arthritis in
which the patient was first treated, without definite improve-
ment, by diathermy and massage. Short-wave treatments, in
the course of 2 months, decreased the swelling, and roentgeno-
grams showed great improvement in the joint. Similar favorable
reports are made by Peemoller, Sennewald, Schaffler, and R6zsa.
Last met with success in treating hypertrophic arthritis of the
shoulder, coxitis deformans and spondylo-arthritis.
On the other hand, Rehn states that short-wave diathermy
has been overestimated as to its effects in arthritis. Laqueur and
Remzi, who treated 35 cases of hypertrophic arthritis, using
mostly the 15-meter wave length, reported 5 failures in the
group. Dausset, among his 9 cases of chronic arthritis, cured 2,
improved 5, but failed in 2. Horsch published a statistical sur-
vey covering 160 cases of chronic arthritis; besides the failures,
38.5 percent showed favorable results, with 2 genuine cures;
and 22.6 percent improved in hypertrophic arthritis.
Berry reported the case of a 69-year-old woman with
hypertrophic arthritis of the shoulder, hips, knees and lower
spine, further incapacitated in the right shoulder through a fall.
After a course of short-wave treatment, she recovered the use
of her arm.
We have treated 35 cases of hypertrophic arthritis, and on an
average have secured subjective improvement after the second
to the fifth treatment. The pain was decidedly diminished,
swelling decreased and function improved. With continued
treatment, a great deal of relief was given these patients, al-
though there were a few failures. Those cases in which patho-

logical changes have taken place in the articular surfaces, for
example exostosis formation, could not be favorably influenced.
Among the cases reported by Weissenberg was that of a man, 28
years of age, in whom short-wave treatments, consisting of 155
sessions in the course of 2 years, were given with periodic im-
provement. No damaging effects resulted from the large number
of treatments, but neither were any changes in the deformed
osseous structure observed.
Experience so far is too limited to permit the drawing of
definite conclusions as to the value of short-wave diathermy in
this crippling form of arthritis; but judging by what has been
accomplished, it is fair to say that with further study and con-
tinued development, short-wave diathermy will prove a boon
to such sufferers, especially as an adjunctive measure together
with general medication and the usual methods of treatment.
It has been demonstrated by experience that a number of those
unsuccessfully treated by diathermy were symptomatically im-
proved by short-wave diathermy.
TUBERCULOSIS
Reports of the use of short waves in tuberculous disease of

the osseous tissues are as yet too scanty and scattered for proper
evaluation, and further data are necessary. Furthermore, in a
condition of such serious import, so refractory to treatment, and
so related to other factors, careful observation as well as careful
application of a therapeutic measure is vital for the sake of the
patient, as well as in the interests of science. Some of the re-
ports are so vague that their import is uncertain. Others are
mentioned here primarily for the purpose of indicating the di-
rection in which this work has so far been carried.
In 4 treatments with short-wave diathermy, Heymann re-
ported that he was able to close 5 long-standing fistulas in a
case of rib tuberculosis. Lohrig observed the closing of the fistulas
in a tuberculous joint after 14 treatments of from 6 to 8 minutes'
duration.
Liebesny reported a case of tuberculous tendovaginitis, with
tubercles on the thumb, unsuccessfully treated for 2 years with
roentgenotherapy and other measures. The infection had been
contracted in the course of a post-mortem dissection. Using
short-wave diathermy, Liebesny claims a cure in 2 months, with
complete function of the hand. Two years later the patient was
still free of recurrence. At the International Congress of Radi-
ology, Zurich, 1934, Liebesny demonstrated cases of tuberculous
arthritis in which improvement had been obtained; and Pflomm
and Liebesny believe that certain forms of tuberculous arthritis
can be cured by short-wave diathermy. Nevertheless, in spite of
reports of an indefinite degree of improvement in a few cases,
short-wave diathermy cannot be used generally in this condition.
Lob reported negative results.
Last believes that favorable results can be looked for only
in old fungous tuberculosis of the joints, pain in the healing stage
being favorably influenced. In the other types of tuberculous
arthritis, pain and inflammatory process were increased by this
treatment.
On the whole, it is clear that so far as short-wave diathermy
in tuberculous bone disease is concerned, the question is as yet
unsettled. Short-wave diathermy in this disease should be given
with extreme care, if at all! In chronic cases and even in the
presence of fistulas, the treatment may be of benefit, at least to
clear up secondary infections. It would also be interesting
to learn what results could be achieved in treating tuberculosis
of the joints, if radiotherapy were combined with short-wave
diathermy. In the case of proliferative arthritis, this combi-
nation may give better results. A great deal of experimental data
is required before short-wave diathermy could be used with a
clear conscience in tuberculous lesions.
The main principle of the technic lies in placing the affected

joint between two electrodes, in order to obtain an active effect
of the electromagnetic field. The size of the electrodes should be
governed by the extent of the area to be covered, the electrodes
reaching well beyond the joints. Flexible electrodes can be
adapted to the curvature of the joint, but rigid electrodes may
be used, although they must be placed at a sufficient distance
from the skin surface to avert undue concentration of the current
at one point. In the case of the larger joints, the electrodes should
be placed at a distance of several cm. from the skin, to assure

homogeneous and deep action. Schliephake suggests 3 cm. as
the distance for the elbow and knee, 4 cm. for the shoulder
joint, using a 10-cm. electrode. It is well to place Turkish
toweling as insulating material between the flexible electrodes
and the skin, to secure the required distance. This serves not
only to maintain an adequate distance, but also absorbs per-
spiration, thus avoiding blistering. I t is wise to start with a low
dosage and to raise this gradually. Ten minutes' exposure with
moderate energy, giving the patient a sensation of agreeable
warmth, is a good beginning. The dosage is increased little by
little, to daily exposures of from 20 to 30 minutes each, accord-
ing to the size of the joint. In chronic cases, a series of 10 daily
treatments are given, followed by treatments every other day
or every third day.
Nagell and Berggreen used the 4-meter wave length, and as a
rule gave no more than 10 minutes of treatment at one time.
Some of their patients with gonorrheal arthritis received treat-
ments 3 times a day. Others were treated every second day.
Pflomm, observing lasting effects, on the basis of his experience,
gave treatments every second day in gonorrheal arthritis. The
majority of those reporting their findings used principally the
15-meter wave length (Laqueur and Remzi); Graf used the wave
lengths from 14 to 19 meters, with beneficial effect.
The question of wave length is still unsettled, and it is very
urgent. It's answer must be based on experimental work, bearing
in mind that the short wave lengths penetrate better than the
longer.
Summarizing what is recorded in the literature, it may be
said that in the treatment of joint disease the wave lengths from
4 to 15 meters appear to be those most used. I t is interesting to
note, however, that in one of our cases of atrophic arthritis of
the hand, no improvement took place after 8 treatments with
the 12-meter wave length, but remarkable improvement oc-
curred after a change had been made to the 6-meter wave,
using the same intensity. This may, of course, be purely coin-
cidental, although other authors also have found the 6 to 7-
meter waves more effective.
G E N E R A L COMMENT
The fact should be emphasized that local short-wave dia-

thermy will be of benefit only in cases of mono-arthritis—since
only the treated joint responds to the measure—unless the entire
field of disturbed function can be covered by the electrodes,
as in the case of hands or feet. This would apply especially in
atrophic and hepertrophic arthritis, which are considered to be
systemic, rather than local disorders. The disturbances of endo-
crine function at the age of involution have a bearing on this.
Thus electropyrexia may have a stimulating effect upon the
endocrine system.
Judging by reported results, it would seem that favorable
effects are achieved in traumatic arthritides, apparently satis-
factory results in the gonorrheal arthritides, and immediately
beneficial symptomatic results in atrophic arthritides. As to the
final results, nothing can be definitely stated, as too short a
time has elapsed since short-wave diathermy was adopted and
applied, and as the follow-up work is necessarily insufficient.
It is not at all improbable that several courses of treatment at
intervals will be found necessary in individual cases, a procedure
which, according to observations, is harmless.
In the hypertrophic arthritides, satisfactory symptomatic
relief has been obtained, without, however, influencing the
changes in the joint which had been already established. Arrest
of the disease process is questionable. A longer follow-up period
may throw light upon this point.
In the mono-arthritides, from 6 to 30 or more treatments for
from 20 to 30 minutes each are necessary to achieve curative
or palliative results.
In polyarthritis, electropyrexia may be more successful. It is
advisable also to supplement short-wave diathermy by the
customary adjuvant measures.
The warning should be reiterated to use short-wave dia-
thermy in tuberculous arthritis with extreme care and under
strict supervision, as its curative function here is as yet open
to question.
TRAUMATIC I N J U R I E S
Injuries resulting in hematoma, sprain, and in lesions of the

soft parts may be affected favorably, both symptomatically and

functionally, by short-wave diathermy.
Laqueur and Remzi, and Lob, reported quick organization
and absorption of hematoma. I have also made this observation.
Effusion into the joints and extravasation of lymph are readily
removed by this treatment. Turrell found short-wave diathermy
beneficial in sprains of the wrist or ankle. Early traumatic
arthritides and peri-arthritides may be cured by a few treat-
ments. This is also true of infected wounds and lacerations,
which are cleared up in a short time.
In all cases of trauma, examination is necessary before short-
wave treatment is begun, in order to exclude those lesions to
bones and tendons which may require surgical or orthopedic
repair.
Berry reported a case with somewhat dramatic features.
A 58-year-old woman received an injury to the anterior wall of
the thorax, with extensive bruising and extravasation on the
median aspect of both breasts and with tenderness and swelling
over the sternum. Daily treatments of 15 minutes' duration re-
sulted in a "dramatic disappearance" of the extravasation, sug-
gesting the possibility of achieving a similar result in the case
of injuries of the joints. Peculiarly enough, the author con-
tinues, the patient's symptoms of chronic cholecystitis, with
which she had suffered for years, disappeared entirely during
the course of treatment.
XIV
D I S E A S E S OF T H E NERVOUS S Y S T E M
IN THE therapeutics of diseases of the nervous system, any agent

or procedure which holds the possibility of causing organic
injury must be used with caution. This holds true of short-wave
diathermy, which should not be used indiscriminately and with-
out cautious approach. It should be employed only after thor-
ough study of the individual case and the indications for this
treatment, and with care as to technic. Results are as yet by no
means conclusive. The material is scattered; in some instances
only isolated reports have been published, although Krojl
presented a study of 260 classified cases. A good deal of study
will be required before the place for short-wave diathermy in
diseases of the nervous system will be adequately appraised.
NEUROSYPHILIS
In the field of fever therapy, it is clear that the greatest

praise goes to investigators in the United States. Fever therapy
of syphilis has been under investigation for some years. Recently,
electropyrexia has come to take the place of other forms of
artificial fever, with interesting and promising results. Experi-
mentally, Carpenter and Boak cured by short-wave diathermy,
rabbits inoculated with syphilis. Hinsie and Carpenter were
then the first to use the measure in clinical cases of general
paralysis. The valuable work of Bierman, Hinsie and Schwarz-
schild is well known to the medical profession. Local application
of short waves to the nerve centers in general paralysis was tried
for the first time by Schliephake. He directed the treatment to
the center of the lesion, by placing the electrodes on the head for
an hour daily. He used an apparatus of high output and em-
ployed the 12-meter wave length. The patients experienced a
sensation of pleasant warmth. This direct application made it
possible to giv& a treatment that was more agreeable and less
THE NERVOUS SYSTEM 201
strenuous than electropyrexia. The oral temperature did not

rise above 100° or 101° F. He found that his patients did extra-
ordinarily well and that their weight increased during treatment.
In the case of tabetic patients, examination showed the pupils
rigid, and the patellar and ankle reflexes absent. After treatment
over a period of 3 weeks, the eyes and reflexes were normal. This
method could be combined with specific medication. In the crises
of tabes, Krusen found short-wave diathermy to fail completely,
while Kronfeld observed temporary amelioration of the pain.
Pieper, after applying weak currents for 6 minutes, found that
he could dispense with analgesic medication. The crises of
tabes, according to Schliephake and Weissenberg, can be spaced
further apart in some cases through short-wave diathermy.
Halphen, Auclair and R6chou treated 500 cases with partially
beneficial results, as reported by Schliephake.
In general paralysis, Kauders, Liebesny and Finaly experi-
mented with short-wave diathermy. Kauders worked with 5
patients. He used the 15-meter wave length with round elec-
trodes 18 cm. in diameter, and gave up to 30 treatments varying
in duration from 20 to 30 minutes. The patients were in the ad-
vanced stage of the disease, with memory and intelligence al-
ready suffering from the malady. Owing to the limited number of
cases treated, no definite conclusions can be drawn, but the
impression is gained that in certain cases remission can be
brought about. The temperature during treatment rose by 0.3°
to 0.8° F.
Kauders and others believe that a not inconsiderable effect
of short-wave treatment in the paralytic process is the effect it
exerts on the cerebrospinal fluid, both during and after treat-
ment. A definite increase in total albumin is noted. There is also
a marked rise in the number of cells. This lasted for several
months after the conclusion of the treatment. The globulin
reaction and the Pandy and Nonne-Apelt reaction were much
more pronounced after the treatment than in the case of patients
treated with short waves for other disorders.
Notwithstanding these pronounced changes in the cerebro-
spinal fluid, suggesting a meningitic process, the patients showed
no symptoms pointing to meningitis or meningeal irritation,
and were in no way disturbed in their general well-being. The
202 T H E NERVOUS SYSTEM
improvement, however, lasted only a few months. Within a year

2 of the patients died, and necropsy revealed evidence of old
extravasation in the dura. This should serve as a warning against
the careless use of short-wave diathermy.
In his book, Liebesny described a case in which the first
treatment was for 20 minutes and the succeeding treatments
(29) for 30 minutes. In 5 other cases the treatments did not ex-
tend beyond 20 minutes each. The average increase of tempera-
ture was 0.5° to 1° F.
Short-wave diathermy, with the dosages and method used
today, shows a tendency to clear and absorb the infiltration, but
the paralytic process in the cortex is not influenced. The serious
disturbances in the meninges and vessels, which result from
short-wave diathermy at great intensities, are apparently
irreparable.
Wagner-Jauregg believes that it is erroneous to ascribe the
effect of malaria therapy exclusively to the hyperthermia which
is induced thereby. There are successes with malaria therapy in
which no rise in temperature has taken place. Consequently, he
thinks, it is not the fever that brings about cure. This view
seems to be supported by the results of tuberculin and staphylo-
coccus vaccines, the administration of which does not cause fever.
It is still an open question, both as to diathermy and short-
wave diathermy, whether they cure through hyperthermia only.
Wagner-Jauregg suggests combining these two forms of treat-
ment with specific antiluetic therapy, in order to promote
beneficial results. He believes that it is still too early to give a
final opinion as to the possibilities of short-wave diathermy in
general paralysis. Further studies should, however, be pursued,
with larger numbers of patients and adequate controls.
Wagner-Jauregg refers to Schleiphake's experiments in at-
tacking the disease in its location in the brain by treating the
head. Beneficial results might come from such a procedure.
Netjritides
Schliephake, Lob, and Laqueur report favorable results ob-

tained with short-wave diathermy. Among the cases treated
were some which did not respond to diathermy and other physio-
therapeutic methods. It is known that in acute cases, as well as

occasionally in chronic cases, diathermy may result in aggrava-
tion of the condition. According to Laqueur, painful reactions
are rarely observed after short-wave diathermy, and when they
do occur they are transitory. The homogeneous even heat
generated by short waves acts more effectively upon the dis-
eased nerve, whereas in the case of diathermy, the current circu-
lates in those tissues which have the best conductivity.
Ravault and Ceccaldi and Weissenberg, had best results with
weak doses. On the other hand, Raab states that good results
can be obtained only with apparatus of high output, which
secure deep penetration and even, deep heating of tissue. He
further maintains that failures can t e attributed to weak
dosages. In acute cases, it is well to follow the recommendation of
Weissenberg, that is, weak doses in the beginning, which
may be increased according to the patient's reaction.
Authors agree that acute sciatica responds better and quicker
to short-wave diathermy than the chronic form. In obstinate
cases the usual physiotherapeutic measures are recommended
in combination with short-wave diathermy. Weisz treated several
cases, and Peterson 90 cases, with beneficial results. Of 20 cases,
Kroll reports 16 improved after an average of 15 treatments
lasting 15 minutes each.
In stubborn cases of sciatica, which had been resistant to
other forms of treatment, Lob achieved success with short
waves. In cases of recent onset, he advises careful treatment to
begin with, with weak dosage, in order to avoid undesirable re-
actions. The dosage is gradually increased. Even in some cases
showing changes roentgenographically in the fourth and fifth
lumbar vertebra or in the lumbosacral joint, short-wave dia-
thermy gave satisfactory results.
Last observed favorable results in sciatica and trigeminal
neuralgia under local application of short waves, and stated that
no unfavorable after-effect was observed over a long follow-up
period.
Schliephake is of the opinion that local treatment of sciatica
is not enough to achieve adequate results, and suggests electro-
pyrexia for the lower part of the body, including the legs. This
procedure should secure results also in chronic and refractory cases.
204 THE NERVOUS SYSTEM
Laqueur and Remzi, using the 15-meter wave length for 15
minutes daily, found short-wave diathermy effective in 22 cases
of neuritis. They failed in only 3 cases.
In our own clinical experience, it was difficult to decide as to
the advantage of local short-wave diathermy over other thera-
peutic methods. We treated 18 cases of neuralgia, with improve-
ment in 50 percent and cure in 25 percent. It should be noted,
however, that most of the cases were referred for short-wave
diathermy after other customary medical and physiotherapeutic
methods had failed.
The technic for sciatica is the same as for other conditions,
that is, the electrodes should be placed opposite each other
with the tissue between, and not both on the same side of the
body, as in diathermy. Ravault, Kroll and Ceccaldi place the
electrodes upon the point of emergence of the sciatic nerve from
the spine, the electrodes thus being in an oblique position in the
sacrogluteal region. Raab recommended treating the thigh and
leg separately. Wertheimer, following this procedure, obtained
satisfactory results.
Pitzen used the 15-meter wave length with success in sciatica,
by treating across the leg. He remarks that treating the length of
the leg might be even more successful. This is questionable, as
the effect of this procedure would be analogous to that achieved
by diathermy.
Kroll claims cures in 7 cases of neuralgia of the lumbosacral
plexus, which had been treated on an average 18 times.
Miiller and Stiebock treated 32 cases of neuritis with their
special method, and suggest further experimentation along
this line. In chronic neuritides they used the 10-meter and even
shorter wave lengths. The treatments lasted from 3 to 5 minutes.
One of the electrodes was a head plate, applied to the specified
part of the body. The other was a brush electrode, which they
passed along the diseased nerve route, alternately pressing down
and lifting the brush. Although the patients complained of dis-
agreeable internal heat, the authors maintain that this method
generates no noticeable heat within the body. The brush elec-
trode caused a little scorching and burning of the skin, in fine
points. These disappeared after a few days.
In acute neuritis, these authors used a wave length of from
50 to 60 meters. They firmly maintain that no heat effect is

generated, but suspect that a special electric effect is responsible
for the curative action. Plate or ring electrodes were used.
Pitzen was entirely unsuccessful in his attempts to cure or
ameliorate intercostal neuralgia, which was a consequence to
scoliosis, and finally concluded that his failure lay in the ana-
tomical compression of the nerve by the bony structure. Kroll
achieved satisfactory results in 2 out of 3 cases of intercostal
neuralgia, with an average of 18 treatments of 10 minutes'
duration.
Hoffman treated brachial neuralgia by placing the electrodes
on both elbows with the arms in abduction, this promoting con-
duction. Of 22 cases of this type treated by Kroll, only 4 were un-
successful. The treatments averaged 10 in number, and were 10
minutes in duration. The group included some which were com-
plicated by palsies of rheumatic origin.
In trigeminal neuralgia, short-wave diathermy may result in
irritation occasionally, and in such cases it is well to interrupt
treatment by a lapse of a few days. Kroll reports 12 cases, of
which 7 were genuine trifacial neuralgia, receiving from 6 to 25
treatments of an average of 10 minutes each (preauricular ap-
plication). These reacted as follows: definite improvement in 6,
in 2 of which short-wave diathermy had to be resumed within
3 months. Of 3 cases of trifacial neuralgia, with arteriosclerotic
basis, 2 were improved. Of 13 cases of palsy of the facial nerve of
rheumatic origin, all recovered after short-wave treatments
(average 26 in number), the largest number of treatments given
in any one case being 46, and the smallest 10.
Dietrich found that cure can be achieved in from 60 to 70
percent of cases of trigeminal neuralgia, while in intercostal
neuralgia this figure can be raised to 90 percent. Liebesny had a
case of trigeminal neuralgia, which, after being reported cured
by 6 treatments, recurred in 6 weeks, and could not be influenced
by the same dosage as before.
Schweitzer found that in the acute neuralgias some cases
will respond to very small doses, others will react with increased
pain; and he concludes that the treatment with short waves
must be individualized.
206 T H E NERVOUS SYSTEM
Weissenberg states that polyneuritis, and trigeminal,

brachial, occipital, and intercostal neuralgias, respond well to
weak doses. Kroll recommends electropyrexia in polyneuritis, as
giving better results than local treatment to different parts of
the body. It is his opinion that the traumatic neuritides respond
best of all to this form of treatment. Raab collected data on
cases reported, from which he finds that in neuritis the cures
amount to about 60 percent of the cases, with improvement in
10 percent and failure in 30 percent.
Kroll's technic is to use the 4-meter wave length, with from
1.5 to 2.5-cm. air-spacing. Each treatment is of 10 minutes'
duration, except in very sensitive patients, for whom the treat-
ments are limited to 5 minutes.
MIGRAINE
A number of investigators, among them Babin-Chevaye,

Drouet, Liebesny, Schliephake and Weissenberg, are of the
opinion that in true migraine short-wave diathermy gives the
best results of any form of treatment, especially if the migraine
is of angiospastic origin. The headaches frequently stop after
one treatment for 10 minutes, and in a few cases it is necessary
to give another treatment the following day.
Drouet reports 7 cases in which definite and complete cure
was achieved in a majority with from 4 to 15 treatments.
The action of short waves is essentially one of vasodilatation,
which explains the rapid and sometimes immediately palliative
effect during treatment. Though definite cures are reported,
permanent cure depends upon the extent of the pathological
changes in the diseased area.
No damaging effects on the brain were observed after this
treatment. It is reported that the patient may be dizzy for a
few minutes, but this subsides completely. This is attributed to
the hyperemia induced in the brain and its covering.
The technic is simple. The head is placed in the fronto-
occipital position, between two electrodes. Moderate intensity is
recommended and the duration of the treatment may be from 10
to 15 minutes. The patient will experience an agreeable sensation
of warmth. The treatments are given twice weekly.
Schliephake recommends the 15-meter wave length as giving
the best results. Liebesny advises avoidance of the short wave
lengths, on the ground that they may be too irritating to the
brain. We cannot agree with this view, as we treated numerous
affections of the nose and eyes with 6, 8, and 10-meter wave
lengths, the brain here being necessarily treated also, because of
the position of the electrodes; yet we noticed no signs nor
symptoms of deleterious effects. Some of our patients fell asleep
during treatment, but no disagreeable effects were observed. It is
important, however, not to prolong the treatment beyond 25
minutes, and not to use too great intensity.
MISCELLANEOUS N E R V O U S CONDITIONS
A few isolated reports of the use of short-wave diathermy in

a variety of diseases of the nervous system are available.
Saidman noted improvement in the paralysis following
poliomyelitis, and this without a rise in the temperature.
In encephalitis, Schliephake observed improvement in the
chronic phase of the languor, apathy, drowsiness and muscular
rigor, but the tremor remained unaffected. Schaffler-R6zsa im-
proved 3 cases of chronic encephalitis. Groag-Tomberg observed
the symptoms subside after 35 treatments with the 3-meter
wave length, for 15 minutes daily.
Becker and Kronfeld, and Hayer, met with encouraging re-
sults in multiple sclerosis. Weissenberg also note improvement,
especially where spasm was present. The condition of one
patient, who had great difficulty in walking, so improved that
he could ride a bicycle. Spontaneous remission, however, cannot
be excluded as a possibility.
At the Fourth International Congress of Radiology in Zurich,
1934, Delherm and Devois discussed the use of short waves in
hemiphlegia. They achieved favorable functional results, using
large electrodes for 20 minutes at a time, with a very weak
current. Cases were described in which the function of the hands
was restored sufficiently to permit writing and sewing.
Among the experiments reported are those of Hoff and
Weissenberg, who used the 15-meter wave length with electrodes
of different sizes, to treat the brains of patients. They observed
a vagotonic and a sympathicotonic effect, which may, at a
subsequent treatment, either be absent or be the reverse of
what it was, according to the varying sensitivity of the indi-
viduals. Thus the more pronounced effect appeared on the side
on which the smaller condensor had been placed, owing to the
denser field, even though patients were conscious of greater heat
increase on the side with the larger plate. With glass condensor
electrodes, the air space between plate and head was at least
0.75 inches, and one to 4 amperes was used.
These authors treated the cerebellum and the frontal lobes
of normal patients, and found that the arms which had been
held forward, swung during the treatment to the side opposite
the smaller electrode. These and similar experiments point to an
influence exerted by short waves on the function of the brain.
IMPAIRMENT OF MOTILITY
In contrast to the action of the faradic and galvanic current,

the high-frequency current does not irritate the motor or sensory
nerve endings. Nevertheless, Weissenberg on occasion observed
muscular cramps during treatment, after intensive doses of
short waves. In cases of facial palsy, Kellner observed muscular
contractions on the palsied side. Dausset saw regression of the
symptoms of palsy in hemiplegia. Weissenberg treated such
cases with weak doses of short waves and noted improvement.
Cures in facial palsies, after 5 or 6 treatments, have been re-
ported. Stefanesco and Georgesco treated 6 cases with success.
They gave daily treatments with short waves for from 20 to 25
minutes, and after from 15 to 18 days short-wave diathermy was
combined with galvanization. Short-wave diathermy should be
started on the day of the onset of the disease.
The palsied muscle groups of the extremities do not recover
in any wise differently after short-wave diathermy than they do
after other methods of treatment (Weissenberg).
PARKINSON'S DISEASE
There are reports in the literature, including Weissenberg's

18 cases, in which short-wave diathermy improved the symptoms
of Parkinson's disease. Akinesis especially yielded to treatment
well, and tremor and drooling could be controlled with 10 or
more treatments of the head.
SYRINGOMYELIA
Less favorable results than in Parkinson's disease were ob-

served by Weissenberg in syringomyelia.
EPILEPSY
Longer intervals of freedom from attack were achieved in

some cases, and in a few the attacks were completely eliminated,
according to Weissenberg, through treatment of the cervical
sympathetic or treatment of the head (8 to 15 treatments).
Others report similar results.
MENTAL D I S E A S E
Among 8 cases of melancholia treated with short waves,

Weissenberg observed 2 successes. The head was treated, in one
case 25 times in 10 weeks.
Dementia praecox.—Horn treated 10 cases of dementia
praecox with 15-meter waves, by exposing the brain for 20
minutes for a course of 30 treatments. Results were essentially
negative, but necropsy was performed on 2, who died 8 and 10
months' after the termination of treatment. The findings showed
that, although there was a clearing up of the infiltration, this
was only in the most superficial cortical layers. Under the cortex,
the pathological process continued unchecked.
Horn believes that the effect of short waves on the cerebral
vessels is mostly a specific effect on the sympathetic. Neverthe-
less, in his patients the oral temperature rose as much as 1° F . ,
though he hopes to be able to avoid this with changes in technic.
Of course, the rise in oral temperature is not indicative of a rise
in brain temperature.
BRAIN ABSCESS
Schliephake successfully treated a case of brain abscess, the

improvement being evidenced in a decrease in the number of
leucocytes; the duration of treatment was 4 weeks. It may be
that short-wave diathermy will prove beneficial, especially in
cases of multiple abscesses.
HICCUP
Weissenberg was able to arrest singultus in 6 cases, with one

short-wave treatment, after the hiccups had lasted from a
number of hours to 14 days. The treatment, 10 minutes in
duration, was directed to the occipital region and to the upper
abdomen. This author failed in one case of postoperative
singultus. This beneficial effect is on the vegetative nervous
system.
URINARY INCONTINENCE OF NERVOUS ORIGIN
In 5 of 6 cases of urinary incontinence due to multiple

sclerosis, syphilis, traumatic hematomyelia, enuresis nocturna
(spina bifida) and a neuropathic state in general, patients were
free from recurrence after short-wave diathermy directed to the
bladder-sacral area. An average of 18 treatments were given and
with a few exceptions, all the patients were relieved.
NEUROMA
Kroll believes that the inflammatory type of neuroma, for

example amputation neuroma, is amenable to short-wave dia-
thermy.
COMMENT
For a true evaluation of the place of short waves in the treat-

ment of diseases of the nervous system, much more study and
experience is required. Short waves may be used in weak dosages
of longer wave lengths, combined with other therapeutic agents.
The treatment may aid in promoting cure by its hyperemic or
analgesic effects. In general, it seems that in some cases weaker
energies give better results than stronger energies. This applies
especially to those cases presenting acute conditions.
XV
MISCELLANEOUS CONDITIONS
D I S E A S E S OF T H E S K I N
THE success of short-wave diathermy in infections of the skin

has been ascribed to several factors, chief among which is the
marked vasodilatation which is the immediate result of the
application of short waves. The increased circulation increases
phagocytosis. Incidentally, there is the antitoxic and bactericidal
effect which assists the organism in combating infection.
FURUNCLE*
Although as a rule most furuncles are cured by conservative

treatment, there are cases with marked inflammation and
eventual abscess formation which require surgical intervention.
It is in this type of case that short-wave diathermy has proved
to be of particular benefit, as a simple and mild form of treat-
ment.
In the past 6 years, Schliephake has treated more than 500
cases of furuncle and furunculosis, of greater and lesser severity.
He reports only 2 failures, attributable to the patients them-
selves. The cases were unselected, just as met with in general
practice. The average number of treatments required were from
2 to 6, and the average time until cure was effected was 4.6
days. Pflomm stated that short-wave diathermy induced cure
on an average in 6 days, whereas the normal healing period for
the lesion under ordinary conditions is 13 days. In the follow-up
examinations no recurrence was observed. Hoeffler and Weissen-
berg reported rapid cures, with smaller doses, in children.
Schliephake, Raab and others noted that by treating only a
few furuncles, the remainder were apt to subside spontaneously.
*Arch. Physiother., XVI (1935), 587-94.
212 MISCELLANEOUS CONDITIONS
I t was also found that chronic recurrent furunculosis was cured,
after treating periodically-recurring furuncles, and a follow-up
record, in some cases of some months and in others of years,
showed no recurrence.
This may lend support to the hypothesis that absorption
from furuncles treated by short waves, induces some sort of
autovaccination which prevents recurrence. A number of in-
vestigators, including the present author, favor this view.
Schliephake thinks that the dead and dying bacteria give rise to
a form of autoinoculation. For example, in the case of furun-
culosis, one can observe a definite shrinking and regression of a
whole group of smaller boils, after treatment of a single large
furuncle or carbuncle. For this reason, it would seem advisable
to subject furuncles with abscess formation to short-wave
diathermy, if there is no emergency, even if surgical intervention
is contemplated. This holds good also for axillary abscesses.
In the case of facial localization of furuncles, especially on the
lip and nose, short-wave diathermy without doubt gives the
best results, since it lowers the mortality and the danger of
serious complications. The danger inherent in labial and nasal
boils is well known. The infection may invade the cavernous
sinus, by way of the vena angularis or vena ophthalmica
superior, with fatal outcome. Because of the possibility of such a
serious complication, the tendency has been toward a conserva-
tive treatment, since the operative mortality has been given as
between 5.5 and 30 percent, according to different authors. For
this reason, short-wave diathermy proves to be a peculiarly
efficacious measure. Liebesny, out of a series of 81 cases of facial
furuncles, reported one death of meningitis, or 1.2 percent. His
cases were localized as follows: lower lip, 7; upper lip, 30; nose,
24; chin, 14; forehead, 2; cheek, 4. In some cases the tempera-
ture, already high, rose to higher levels after the first short-
wave treatment and fell after the second and third. As a rule,
the inflammatory process was arrested and pain usually de-
creased after the first treatment. The redness subsided and
became demarcated after from 2 to 4 treatments. This was also
the case in furuncles of the auditory canal. Although the lesion
may not proceed to suppurate, a relatively quick abscess forma-
tion was frequently observed. This evacuated spontaneously,
MISCELLANEOUS CONDITIONS 213
or was drained through an incision best performed by electro-

cautery or electrosurgery. Where no distinct fluctuation was
present, short-wave diathermy alone was sufficient.
In the infiltrative stage, the infiltration may soften and re-
sorption may take place without discharge. The pain and tumor
usually subside after the first or second treatment. After a few
treatments, the skin becomes loose and wrinkled and quick
regression is observed. For a few days the skin may be a bluish
or brownish-red, gradually fading to normal, without tenderness
or sensation of tension.
In those cases in which a core has developed, surrounded by
inflammation and with edema or abscess, and in which surgery
is usually resorted to, the throbbing pain and tension will sub-
side after the first or second treatments with short-wave
diathermy. After from 12 to 24 hours, demarcation of the inflam-
matory area is observed. The lesion may acquire a dull bluish-
brown color, gradual resolution of the edema follows, with soften-
ing of the entire infiltrated area; abscess formation around the
core is moderate, and there is spontaneous elimination of the
core, accompanied by a small amount of purulent, seropurulent
or serosanguineous discharge. With subsidence of the inflam-
matory process, healing takes place in an average of from 2 to 5
treatments, in from 4 to 6 days and, after the pathological
process is terminated nothing remains but a small scab over
what was the necrotic focus.
In the case of furuncles of a more advanced stage of develop-
ment, which are already softened and where an abscess has
formed, the pus is spontaneously evacuated after or during, the
first treatment, and healing takes place with unusual rapidity in
2 or 3 days. In severe cases, healing is quicker if the affected
parts of the body are immobilized until the inflammation dis-
tinctly subsides. As a rule, patients are not prevented from pur-
suing their usual occupations or the routine of their daily lives.
A few illustrative case reports from our material follow:
1. Furuncle of the buttock.—The patient, female, 50 years of
age, came for treatment on October 8, 1934, stating that she had
suffered from boils since June 15 of that year. Surgery had been
resorted to several times, and an anesthetic had been required
for the opening of one boil in the gluteal region.
Clinical Findings.—A large furuncle of a week's duration
was situated on the left border of the anal and gluteal region,
and was so painful that it interfered with walking, sitting and
sleeping. The skin was red and edematous over an area 2 inches
in diameter. In the center of the lesion was a small scab. On
palpation, the entire area was tender and infiltrated, and sligKtly
fluctuant in its midportion. One treatment was given with the
6-meter wave length for 10 minutes, followed the next day by a
second treatment. There was decided subjective improvement,
32. Furuncle of the Chest Wall

a. Before Treatment by Short-Wave Diathermy; 6, Four Days after Treatment by Short-
wave Diathermy (6-Meter Waves)
and only slight pain. The area of infiltration was diminished

and of a dark bluish-red. Three more treatments were given,
with gradually diminishing inflammation and infiltration. A
moderate amount of serous discharge necessitated a small
dressing. Six days after the first treatment, all that remained
was a painless area of infiltration under a small scab. The patient
was discharged as cured. No further furuncles developed during
the following 6 months. No recurrence was observed and a fine
pin point of scar indicated the site of the original lesion.
2. Furuncle of the neck.—Dr. F., 63 years of age, presented a
large furuncle on the left posterior side of the neck, which had
developed 4 days before. He complained of throbbing pain and
tenderness, radiating to the shoulder and the occipital region.
Clinical findings.—The inflamed and infiltrated area was
about 1.5 inches in diameter. After the second treatment with

short-wave diathermy, using the 6-meter wave length for 15
minutes, the subjective symptoms subsided. There was no pain,
although tenderness to palpation and on motion continued. The
inflammation became localized, with central fluctuation and
pointing. After the fourth treatment, the core was extruded
with a slight amount of pus. The lesion was slightly tender to
the touch, and an area of infiltration about 0.75 inch in diameter
remained. After two further treatments, the infiltration and
tenderness disappeared; and after a sixth, only a bluish-red area
about one inch in diameter, circling a small scab, gave evidence
of the former site of infection. The lesion healed completely in
three weeks, without surgical intervention and with a practically
invisible scar. The healing in this case was unduly prolonged as
the patient came for treatment spasmodically, neglecting it
whenever subjective relief had been obtained.
3. Furuncle of the face.—A.B. female, 23 years of age, de-
veloped a painful furuncle 3 days after a pimple had been ma-
nipulated. When first seen, the left side of the cheek had been
swollen for a day and the patient was unable to speak or to eat
in a normal manner. The left chin area and cheek were swollen
and red. Near the left angle of the mouth was an infiltrated area
about one inch in diameter, surrounded by an edematous area
of about 1.5 inches. From the center of the lesion, pus exuded
from a small sinus. Short-wave diathermy was given for
15 minutes, and the patient reported relief from pain 6 hours
later. The next day the swelling had decidedly diminished, with
a slight seropurulent discharge. After the second treatment, on
the third day, the swelling had subsided completely. The inflam-
matory area was about 0.75 inch in diameter, and there were no
subjective symptoms. Altogether, 3 treatments were given,
using the 6-meter wave length for 15 minutes, and the patient
was discharged. The pathological process subsided in 5 days,
leaving first a reddened area which cleared up in a few days,
and finally only a scar about one mm. in size.
4. Furuncle of the right lower arm.—T.W., boy, 11 years of
age, had undergone splenectomy 3 years before for throm-
bocytopenic purpura, and gave a history of having had 15 trans-
fusions on different occasions, to control bleeding.
Clinical findings.—There was a painful tumefaction on the
right lower arm, of 2 days' duration. The proximal radial third of
the lower arm was red and edematous, over an area about 21
inches in diameter. The area of infiltration, about l j inches in
diameter, had a bluish hue, with the core showing in the center
as a small yellow point. There was tenderness on palpation, but
no fluctuation could be detected. Because of the history of
purpura, operation was considered inadvisable. A first treat-
ment with the 6-meter wave length, for 15 minutes, was given,
and on the following day edema and inflammation were con-
siderably diminished and, although tenderness to touch was still
present, the pain had subsided. The lesion was discharging and
about 1 cc. of sanguineous pus, followed by moderate bleeding,
could be obtained by gentle pressure. A second treatment was
given, and on the third day there was no further pain, with only
slight edema and localized inflammation around the discharging
sinuses. An ecchymotic ring, about 1.5 inches in diameter, was
noted around the lesion. A third treatment was given, and 2 days
later there was no sign of inflammation, and only a slight area
of painless infiltration topped by a small scab. The ecchymosis
gradually faded. Cure was accomplished within 5 days, with 3
treatments.
5. Furuncle of the sacral region.—G.M., female, 61 years of
age, a diabetic, suffered from a furuncle on the lower back. The
lesion was of 5 weeks' duration. It had discharged periodically
and had grown more extensive. The patient was unable to lie in
bed because of the pain. Inspection revealed a red infiltrated
area about the size of an apple, not discharging, but tender to
the touch. Following the first 2 treatments with short waves,
the lesion was smaller and softer and less tender to the touch.
Fluctuation was absent, but there was very slight serous dis-
charge. Two more treatments were given with the 6-meter wave
length, for 15 minutes each, and these effected a complete cure.
The only lesion remaining was a small area of painless infiltra-
tion with a small scab in the center. There was no recurrence
while the patient was under observation, a period of 3 months.
6. Furuncle of the left eyelid.—E.S., female, gave a history of
swelling and pain of the left eyelid and eye, of 3 days' duration.
On the left upper eyelid was an area, one inch in diameter, that
was red, swollen and edematous. The patient was unable to

open her eye. The eye showed conjunctivitis and an area of
infiltration 0.5 inch in diameter, with a yellow spot in t"he center.
The glands in the pre-auricular region were swollen and tender.
Following 2 treatments with short waves, the pain decreased and
the edema subsided, but the original lesion increased in size,
inflammation was more distinct and fluctuation was present. A
small incision was made under local anesthesia, and about 4 cc.
of pus removed. Two days later the swelling and inflammation
had subsided completely, and the 2 incised wounds showed
healthy granulations. In this case operation was indicated, to
relieve the patient and to promote prompt healing.
These selected cases give a clear picture of the effectiveness
of short-wave diathermy in promoting healing of furuncles.
We gain the impression that the conservative treatment of
furuncles, with the aid of short waves is a decided advance over
methods hitherto employed. Short-wave diathermy is a simple
method, with no attendant dangers, and in most cases it renders
surgery unnecessary. Nevertheless, as we have stated, in certain
cases it may be necessary to make a small incision in order to
quicken the healing process, and to facilitate evacuation. In our
51 cases of furuncle, it was necessary to incise (by lancet) only
twice. These were instances in which abscess formation was
present, inconveniencing the patient by its size or location.
When surgery is employed, its conjunction with short-wave
diathermy shortens the time of recovery.
Furuncles in the auditory canal are rapidly relieved by short-
wave diathermy. We observed relief from pain after one or 2
treatments, and complete regression of the infection in from 2 to
6 treatments, over an average period of 4 days. The 6-meter
wave length was used for from 10 to 15 minutes, and surgical
intervention was unnecessary in 8 cases. According to Ruete,
electropuncture, in addition to short-wave diathermy, may be
necessary in some cases.
Technic of treatment.—The method of applying the current
for furuncles is relatively simple. The electrode should cover the
lesion and the surrounding inflamed area. In order to obtain the
best electric field for curative purposes, electrodes of differing
sizes may be used, a smaller one on the lesion and a larger for
the opposite pole. This will result in greater concentration of the
electric field in the affected area. In the treatment of furuncles,
the Tomberg unipolar application may also be usefully employed.
Should the lesion to situated on anatomically prominent
parts, for example the tip of the nose, then rigidly fixed elec-
trodes with proper air-spacing may be used to advantage.
All the wave lengths within the range of short waves
may be successfully used. Schliephake, Raab, Last and the
present author prefer the 6-meter wave length, or the 12 to 16-
meter wave lengths. Schliephake and other investigators believe
that the 8 to 12-meter wave lengths are not so effective.
If there has been faulty technic, for example if too strong a
current has been employed in order to obtain a marked heat
effect, a mild degree of heat coagulation of the superficial
cutaneous layers may occur. This is characterized by a bluish-
red discoloration of the area surrounding the furuncle. In such
an event, healing is prolonged to 8 or 10 days, without, however,
any deleterious effects resulting.
If there is a concomitant lymphangitis, this will regress
simultaneously with the healing process in the main focus of
infection. Should there be an accompanying regional lymph-
adenitis, it will also yield to the short-wave diathermy directed
toward the involved area. If the affected glands are near the
principal lesion, the cure of both may be accomplished by a
single series of short-wave treatments.
There appear to be no contraindications. The patient treated
with short waves does not exhibit marked secondary effects. On
the contrary, the method is definitely indicated in cases in which
surgery is not without its dangers, that is, in diabetics and in
hemophilia.
CARBUNCLE
The von Seemen treatment of extensive and severe car-

buncles destroys the infection through electrocoagulation. This
leaves a clean granulating surface, after from 7 to 12 days,
which is ready for the plastic procedures of skin transplantation.
Very often the treatment of carbuncles with short waves is a
simpler and milder method, shortening the duration of the
affection and causing fewer complications, if instituted in time,
as evidenced by a statistical survey of the literature.
In the early stages, when only infiltration with tenderness is

present, resolution may take place, as in the case of a furuncle,
after irom 3 to 5 treatments. But where extensive necrosis is
evident, the wound clears after an average of from 6 to 8 ap-
plications, and is then covered with fresh healthy granulations.
It goes without saying that where fascia and muscle are involved,
the healing period is longer, even though distinctly shortened by
short-wave diathermy, as compared with the course of healing
under other forms of treatment.
Scar formation takes place quickly, owing to the stimulating
biological processes by this form of therapy. This therapeutic
agent is especially recommended for use in diabetic patients.
Raab describes a man, 72 years of age, with a carbuncle on the
neck, measuring from 4 to 6 inches in diameter. This case was
treated unsuccessfully with light therapy, protein injections, and
other measures. The temperature was 102° F., and the patient
was in an unsatisfactory condition generally. After the second
treatment with short waves, the lesion began to regress, became
softer and, after 1'4 treatments, clear healthy granulations, with
subsequent cure, ensued. Raab believes that in this case short-
wave diathermy was a life-saving measure.
Certainly there are cases in which it is wiser to combine
surgery with short waves, in order to hasten healing. Two cases
from our own material illustrate this point. A young man, 28
years of age, gave a history of suffering for 6 days from a
carbuncle 2.5 inches in diameter and situated on the neck. The
patient's average temperature was 99.9°F. On November 10,1934,
the first short-wave treatment was given, after which the
patient's temperature returned to normal and he felt com-
fortable. Two days later, an abscess had formed, with distinct
fluctuation, but not markedly tender. As resorption could not
be expected, an incision 1 cm. long was made with the electric
knife with coagulating current. About 10 cc. of pus was dis-
charged. Culture showed staphylococci. Two days later, the
patient had no pain nor discomfort. At the point of incision was
a small granulating wound, with slight serous discharge. The
patient was discharged next day, after having had four short-wave
treatments, with the lesion showing a small area of infiltration,
covered with a dry scab over the site of incision. Follow-up ex-
amination 12 days after the beginning of the treatment showed
that a complete cure had been effected.
T h e other case was that of a man 45 years of age, with a
furuncle and a carbuncle of the neck, and who gave a history of
having been suffering for 3 months from the lesions in this
locality. He had been operated upon several times for these
periodically recurring infections. The present carbuncle had
caused him much suffering for about two weeks. It presented an
infiltrated red area with edema, about two inches in diameter,
with several yellow cores in the central portion. The urine was
negative for sugar. Two short-wave treatments in two days were
given, with improvement in the subjective symptoms. Daily
treatments were continued, with further local and general
improvement. After the fifth treatment, the lesion was no longer
discharging and the reddened area of infiltration was reduced to
0.5 inch and was no longer tender. The lesion was entirely healed
in 7 days. T h e treatments were from 10 to 20 minutes in dur-
ation, using the 12-meter wave length. Five days after discharge,
the patient returned with an inflamed area on the chest, two and
a half inches in size, slight elevation of temperature, the general
picture suggesting a new streptococcus infection about the right
breast. This lesion was cleared and healed in 4 days under short-
wave diathermy. While this lesion was under treatment, a fresh
lesion appeared on the neck, on the site of a scar from a former
surgical intervention. I t became swollen and very tender. After
2 treatments, it opened spontaneously, evacuating about one cc.
of purulent matter. T h e next day there was an abscess, with
distinct fluctuation in this area, and lymphadenitis on the cor-
responding side of the neck. This patient developed a subfacial
abscess, which gave him a great deal of discomfort. I t was in-
cised 1 cm. by electrosurgical incision with the coagulating cur-
rent. Without further drainage, this resulted in the evacuation
of 5 cc. of sanguineous-purulent material. Treatment for 6 days
with short waves resulted in a cure. The lymphadenitis subsided
after 2 treatments. Three other cases healed readily in from 10
to 15 days, with short-wave diathermy and without surgical
intervention. Had no recurrence during the 6-month follow up.
Pain is quickly relieved after 2 or 3 treatments, as a rule. In
Liebesny's 15 cases of carbuncle of the neck, cure took place in
between 8 and 14 days. Schliephake, on the basis of an extensive

series, found that large carbuncles heal in from 10 to 20 days,
after from 8 to 15 treatments, without surgical intervention.
Lob observed increased inflammation of the carbuncles
treated, with aggravation of the condition, which was attributed
by Schliephake and Weissenberg to overtreatment. Lob also
believes that short-wave diathermy should not be employed in
acute surgical infections, in fact, that the measure may be
dangerous to the patient and the surgeon. He compares the
action of short waves to hyperemic treatment of pyogenic in-
fections, and states that, as such, the treatment may result in
increased exudation. Through the increased tissue tension within
the bacteria and the toxins may penetrate to the adjacent deeper
tissues. He believes, therefore, that it is important to open
widely and to drain the diseased area.
Cases may be observed in which overdosage occurs easily
when the protective powers of the surrounding tissues are de-
stroyed. Hence, instead of supporting the organism, short waves,
in such instances, may become destructive. After a survey of
reported cases, however, we find that such aggravation clearly
could not be attributed to the short-wave diathermy. Also, there
are unquestionably cases in which proper surgical drainage is
indicated, in conjunction with short-wave diathermy. I t is there-
fore desirable to employ short waves only under the supervision
of thé surgeon, who should decide the proper time for inter-
vention.
It should be noted that the treated area will often show an
increased redness after the first or second treatment, giving a
picture of "increased inflammation" which is apparent, not
actual. The patient's subjective symptoms are improved, even
when a rise in temperature for a day is observed.
Judging by reported results in the literature and by our own
cases, the treatment of carbuncles by short waves impresses us
as being eminently satisfactory. It is a mild, conservative form
of treatment, giving quick comfortable resolution of the lesion,
even in cases of diabetes, in which it is particularly indicated,
simultaneously with the control of the sugar content of the
urine and the blood.
Nevertheless, in certain cases, after a deep abscess has
formed, drainage quickens the healing process, and to this end
a small incision should be made, preferably by electrosurgery or
cautery, while continuing short-wave diathermy. The healing
of the lesion after short-wave diathermy is very satisfactory
from the cosmetic point of view, as only small scar points remain
where the cores were situated. The decision that surgical inter-
vention is indicated is a matter of judgment and experience.
Technic of treatment.—This is the same as for furuncles. It is
a good plan to cover the entire inflamed area with one of the
electrodes, and to prolong the time of exposure from 15 to 25 or
30 minutes daily. Two different electrodes should be used, the
smaller one covering the diseased area, the larger one placed on
the opposite side of the body. The electrodes can be placed on
the head without harmful effect. Greater concentration in the
electric field in the diseased area may also be obtained by placing
the electrode closer to the surface of the diseased area than on
the opposite side. The Tomberg method of unipolar application
can also be used in such treatments. It is important to obtain
an even exposure, with stronger doses than in the case of
furuncles. The more severe the condition, the longer the treat-
ment should last, but by no means should it exceed 20 or 30
minutes. Usually from 5 to 8 treatments, of from 15 to 20
minutes daily, will suffice to bring about healing. The recom-
mended wave lengths, as suggested by different investigators,
are 4, 6, 8 and 12 meters.
In the cases of large carbuncles, progress is less rapid, but
resolution invariably takes place and the temperature subsides
to normal after a few treatments.
AXILLARY SWEAT-GLAND INFECTION AND ABSCESS
As every practitioner knows, pyogenic infection of the axil-

lary sweat glands is sometimes obstinate to treatment. Many
measures are employed, cure eventually following. Roentgeno-
therapy and vaccines have also been used with success. In
complicated cases, recurrences are common.
Since the advent of short-wave diathermy, this form of
treatment has been acknowledged, by those who have used it,
to be superior to any other form of treatment. Early infiltration
is resorbed after from 3 to 5 treatments. If abscesses have
formed spontaneous evacuation with quick healing may follow

from one to 3 treatments. Tenderness usually subsides after the
first or second treatment, and the inflamed areas decrease in
extent and become limited. Sometimes there is distinct shrink-
age of skin over the lesion. In other cases swelling may be in-
creased, and tenderness may become more acute until sponta-
neous rupture occurs. Some patients, more sensitive than others,
cannot bear pain well. In such cases, opening the abscess may
be advisable, using high-frequency cutting (coagulotomy) or
cautery for drainage, in combination with short waves.
Electrosurgical or electrocautery incision of abscesses is ad-
vised, for one thing, to prevent dissemination of the infection in
the surrounding tissues. A second reason is that the wound
edges are thus covered with a film of coagulated tissue. Granu-
lation being delayed in this manner, the wound remains open
until the abscess is discharged. The slower healing of the wound
edges prevents untimely closure and clogging, therefore drainage
can be omitted. Short-wave diathermy should be continued until
complete healing takes place, in order to preclude recurrence.
This is assured, when no infiltration or pathological changes are
present. Scar formation is avoided by this form of treatment.
Estimates by various authors give a healing time 50 percent
shorter by short-wave diathermy than by other methods.
Healing depends to some extent upon the stage and severity of
the lesion, but usually it takes place between 3 and 14 days, after
from 2 to 10 treatments. Rarely, from 14 to 21 days are necessary
for cure. Immobilization of the arm shortens convalescence.
Liebesny reported a series of 26 cases, in which from 14 to 21
days were required for cure. In the follow-up examinations,
recurrences are rarely observed.
Technic of treatment.—Special electrodes, on the same prin-
ciples as those employed for furuncles and carbuncles, are used
for axillary abscesses. When both axillae are affected, the
electrodes may be placed in both, but they are usually treated
separately.
Capaldi found that only the 8-meter wave gave him results.
It proved effective in one case in which the 4 and the 15-meter
waves had been without result. He stresses the fact that the 4
and the 15-meter waves generated more heat than the 8rmeter
wave, and draws the conclusion that the benefit in the latter
does not rest in its heating effect. We cannot agree with this
observation, since we obtained our best results with 6, 12 and
14-meter wave lengths. We are under the impression that in
superficial infections, such as axillary abscesses, the wave length
is not of primary importance.
The time of application varies from 10 to 30 minutes, de-
pending upon the character of the lesion.
PARONYCHIA, CELLULITIS, AND OTHER INFECTIONS

OF THE EXTREMITIES
Short-wave diathermy has been found very useful in pyo-

genic infections of the extremities. In early cases of paronychia
and allied infections, quick resolution follows after 2 to 3 treat-
ments. The infection regresses and, if pus is present, slight
spontaneous discharge may be observed before healing takes
place. In some of the more advanced cases, it may be possible
not only to arrest and cure the infection, but also to save the
nail. If the nail has already separated, it should, with the sur-
geon's advice, be removed, after some treatment with short
waves has been given. If there is deep involvement of the soft
parts, short-wave diathermy may not bring about retrogression
of the infection, but only a localization of the process.
In the event that pus has collected and no further improve-
ment is evident from short-wave treatment, drainage (by elec-
trosurgical incision) and evacuation of pus will be necessary,
similar to the procedure carried out in axillary abscesses.
On the whole, cure is achieved in a shorter time with short-
wave diathermy than with other measures and, if bone is in-
volved, sequestration occurs earlier than it does otherwise.
Schliephake found that he had to intervene surgically in only
3 cases, in a series of several hundred pyogenic infections of the
fingers. It seems to us, however, that surgical intervention is
indicated definitely in cases showing tendon necrosis or bone
sequestration, and that the simultaneous administration of
short-wave diathermy has a tendency to arrest the progress of
infection. The demarcation of the sequestration is also acceler-
ated by short-wave diathermy. A few illustrative cases follow:
(1) Dr. H., surgeon. His injury was sustained in the course
of operating. Pain and inflammation had been present for two
days. The skin around the thumb-nail was red, swollen and
tender to touch, in an area about 2 cm. in diameter. After
the first short-wave treatment, the pain diminished, and after
the second, definite demarcation of the infection took place,
followed in 12 hours by the discharge of a small amount of sero-
purulent material. Three days after treatment, there was a
small bluish-red area without symptoms of infection, which
cleared up quickly. This was a case of cure after 2 treatments,
with the 6-meter wave length, of 15 minutes' duration.
(2) Mrs. R. P. There was a history of pain and inflam-
mation around the nail of the right fourth finger, of 6 weeks'
duration. A small amount of seropurulent material was dis-
charging from around the nail bed. Iodoform gauze packing was
inserted, but after a few days the lesion showed no improvement.
Two treatments, 10 minutes in duration, were given, with the
6-meter wave length, after which the pain and discharge sub-
sided. Cure was effected with the third treatment, 4 days after
the commencement of short-wave diathermy.
(3) Mrs. A. S. Paronychia and cellulitis. The history was
of a splinter, penetrating beneath the thumb nail. This the
patient removed in part. She complained of intense, throbbing
pain. The whole thumb was swollen, red, edematous and very
tender to the touch. Around the nail a large phlegmonous bulla
was exuding pus. The temperature was 101.6° F. The patient
was admitted to the hospital for operation, but this she refused.
Short-wave diathermy was begun on December 14, 1934, using
the 6-meter wave length for 20 minutes. The throbbing pain
stopped at once. The patient slept well that night, and the pain
decreased markedly. The next morning there was only slight
pain without discomfort, decreased swelling, and no elevation of
temperature. Examination of the hand revealed distinct fluctu-
ation on the palmar surface, suggesting deep involvement and
tenovaginitis. Tenderness was localized around the first phalanx.
A second treatment was given the next day, with the same wave
length and for the same time as the first. Improvement con-
tinued and the temperature remained normal. The patient left
the hospital and did not return for further treatment. She was
visited at home two weeks later, and stated that she had not re-
turned because the finger "did not hurt." The finger was normal
in appearance, but still tender to pressure around the first
phalanx. Gradual resolution followed, with ultimate normal
function.
Kowarschik, Last, Stieböck, von Köhler, Nagelschmidt and
others confirmed Schliephake's favorable results. On the other
hand, Haas and Lob consider it dangerous not to intervene
surgically. We incline to the view that short-wave diathermy in
these infections should be under the supervision of the surgeon,
who will know best when surgical intervention is indicated.
In the case of a specific infection, such as syphilis or tuber-
culosis, a favorable influence can be exerted by short-wave
diathermy, in combination with the proper specific treatment
(Liebesny).
Technic of treatment.—With wave lengths around 6 meters,
treatments daily or even twice daily, for 15 or 20 minutes, are
recommended, according to the extent and severity of the lesion.
The average case may be cured in from 2 to 15 treatments, de-
pending upon the gravity of the individual case. The average
time of cure is from 3 to 16 days.
PHLEGMON
Short-wave diathermy of this diffuse inflammation of the

connective tissue leads almost without exception to resolution
or to localization in abscess, after from 2 to 5 treatments. If the
abscess is considered by the surgeon to be too large for spon-
taneous resorption under short-wave treatment, a small electro-
surgical incisions to promote drainage is justified. Surgical
intervention, in conjunction with short-wave diathermy, should
be instituted in progressing phlegmonous infection of the sub-
cutaneous and soft tissues and intermuscular spaces.
Case report: Mr. C. C., 68 years of age, with phlegmonous
cellulitis (streptococcus), gave a history of having been operated
upon a month before for extensive cellulitis of the right thigh.
The wound showed no tendency to heal. Among other forms of
treatment, the patient had received treatment with ultraviolet
light. When first seen, the entire lateral side of the right thigh
was red, infiltrated, and tender to the touch. There were 2
sinuses, from the previous incisions, about one-half inch in
diameter, discharging seropurulent material.
The first treatment, lasting 15 minutes with the 12-meter
wave length, was given January 23, 1935, and the patient pro-
fessed to feel comfortable following the treatment. After the
second treatment, on the next day, the discharge became more
serous in character. Following the third treatment, 2 days later,
the wound was granulating, the infiltration was softer, and there
was less discharge. A fourth treatment was given on the next
day, and a fifth 2 days later. Erythema localized around the site
of the previous incision. There was no more discharge. The
wound was covered with a dry scab. The patjent was discharged
as cured in 7 days, and follow-up examination verified and sub-
stantiated the cure.
Another case illustrating the control of diabetic infections by
short-wave diathermy, without surgical intervention, is the fol-
lowing. The patient, female, aged 62 years, cut her hand with a
knife. A week after the injury, the wound area showed pus and
was swollen and painful. In one of the New York hospitals,
a small incision was made and a wet dressing applied. The
urine was not examined. Within the next 2 days, the infection
became more widespread and several pustules appeared on the
wrist and the back of the hand. When the patient came under
my care, three weeks after the injury, there was on the palm
a large phlegmonous lesion and 16 pustules on the wrist and
M I S C E L L A N E O U S CONDITIONS 229
back of the hand, measuring from one-half to one cm. in di-

ameter. The urine gave a 4-plus reaction for sugar (fig. 35).
The first short-wave treatment lasted 15 minutes, with the
6-meter wave. The number of pustules increased every day up
to the sixth short-wave treatment, until there were in all 29.
Two weeks later, after the tenth treatment, there was decided
improvement. Complete cure took place in 3 weeks.
35. Palmar Abscess in a Diabetic

a, Before Treatment by Short-Wave Diathermy; b, After Treatment by Short-Wave Diathermy
Though there may not be anything unusual in this case, I

considered it of interest because the patient refused all further
surgical intervention as well as blood examinations. We were
able to control the infection without treatment of the diabetic
condition.
Animal experiments show that short waves directed to the
central nervous system may increase the blood sugar for a time.
They are without such effect when applied to other parts of the
body, except the pancreatic region. In the latter case, the effect
is a definite decrease of the blood sugar, after an initial slight
increase.
In presenting this case, which is of relatively slight scientific
value, the thought suggests itself that it might stimulate interest
for further investigation and research in the problem of diabetic
infections, as influenced by short-wave diathermy.
Laqueur and Remzi also reported that they were successful
in all cases of phlegmon treated with short waves.
Technic of treatment.—In treating phlegmonous infections,
the recommended wave lengths are 6 and 14 meters, for from 15
to 25 minutes' duration, depending upon the depth and the
extent of the infection, short-wave lengths being more effective
in deeply seated infections. The entire affected area should be
covered with the electrode, beyond the pathological process.
The other electrode is placed opposite, and from 0.5 to one
inch distant from the skin surface, in order to secure greater
concentration in the electric field in the area treated. Dosages
are regulated by the patient's subjective sensation of comfort-
able warmth.
It is wise, in the case of discharging wounds, to place a sheet
of cotton or gauze or, better still, a piece of Turkish toweling
between the electrodes and the skin, if flexible electrodes are
used. This makes no difference in the therapuetic results, and
has the advantage of keeping the electrodes clean and avoiding
skin burns, which may occur if the electrode gets wet. If the
secretion from the wound is sufficient to soak through the in-
sulation, the treatment should be interrupted long enough to
change the insulating material. Rigid electrodes may be used
with greater advantage, where sufficient airspacing prevents the
above inconveniences. In no event should adherence to surgical
principles be slackened.
COMMENT
In none of our acute, subacute or chronic cases could we

attribute aggravation of the infection to short-wave diathermy.
We treated some cases with short waves alone, and others with
short waves in combination with surgery. With our experience,
limited though it is, we could substantiate the observations of
investigators reporting in the literature. We also gained the
impression that in the case of infection, short-wave treatment
should be considered before other treatment is instituted. This is
especially true in the infections such as furuncles, carbuncles,

erysipelas, paronychia, cellulitis of the body or extremities, etc.,
in which surgical intervention may thereby be rendered un-
necessary. Our experience in the case of suppurative tenosyno-
vitis is as yet too limited to justify an estimation of final results,
but it would appear that a combination of short-wave dia-
thermy and surgery would be most effective. Short-wave
diathermy, in addition to rendering surgery unnecessary at
times, also shortens the period of convalescence, the patients
suffer less, and the cosmetic and functional results are more
satisfactory.
Finally, short-wave diathermy is an excellent agent in the
hands of the surgeon, but may prove a dangerous tool in the
hands of one without surgical experience.
MISCELLANEOUS DISEASES OF THE SKIN
Aside from the successes reported with short-wave diathermy

in furuncles and carbuncles, the favorable results obtained in
other skin disorders, although reports are not extensive, would
indicate that with further study short-wave diathermy should
become a valuable addition to treatment in this field.
While treating a patient with furunculosis with short waves,
Schliephake observed that the concomitant eczema healed in a
short time. Further employment of this measure in eczema sub-
stantiated the observation. He succeeded either in curing or in
improving eczemas of varying etiology, in a relatively short
time. Many cases of long standing, which showed no improve-
ment under local and dietetic treatment, were improved after
2 or 3 short-wave treatments, and cured after from 2 to 10.
In a series of 12 cases, 9 were cured and 3 improved. In one case
it required 25 treatments to produce results. The lesions, with
few exceptions, cleared up in from 2 to 10 treatments. Weissen-
berg also cured exudative eczemas, in the course of treating
other affections with short waves.
Auclair and Réchou recommended electropyrexia in gen-
eralized eczema. Auclair reported one case cured and 2 improved
in eczemas of unspecified origin. We treated a case of generalized
allergic eczema, of 4 months' standing, with short-wave dia-
thermy. The lesions covered the body, particularly the abdomen
and legs. The patient was unable to sleep because of the intense
itching. For 15 treatments, however, only the lesions on the chest
and one area on the leg were exposed to the short waves. The
patient professed himself improved, the skin was dryer and there
was less itching. It is possible that in this case generalized
electropyrexia would have resulted in cure. Saidman and Cahen
observed improvement in different types of eczema, in chronic
ulcers and in lupus.
Meyer and Saidman recommended short-wave diathermy in
the different forms of pruritus. In one case of pruritus vulvae,
they obtained a beneficial result after 3 treatments, but they also
state that the treatment did not modify the course of the dis-
order in chronic cases.
Dausset and Auclair mention having improved seborrheic
conditions of the scalp. They observed the regrowth of hair in 6
cases, and also arrested the falling out of the hair. These results
may be attributed to an improvement in endocrine function, as
in these cases generalized short-wave diathermy was admin-
istered. These observations may be considered exceptional, and
the author doubts whether such experiences will be repeated.
Pflomm, in the course of treating various pathological con-
ditions of the skin, observed in 2 cases that patches of psoriasis
disappeared after from 3 to 4 treatments, extending over a
period of 10 days.
Remier reported improvement of scleroderma, following
short-wave diathermy.
In acne vulgaris, Schliephake obtained lasting beneficial re-
sults with this form of treatment. In acne vulgaris refractory to
the unusual forms of treatment, we had one success and 2 fail-
ures. Rahlwes observed some favorable results, as well as some
failures, in cases of acne of the face. Last recommends short-
wave diathermy in acute acne vulgaris, and Last and Stein
advocate this treatment in pubertal acne and acne of endocrine
origin. From 15 to 40 treatments were necessary, using the 6-
meter wave for from 25 to 30 minutes, before improvement was
obtained. The acne of bromism disappeared without incision,
within one week after short-wave diathermy was commenced.
No lasting improvement was observed in acne rosacea.
Rapid resolution of herpes zoster after short-wave diathermy
was observed by Saidman, Bretschneider and Compère. This

was also noted by us, in 2 cases. Ruete obtained satisfactory re-
sults in erythema nodosum and in pernios. There are favorable
reports for syccosis vulgaris.
Mahn was able to achieve complete cure in a case of X-ray
burn, after prolonged short-wave diathermy at weekly intervals,
in treatments of 30 minutes.
Technic of treatment.—In localized conditions, the diseased
area is placed between suitable electrodes, which should cover
the affected parts. Longer wave lengths are recommended—12,
14, 16, 25 meters—except where treatment of lymph nodes is
desired, in which case wave lengths of from 6 to 8 meters are
used. In a case with a generalized disease condition, electro-
pyrexia may be better than local short-wave diathermy.
D I S E A S E S OF THE H E A D
INFLAMMATORY DISEASE OF THE SINUSES

Sinusitis, as every medical practitioner knows, may be one of
the most obstinate conditions he is called upon to treat. With
the advent of short-wave diathermy, an effective measure with
which to combat this affection and to bring comfort to the
harassed patient, has been added to the physiotherapeutic
armamentarium. Short-wave diathermy alone, or its combina-
tion with irrigation, has proved to give most beneficial results,
and to curtail to a marked extent the duration of the disease
(Raab, Hiinermann, Haiman). It has frequently rendered
radical intervention unnecessary, and has proved effective in
cases which had failed to respond to other forms of treatment.
While it is, of course, left to the judgment of the specialist
whether or not to use short-wave diathermy in conjunction with
the customary therapy, it is not unusual to effect a cure without
the latter. We are under the impression that short-wave dia-
thermy should always be tried first in acute, subacute or chronic
cases, before surgical drainage is undertaken.
As compared with diathermy, the main advantage of short-
wave diathermy is the equal, uniform field—local heat action,
penetrating the bony walls of the cavities, whereas diathermy
merely hurdles them.
That the resorptive power of the mucous membrane of the
sinuses is stimulated, becomes evident after a few treatments.

The nasal discharge, even if present in large amount, begins to
diminish after a few treatments. Control examination, with
transillumination and roentgenograms, demonstrates a gradual
diminution of the clouding until normal conditions are restored.
Empyema of the antra and adjacent sinuses is a source of
misery to the victim and taxes the skill and ingenuity of the
physician. It is exceedingly difficult to treat effectively and,
even after radical operation, it often recurs or spreads to neigh-
boring cavities. Schliephake believes that in this field short-
wave diathermy proves a boon. Unquestionable benefit was
achieved in a case of empyema of the ethmoid sinus, which had
proved resistant to every other form of treatment. He reported
a case of antral empyema of more than 20 years' duration, in
which complete comfort for the patient was achieved after a
series of treatments with short waves. A 6-meter wave was used
for a half hour daily at first, with the plates applied to the right
and left cheeks. In this type of case, the obnoxious odor generally
disappeared in from 6 to 10 days, and the incessant use of
handkerchiefs was rendered unnecessary, since the secretion of
pus was so markedly reduced. In from 4 to 6 weeks, these
patients were nearly symptom-free. Schliephake states, "At any
rate, the patient can be spared an operation but it cannot be
expected that a mucous membrane which has undergone severe
pathological changes in the course of suppuration can be com-
pletely restored to its normal functional capacity."
After a few short-wave treatments, the diminishing purulent
secretion changes to a mucous discharge, signifying the improve-
ment in the pathologic condition. The sensation of dryness also
improves readily. Swift amelioration is especially conspicuous
in the acute forms.
In chronic cases with mixed infection and in which degenera-
tive and proliferative changes have taken place in the mucous
membrane, the most troublesome symptom, in addition to
headaches, dryness, localized pain, and changes in resonance of
the voice, is the foul purulent discharge, which may become
continuous. Some of the patients are disabled physically and
become unwelcome socially. In cases of this type, short-wave
diathermy proves a boon, relieving subjective and objective
symptoms. Improvement, to the extent of 50 to 75 percent,

occurs after from 6 to 15 treatments, depending upon the
severity of the individual case. The nasal secretion is diminished,
the purulent discharge is converted into a mucous discharge,
and the foul odor practically disappears. Pain usually disappears
gradually, and only exceptionally at the very start. Severe pain
may persist for a longer period, but with eventual relief. It must
be admitted that complete cure cannot be obtained in all cases,
even after prolonged treatment, but at least palliative results
can always be achieved, with proper applications of short waves.
Schmidt and Leichner,* reporting results of short-wave
treatment of sinus disease in 55 cases, noted marked improve-
ment in 39, moderate improvement in 11, slight in 2, and total
failure, even as to relief of pain, in 3.
According to Liebesny, chronic inflammation of the sinuses
reacts better to the 8-meter than to the 15-meter wave length.
Although exact comparison of results by short-wave dia-
thermy and other radical and conservative measures is as yet
out of the question, the balance seems to favor short-wave
diathermy. A not insignificant factor is the painlessness and
comfort of the method to the patient. Peemoller's results with
short-wave diathermy were better than with diathermy. In-
vestigators are practically unanimous in their view that this
therapeutic measure is the most effective agent, and one that
frequently renders surgical intervention unnecessary. Failures
occur, just as with any other therapeutic measure. It should
be borne in mind that patients exhibiting symptomatic relief or
cure are not necessarily cured of the pathological condition, and
treatment should be continued until the roentgenograms show
clear sinuses and until irrigation results in a clear fluid.
As an illustrative case report, the following may be presented.
This was one of our patients, an 18-year-old girl, suffering from
chronic pansinusitis. She had undergone several operations and
had been under regular treatment in Europe and the United
States for 10 years. When short-wave diathermy was started,
she was using 15 handkerchiefs a day for the excessive san-
guineous-purulent discharge. Her voice was nasal in pitch and
she had continuous headaches. After 6 treatments with the 6-
•Personal communication to the author.
meter wave length for 15 minutes at a time, the discharge was

reduced to mucopus only in the morning. After 12 treatments in
a period of 3 weeks, there were no more subjective complaints,
her voice was clear, and there was a slight, clear mucous dis-
charge. The treatments were continued twice weekly, then once
weekly, for 4 weeks. Three months after discharge, the patient
appeared to be well, but was instructed to return at once for
further treatment in the event that she contracted a cold. An
occasional symptomatic treatment was given, until all symptoms
36. Roentgenograms, Showing Multiple Chronic Sinusitis

a. Before T r e a t m e n t by Short-Wave Diathermy; b. Twenty-five days after Treatment b y
Short-Wave Diathermy (In 27 D a y s There Waa Great Improvement; in 6 Months the Patient
Waa Symptom-free)
subsided. She had altogether 3 courses of treatment during the

year, with prompt relief, and has been well for the past 10
months.
We obtained a cure in our 15 cases of acute sinusitis in from
4 to 8 treatments. Of 39 cases of chronic sinusitis, temporary
cures were obtained in 30 percent after from 8 to 24 treatments,
definite symptomatic improvement in 60 percent, and failure in
10 percent. It should be noted that our cases were, in the
majority, those referred from other clinics, after other treat-
ments had proved unsuccessful.
Aggravation of subjective symptoms.—Schliephake, Haiman

and Raab succeeded in curing a large number of cases with
short-wave diathermy alone. His observations bear out our own,
that is, that after the first or second treatments the patient's
subjective complaints may be somewhat aggravated, but that
this is followed by gradual improvement under continued treat-
ment. In our own cases, where the patient presents symptoms of
slight aggravation, the short-wave diathermy is continued as
before, except at a lessened intensity. Raab also describes a
case in which, toward the end of the treatment, the patient
experienced neuralgic pain around the sinuses—"healing pain"—
which subsided with further treatment. This may be ascribed to
the reaction of the mucous membrane of the sinus. Experience,
however, makes it possible to vary the length and intensity of
the applications so as to avoid the inconvenience and unpleasant-
ness of these secondary symptoms.
Technic of treatment.—The electrodes should be molded to
the nasal surface, in order to avoid undesirable current concentra-
tions. Special sinus electrodes, which cover all the sinuses, thus
assuring adequate and even field action without covering the eyes
or interfering with respiration (fig. 22c), were recommended.
The sinus electrode is applied with a proper lining, to insure
absorption of perspiration. Another large electrode is placed in
the occipital and shoulder region, or the electrodes are placed
on the cheeks. The treatment at first is for from 10 to 15 minutes
in duration, and is then increased to from 15 to 25 minutes. In
acute cases the patient is treated every day until definite im-
provement sets in (50 percent), usually after from 3 to 10 treat-
ments, after which the treatments are given every second day
until the patient is practically free of symptoms. In cases in
which the maxillary sinuses are involved, the electrodes are
placed at both cheeks, in which case air-spaced rigid electrodes
may be used to advantage. If air-spaced electrodes are used, the
frontal or ethmoidal sinuses are treated in the anteroposterior
position, using a smaller electrode to cover the disease area, this
having an air-space smaller than that of the opposite electrode.
This assures current concentration at the desired level. The air-
spacing may vary slightly, in accordance with the output of
the machine and with the location of the diseased sinus.
In maxillary sinusitis, the rigid electrodes are applied in
opposition, cheek to cheek, on the principle outlined above.
Should there be a concurrent tonsillitis or pharyngitis, the
neck electrodes may be used (fig. 22); or these infections might
be treated separately. But rigid electrodes are more convenient
to use.
In chronic cases the same procedure is followed as for the
acute type, at first daily, and after improvement has begun,
every second day. As a general rule, the acute form is cleared
up in from 4 to 8 treatments. Chronic cases, however, will re-
quire longer treatment, usually from 8 to 30 sessions. In such
obstinate cases, Raab recommends that after the fifteenth
treatment, treatments should be given only every second or
third day. Schliephake considers the 4 to 6-meter wave lengths
as the most effective in acute and chronic sinusitis. The wave
lengths used in our cases were 6, 8, and 12 meters. An effort
was made to use each of these 3 wave lengths in cases as similar
in character as possible, the purpose being to determine thereby
the most effective wave length in the acute and chronic cases.
With the exception of 2 cases of chronic sinusitis, the patients
thus treated did not in general complain of symptoms which
could be attributed to short-wave action. These 2 patients com-
plained of more intense headaches and refused to return for
further treatment, in spite of urging. The results are very
promising, although adequate follow-up records over a long
period are still lacking.
Recurrence.—Recurrence may take place after fresh exposure
to infection, which, however, will respond favorably to short-
wave diathermy; and it is possible to bring the patient's con-
dition to the pre-infection level by a short course of treatment.
DISEASES OF THE EYE
On the basis of experimental work, short-waves are reported

as being indicated in atrophy of the optic nerve and in corneal
ulcer (Babin-Chevaye), on the assumption that there is a deep,
lasting hyperemia and revitalization of the tissues. Indeed
Jacquet was able to observe marked vasodilatation after short-
wave diathermy on ophthalmoscopic examination, and in one
case noted hemorrhage which cleared without grave results.
Although Kiewe's experiments on enucleated animal eyes and

on living guinea pig eyes showed that heating of the posterior
pole is stronger and that coagulation temperature may be ob-
tained with resulting damage to the eye, such effects have not
been noted clinically where short waves have been used in treat-
ment. Nevertheless, the danger of possible damage should be
kept in mind. Kiewe could not improve tuberculous processes in
the eye, but found short-wave diathermy beneficial in scleritis.
E. von Kohler and Hertenstein experimented on animal eyes,
studying the deep effect of short waves. Griiter inoculated
guinea pigs' eyes with standardized herpes virus, and observed
delayed evolution of the keratitis on the first to second day, but
failed to secure lasting favorable result. He treated 22 cases of
superficial serpigenous ulcer with short waves, with healing
within 6 days in 17 cases, leaving soft scar tissue. Among the
more advanced cases, 2 healed and 3 remained uninfluenced.
He concluded that the superficial lesions reacted more favorably
than the deep.
Orbital phlegmons generally receded quickly after short-
wave diathermy. Krause found this treatment uniformly suc-
cessful in phlegmon of the lacrimal sac and in inflammatory
processes of the eyelids.
Gutsch recommends short-wave diathermy in all types of
iridocyclitis, tuberculous lesion, inflammatory disorders and
palsies of the ocular muscles, but reports failure in corneal dis-
ease, scleritis and glaucoma.
Short waves seem to increase the fluid exchange of the eye,
and after more intense treatment this takes the form of a
fibrous exudate.
The treatments were given daily for 20 minutes, for from 4
to 7 days. If a more powerful apparatus is used, the doses should
be of shorter duration. The electrodes must be kept dry, and
protected against the moisture of lacrimation; otherwise, acci-
dents may occur. Air-spaced electrodes are preferable.
DISEASES OF THE EAR
Reiter successfully treated cases of otitis media. It seems to

us that in the presence of distinct pressure, paracentesis, in
conjunction with short-wave diathermy, is indicated to prevent
complications; this should naturally be decided by the specialist.

With a few treatments, A. Laszlo* cured a case of catarrhal
otitis, and 6 cases of furuncle of the auditory canal, in 4 days on
an average, and without a failure. In otosclerosis, and all catar-
rhal conditions short-wave diathermy may be of benefit.
MASTOIDITIS
A number of authors have reported favorable results with

short-wave diathermy of mastoiditis, among them being Last.
There may be cases of moderate severity, in which this measure
alone will induce cure, and it should reduce the inflammatory
process in all cases. But our experience to date does not permit
conclusions to be drawn, although favorable results have been
obtained. Further observations are necessary by the specialist,
to establish the exact point at which short-wave diathermy can
be used with benefit.
MASTITIS
Inflammatory conditions of the breast are readily amenable

to short-wave diathermy. According to Hoeffler, mastitis neona-
torum can practically always be cured by short-wave diathermy,
if subjected to daily treatments from of 3 to 5 minutes' duration.
Mastitis may be acute, subacute or chronic, and short-
wave diathermy may prove of benefit in each type. In the acute
and subacute forms the inflammatory process and the infiltra-
tion may be checked in a relatively shorter time than by other
methods. Consequently, either resolution or abscess formation
will take place.
When a small abscess has formed and the general condition
of the patient, as judged by the surgeon, will not necessitate im-
mediate surgical intervention, short-wave diathermy will reduce
the inflammation, decrease the edema, and localize the patho-
logical process, with a gradual absorption of pus. If the purulent
accumulation is such as to necessitate immediate drainage, this
may be achieved by a small electrosurgical incision. In super-
ficial abscess insertion of tampons is not required during the
continuation of the short-wave treatments. There may be cases,
however, especially with deep-seated abscesses, in which a rub-
* Personal communications.
ber drain may be required to assure uncomplicated recovery.

Incision by electrocautery or electrosurgery is recommended,
as by these methods the blood and lymph capillaries will be
closed. Also, through the coagulation of a small layer of tissue,
the clogging and untimely granulation of the skin incision will
be prevented.
Laqueur and Remzi report beneficial results in acute mastitis.
Dalchau treated 15 cases of mastitis. When he began with
short-wave diathermy in the early stage of acute mastitis,
the inflammation regressed entirely after from 3 to 5 treatments.
In general, he confirms the healing process noted above. In
most of his cases, the subjective symptoms subsided after the
first treatment. In the cases in which abscess had formed, a
small lancet incision was made. Egan states that incision may
be avoided by the use of short-wave diathermy, and, in 6 cases
of pueperal breast abscess, found the results very gratifying.
One of our cases of subacute mastitis illustrates a possibility
of burns while under short-wave diathermy, resulting in a small
superficial area of coagulation at the site of novocain injection.
This small area of coagulation healed readily, leaving a scar
the size of a pea. The lesion developed after puncture for bac-
teriological material. The novocain injection into the skin
formed a point of protrusion in which coagulation took place.
The case report follows:
The patient, female, 43 years old, stated that 4 days before
she had experienced sudden pain in her right breast. Redness
appeared after 2 days. Physical examination showed that the
right breast was increased to half again its natural size. It was
red, slightly edematous, and under the skin there was a firm
area of infiltration about 2 inches in diameter, slightly adherent
to the overlying skin. It was tender on palpation. A few swollen,
slightly tender lymph glands were noticeable in the right ax-
illa. The temperature was 99.6°F. Aspiration was performed,
but no pus could be obtained.
The first short-wave treatment was then given with 6-meter
wave length, for 15 minutes. The next day the patient expressed
herself as being much relieved; she had slept well and had no
pain. The infiltration had subsided and the redness diminished
in area. On the site of the novocain injection, a small vesicle
with serous exudate was present, and there was desquamation
of the superficial layer of epithelium, presenting the picture of
a second-degree burn. This was attributable to the fact that
the novocain infiltration created a higher concentration of the
electric current, resulting in local coagulation. The second treat-
ment was given with the 6-meter wave for 15 minutes. Two
days later the patient was much improved. The area of infiltra-
tion was soft and diminished in size. A third treatment was given
with the same wave length and of the same duration. In 3 days
the patient felt entirely well. A spot of infiltration about one
inch in diameter, slightly painful on palpation, was present
in the center of the breast. There was no redness of the over-
lying tissue, but at the point of novocain injection there was
yellow necrotic tissue of about one cm. in diameter. Treatment
was discontinued. Gradual resolution of the infiltration and
healing of the burned area followed. The patient was seen 2
weeks later, at which time the breast was healed and the site
of the coagulation necrosis remained as a red spot, 0.5 cm. in
diameter; ultimately resulting in a small scar formation.
Aside from the quick beneficial effects of short-wave dia-
thermy, this case demonstrates the necessity for care in treating
areas which have been the site of injections of anesthetics.
There are as yet no available records giving results of short-
wave diathermy in chronic mastitis. It seems to us, after treating
20 cases with variable results, that this condition may be influ-
enced favorably. In our cases, symptomatic relief was obtained
on local treatment of the affected breast, especially if no marked
glandular changes were present. At this time, however, no defi-
nite conclusions can be drawn, even though relief was obtained
where gland therapy and other medication had failed. The time
of observation and follow up record have been too short.
Tuberculosis of the breast, especially with fistula, may also
respond to prolonged short-wave treatments, and this may be
effectively resorted to if operation is contraindicated or refused.
In treating breast conditions, especially adjusted breast elec-
trode may be used (figs. 22b and 37).When the electrode is applied
on the breast, a larger electrode is placed on the opposite side
of the chest. If no specially designed electrodes are available,
a pair of rigid air-spaced electrodes of the proper size should be
so applied as to include within the electric field the whole patho-

logical area. The length of time of application may be from 10
to 20 minutes, daily. In the case of chronic mastitis, the treat-
ments may be spaced at longer intervals.
Owing to a lack of sufficient material, no comment can be
made at this time as to the proper wave length to be used.
37. Short-Wave Treatment with

Breast Electrode
Application of the general principles of short-wave technic are

recommended here as described above in Chapter VII, "Gen-
eral and Mechanical Principles in Short-Wave Technic."
If the left breast is involved, it is wise to apply the electrodes
in such a manner as to exclude the heart from the electric field.
Since we do not as yet know the exact action of short waves on
the different organs, the brain and the heart should, if possible
and on general principles, be excluded from the electric field
when neighboring tissues are being treated.
XVI
MALIGNANT DISEASE
WITH the appearance of a new measure upon the therapeutic

horizon, new hopes rise for possible victory over cancer. Since
the high-frequency current was already being so effectively em-
ployed in different cancer operations, it was hoped that in short
waves an even more effective agent had been found. From the
surgical point of view, temporarily this hope soon vanished, in
view of the results of the laboratory experiments of Katsura
and Ito, and Ravault.
Much experimentation has been carried out with short
waves in the treatment of malignancy. A cause for hope of thera-
peutic effectiveness was seen in the success achieved by Scheres-
chewsky in large-scale experiments on inoculated animal tumors.
Schereschewsky used the most malignant experimental tumor
and constructed an apparatus which furnished 68,000,000 cycles
per second (4.4-meter waves), according to the suggestions of
Professor G. W. Pierce, of Harvard University, in order "that
tissue cells placed in a electrostatic field and subjected to the
displacement currents caused by the rapid alternations in polar-
ity of the field may undergo some mode of electromechanical
vibration which might well have definite effects upon the cell."
The tumors were implanted on the right anterior surface of
the belly. When they reached the size of from 5 to 10 mm. di-
ameter (in about 3 days), they were treated with a specially
constructed electrode from one to 4 times, with from 4 to 18
minutes of treatment. Almost without exception recrudescence
was achieved, as a rule in 10 days. Final recovery was secured
in practically 25 percent of the cases. In all, however, there seemed
to be some shedding of the hair, so that the involved area could
be detected for from 2 to 3 months after absorption of the tumor.
The remaining 75 percent succumbed to intercurrent disease
after the tumor had receded. A histological examination by Dr.
S. B. Wollbach, of Harvard, was as follows:
MALIGNANT DISEASE 245
In general, the immediate effects of the agency you have supplied to

the tumor is necrosis of the tumor cells and the accompanying vascular
and connective tissue structures. The general picture produced is that
of so-called coagulation necrosis and the most familiar corresponding
picture that I know of is in completely infarcted tissue. A very striking
phenomenon, however, as brought out in the slides, is the extraordinarily
rapid disappearance of the necrotic tumor. I am quite unfamiliar with
anything corresponding to it. In the few microscopic preparations sub-
mitted, one gets the impression that there has been very rapid solution,
possible solution by autolysis (?) of the cells including the nuclei.
Using the same technic, Schereschewsky also obtained cura-
tive results on Rous chicken sarcoma. A histological study of
tumors, removed immediately after exposure to high-frequency
current of the given dosage, showed that normal tissue cells
surrounding the tumor seemed to be influenced by the current
to a lesser degree than the tumor cells. Later, Schereschewsky
found that the heating of mouse sarcoma to 48° or 49° C. for
three minutes, prevented its growth when transplanted into
mice. He could also bring about regression of tumors by circu-
lating hot water through hollow copper applicators until the
tissue temperature rose to 48° or 49° C., though it required a
longer time than by electric current. At the same time he noted
that although the skin was but little heated by the high-fre-
quency field, the temperature in the interior of the tumor rose
rapidly, reaching 48° or 49° C. in from 1.5 to 2 minutes, depend-
ing upon the size of the tumor.
Our own experiments with wave lengths of from 6 to 14
meters, were not conclusive. Results were obtained only with
wave lengths of from 3 to 5 meters, when the electrodes were
applied at a distance of from 5 to 10 cm. from the body surface.
Two types of tumor—highly malignant rat sarcoma and Flexner
carcinoma—were inoculated into the belly of rats, and prac-
tically all the animals perished. Only 5 out of the last 25 sur-
vived, in 2 of which regression of the tumor was observed after
several applications of short waves. In 2 others recurrences took
place after partial regression. The accompanying photograph illus-
trates the results achieved with wave lengths of from 3 to 6 meters.
In Rat 1 (left) strong dosage resulted in complete necrosis
of the hindlegs, tail and tip of the ear, without influencing the
tumor in its growth with the exception of a small spot of coagu-
lation necrosis in the tumor on the right side of the belly. In
246 MALIGNANT DISEASE
Rat 2 (ceDter), using less intensity of current and concentrating
on the inoculated tumor masses, we obtained coagulation necro-
sis similar to that obtained with a high-frequency coagulating
current (by inserting a needle into the tumor and destroying
it with electrocoagulation). It is curious to note that the tumor
was destroyed only on the right side, where the electrode ap-
proached nearer than on the other side, and supposedly resulted
in heat coagulation of prominent tumor tissue. The other side
38. Action of Short Waves on Rat Tumors
continued to grow, uninfluenced. Rat 3, (upper right in illus-

tration) shows that if a greater intensity is used, it may destroy
the growth and the animal may recover. In this instance the
animal lost one of its hind legs by dry necrosis, but survived and
recovered, no tumor being found on subsequent pathological
examination.
In the right lower corner is a rat which was treated daily for
from 2 to 4 minutes, with moderate intensity, for 5 succeeding
days. Coagulation necrosis resulted in the 4 inoculated tumor
masses, but after 2 weeks, while healing was progressing, re-
currence took place which eventually killed the animal.
Hopes for a selectivity of short waves for tumor tissue have
faded, and the effects produced experimentally have been ob-
tained only beyond the limits of physiological safety. While
it may be possible eventually to develop a technic which will
MALIGNANT DISEASE 247
destroy animal malignancies in a high percentage of cases, it

is our impression that the results obtained by ourselves and
by other investigators (Pflomm, Reiter, Haase and Lob, and
others) are essentially due to a heat effect, resulting in coagu-
lation of tumor tissue and of the vessels furnishing the blood
supply. Histological examination shows a similarity to the pic-
ture of electrocoagulation. The effects produced by Scheres-
chewsky may be induced by electrocoagulation of tumor tissue,
as the pathological findings indicate, and are similar to what we
achieve with electrosurgery.
According to Groag and Tomberg, there are no methods at
present available by which the biological effects of short waves,
the localized heat effect, and the specific electric influence
may be separated or isolated. Feeble short-wave application may
stimulate growth, as may be done with diathermy. This may ex-
plain the failures reported, following short-wave diathermy in
human tumors, as compared with the successes reported in animal
experiments. It is interesting to note that the 3.5-meter wave is
the critical point of differences in tissue-heating characteristics.
Overgaard recently stated that it is possible to exert a healing
influence on implanted tumors by subjecting them to short-
wave diathermy. The effect, however, does not differ from that
following treatment with diathermy, and may be interpreted
as simply a heat effect on the tumor tissue, an effect toward
which normal tissue is less tolerant.
Taylor found short-wave diathermy ineffective in inoculated
animal tumors, in combination with radium therapy.
There is some evidence that short waves may "sensitize"
the tumor cells, making them more susceptible to succeeding
roentgen and radium therapy, though further research is neces-
sary to establish this point.
Apparently the principal result as yet achieved with short-
wave diathermy in human malignancies, on the basis of our own
experience, is some reduction of concomitant secondary infec-
tion in the open tumor masses. From this point of view, it is
possible that short waves may become an adjuvant measure,
after the development of proper technic, facilitating surgical
intervention or radiation therapy, although at the present time
the measure does not surpass electrosurgery in this respect.
PART VI
CONCLUSION
XVII
CONCLUSION
WHEN short-wave diathermy was first introduced, its undeni-

able advantages, as shown in the results obtained by competent
clinicians, were constantly denied and its use deprecated by
many outstanding physicians. This is by no means unusual.
There has never been a therapeutic measure, which in its initial
stages has not had to suffer the skepticism of a conservative
profession. To a certain extent, such an attitude is right, and
proves in the end to be an asset rather than a liability, for it
acts as a check on unbridled use, and compels intensive and
scientific study until the new measure has proved itself.
Short-wave diathermy is emerging from the hinterland of
intolerance into which it was thrust for these past years. Con-
tinued intensive study by competent investigators, who are both
clinicians and physiotherapeutists; continued research, experi-
mental and clinical; continued improvement of machines and
the accessories for their use, have gradually modified the physi-
cian's skepticism, until he is willing to concede the usefulness
of short-wave diathermy, provided it is administered by compe-
tent men who know both their medicine and their physics. He
is now more willing to give it a trial.
Much, however, remains to be done. An actual evaluation of
the results of short-wave diathermy will be possible only when
the apparatus becomes standardized, and when the dosages for
the many pathological conditions, in all their individual vari-
ation, become determined. This will, in turn, depend upon the
wave length (frequency) of the applied current, on wattage,
size and type of electrodes, distance of the area to be treated,
duration of treatment, and so on. It will be many years before
these uncertainties will become certainties, before exact indi-
cations for short-wave diathermy will be sharply defined, and the
benefit to be derived clearly known.
252 CONCLUSION
These problems rest in the hands of the physician, experi-

enced in other forms of treatment, who will be in a position to
judge the superiority of short waves over other medication in
each specified diseased condition.
At present, short-wave diathermy may be considered purely
a form of heat therapy. It is superior to other forms of heat
therapy, however, because of its deep action, and is definitely
to be favored in certain conditions. Another advantage over
other forms of heat therapy is the fact that short-wave diathermy
is less cumbersome to manage, is simpler and more hygenic in
use. It belongs to the field of physiotherapy, and its use, in com-
bination with other standard treatment, should be encouraged
by the specialist.
The dosage is as yet uncertain, for no one knows just how
much heat the individual patient or the particular pathological
condition requires. From the practical point of view, however,
when applied by one trained in the method, the degree of heat
desired is usually achieved, even though it is not measurable.
The principal field of application of short-wave diathermy
is that of the inflammatory processes. While it may be used with
benefit in acute infections, subacute and chronic cases show the
most favorable results, although surgical intervention, combined
with short-wave diathermy, may still be required.
While the effect of short waves is analgesic and antispasmodic,
the chief beneficial action seems to be the induction of an in-
tense and lasting hyperemia. By such action, short waves vital-
ize, directly or indirectly, the pathological focus, and support
the weakened tissues. They combat the invading disease organ-
isms within the pathological focus, either by creating a less
favorable medium for the growth of bacterial life, or by pro-
moting the accumulation at the disease area of the defensive
reserves of the body.
In rheumatoid and arthritic conditions, short waves may
eliminate the focus of infection, or, by increasing local metabo-
lism, arrest the disease, eventually reestablishing function.
Very satisfactory results are obtained in injuries of the bones
and joints, nerves and soft tissues, in circulatory disturbances
and allied conditions, the effect of short waves here being anal-
gesic and antispasmodic. In the field of neurology, the vibratory
CONCLUSION 253
effect of short-wave diathermy, in addition to the heat action,

may produce the desired results.
Short waves have proved to be a valuable addition to the
treatment of sinus infections and to that of lung pathology,
with the exception of tuberculosis.
The uses of short-wave diathermy are varied and multiform.
It should always be tried where benefit may be derived from
it, it having proved itself during the past 8 years of clinical
experience one of the least harmful of the physiotherapeutic
agents.
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ABBREVIATIONS
Acta radiol. Acta radiologica, Stockholm
Am. J. Anat. American Journal of Anatomy, Philadelphia
Am. J. M. Sc. American Journal of the Medical Sciences, Philadelphia
Am. J. Physiol. American Journal of Physiology, Baltimore
Am. J. Phys. Therapy American Journal of Physical Therapy, Chicago
Am. J. Pub. Health American Journal of Public Health, New York
Am. J. Surg. American Journal of Surgery, New York
Am. J. Syph. American Journal of Syphilis, Gonorrhea and Venereal
Diseases, St. Louis (title varies)
Am. Med. American Medicine, New York
Am. Rev. Tuberc. American Review of Tuberculosis, New York
Ann. de méd. phys. Annales de médecine physique et de physiobiologie,
Anvers
Ann. di radiol. e fis. med, Annali di radiologia e fisica medica
Ann. d'ocul. Annales d'oculiste, Paris
Ann. di ostet. e ginec. Annali di ostetricia e ginecologia, Milano
Ann. Inst, d'actinol. Annales de l'Institut d'actinologie, Paris
Ann. Inst. Pasteur. Annales de l'Institut Pasteur, Paris
Ann. Int. Med. Annals of Internal Medicine, Lancaster, Pa.
Ann. d'Ist. Maragliano Annali dell'Istituto Maragliano, Genoa
Ann. méd.-psychol. Annales médico-psychologiques, Paris
Ann. Soc. méd.-chir de Annales de la Société médico-chirurgicale de
Liège Liège, Liège
Arch, d'électric. méd. Archives d'électricité médicale, Paris
Arch, de med., cir. y Archivos de medicina, cirugía y especialidades,
especialid. Madrid
Arch, de méd. et pharm. Archives de médecine et pharmacie militaires,
mil. Paris
Arch, di fisiol. Archivio di fisiologia, Roma
Arch. f. d. ges. Physiol. Pflügers Archiv für die gesamte Physiologie . . ., Berlin
Arch. f. exper. Path. u. Naunyn-Schmiedeberg's Archiv für experimentelle
Pharmakol. Pathologie und Pharmakologie, Berlin
Arch. f. klin. Chir. Archiv für klinische Chirurgie, Berlin
Arch. f. Verdauungskr. Archiv für Verdauungs-Krankheiten, Stoffwechsel-
pathologie und Diätetik, Berlin
Arch, internat, de neurol. Archives internationales de neurologie, Paris
Arch. méd. belges Archives médicales belges, Bruxelles
Arch. Path. Archives of Pathology, Chicago
Arch. Phys. Therapy Archives of Physical Therapy, X-Ray and Radium,
Chicago
Beitr. z. klin. Chir. Bruns' Beiträge zur klinische Chirurgie, Berlin
Beitr. z. Klin. d. Tuberk. Beiträge zur Klinik der Tuberkulose, Berlin
Ber. d. deutsch, ehem. Bericht der deutschen chemischen Gesellschaft
Gesellsch.
Biochim. e terap. sper. Biochimica e terapia sperimentale, Milano
Bol. Inst, de med. exper. Boletin del Instituto de medicina experimental para el
para el estud. y tratamiento del cáncer, Buenos Aires
trat, del cáncer
Boll. d. Soc. i tal. di biol. Bollettino della Società italiana di biologia
sper. (1936) sperimentale
296 ABBREVIATIONS
Boll. d. Soc. piemont. di Bolletino della Società piemontese di ostetricia e
oetet. e ginec. ginecologia, Torino
Brit. J. Actinotherapy British Journal of Actinotherapy, London
Brit. J. Phys. Med. British Journal of Physical Medicine, London
Brit. J. Radiol. British Journal of Radiology, London
Bull. Acad, de mid., Paris Bulletin de l'Acadlmie de mldicine, Paris
Bull. Assoc. frail?, p. Bulletin de l'Association française pour l'avancement
l'avance. d. sc. des sciences
Bull, et mlm. Soc. de Bulletins et mlmoires de la Sociltl de radiologie
radiol. mid. de France mldicale de France, Paris
Bull, et mlm. Soc. mid. Bulletins et mlmoires de la Sociltl mldicale des
d. hftp. de Paris hôpitaux de Paris, Paris
Bull. mid. Bulletin médical, Paris
Bull, offic. Soc. fraiiQ. Sociltl française d'electro-thlrapie et de
d'llectrothlrapie et de radiologie. Bulletin officiel
radio.
Canad. J. Research Canadian Journal of Research, Ottawa
Canad. M. A. J. Canadian Medical Association Journal, Montreal
Casop. 16k. desk. Casopis lékafû lesk^ch, Praha
Clin, pediat. Clinica pediatrica, Modena
Compt. rend. Acad. d. sc. Comptes rendus hebdomadaires des séances de
l'Acadlmie des sciences, Paris
Compt. rend. Assoc. Comptes rendus de l'Association des anatomistes
d'anat.
Compt. rend. Soc. de biol. Comptes rendus des slances de la Société de
biologie, Paris
Dermat. Wchnschr. Dermatologische Wochenschrift, Leipzig
Dermat. Ztschr. Dermatologische Zeitschrift, Berlin
Deutsche med. Wchnschr. Deutsche medizinische Wochenschrift, Leipzig
Deutsche Ztschr. f. Chir. Deutsche Zeitschrift für Chirurgie, Berlin
Finska läk.-sällsk. handl. Finska läkaresällskapets handlingar, Helsingfors
Folia med. Folia medica
Fortschr. a. d. Geb. d. Fortschritte auf dem Gebiete der Röntgen-
Röntgenstrahlen strahlen, Leipzig
Fortschr. d. Med. Fortschritte der Medizin, Berlin
Gaz. mid. de France Gazette mldicale de France . . ., Paris
Gazz. d. osp. Gazzetta degli ospedale e degli cliniche, Milano
Gior. di batteriol. e Giornale di batteriologia e immunologia, Torino
immuno 1.
Gior. di c'in. med. Giornale di clinica medica, Parma
Gior. di tisiol. Giornale di tisiologia, Napoli
Gior. d. r. Accad. di med. Giornale della reale Accademia di medicina di
di Torino Torino, Torino
Glasgow, M. J. Glasgow Medicai Journal, Glasgow
Internat. Clin. International Clinics, Philadelphia
Jahresk. f. ärztl. Fortbild. Jahreskurse für ärztliche Fortbildung, München
J. A. M. A. Journal of the American Medical Association, Chicago
J. Am. Inst. Homeop. Journal of the American Institute of Homeopathy, N. Y.
J. beige de neurol. et de Journal belge de neurologie et de psychiatrie,
psychiat. Bruxelles
J. Biol. Chem. Journal of Biological Chemistry, Baltimore
J. de mid. et chir. prat. Journal de mldecine et de chirurgie pratiques, Paris
J. de mid. de Paris Journal de mldecine de Paris, Paris
J. Dent. Research Journal of Dental Research. Baltimore
J. de radiol. et d'llectrol. Journal de radiologie et d'llectrologie, Paris
J. d. sc. mid. de Lille Journal des science médicales de Lille, Lille
ABBREVIATIONS 297
J. Exper. Med. Journal of Experimental Medicine, N. Y.

J. Infect. Dis. Journal of Infectious Diseases, Chicago
J. Lab. & Clin. Med. Journal of Laboratory and Clinical Medicine, St. Louis
Kinderarztl. Praxis Kinderärztliche Praxis, Leipzig
Klin. med. Klinicheskaya meditsina, Moscow
Klin. Monatsbl. f. Augenh. Klinische Monatsblätter für Augenheilkunde, Stuttgart
Klin. Wchnschr. Klinische Wochenschrift, Berlin
Liège méd. Liège médical, Liège
Lyon méd. Lyon médical, Lyon
Magyar orvosi arch. Magyar orvosi archivum, Budapest
Marseille-méd. Marseille-médical, Marseille
Med. Klin. Medizinische Klinik, Berlin
Med. Welt Medizinische Welt, Berlin
M. J. Australia Medical Journal of Australia, Glebe, N. S. W.
M. J. & Rec. Medical Journal and Record, N. Y.
M. Rec. Medical Record, N. Y.
Monatscbr. f. Krebsbe- Monatschrift für Krebsbekämpfung, München
kâmpf.
Monatschr. f. Ohrenh. Monatschrift für Ohrenheilkunde und Laryngo-
Rhinologie, Wien
Monde méd. Monde médical, Paris
Monitore zool. ital. Monitore zoologico italiano
Munchen. med. Wchnscbr. Münchener medizinische Wochenschrift, München
New England J. Med. New England Journal of Medicine, Boston
Nord. med. tidskr. Nordisk medicinsk tidskrift, Stockholm
Orvosi hetil. Orvosi hetilap, Budapest
Oto-rhino-laryng. internat. L'oto-rhino-laryngologie internationale, Paris
Oto-rino-laring. ital. L'oto-rino-laringologia italiana, Bologna
Physical Therap. Physical Therapeutics
Physiotherapy Rev. Physiotherapy Review, Chicago
Polska gaz. lek. Polska gazeta lekaraska, Lwow
Prat. méd. franç Pratique médicale française, Paris
Presse méd. Presse médicale, Paris
Proc. Nat. Acad. Sc. Proceedings of the National Academy of Sciences,
Washington
Proc. Roy. Soc. Med. Proceedings of the Royal Society of Medicine, London
Proc. Soc. Exper. Biol. & Proceedings of the Society for Experimental Biology
Med. and Medicine, Utica, N. Y.
Proc. Staff Meet., Mayo Proceedings of the Staff Meetings of the Mayo Clinic,
Clin. Rochester, Minn.
Psychiat.-Neurol. Psychiatrisch-neurologische Wochenschrift, Halle
Wchnschr.
Psychiat. Quart. Psychiatric Quarterly, Utica, N. Y.
Pub. Health Rep. Public Health Reports, Washington
Quart. J. Med. Quarterly Journal of Medicine, Oxford, Eng.
Quart. Rev. Biol. Quarterly Review of Biology, Baltimore
Radiol, med. Radiología medica, Milano
Rev. Assoc. méd. argent. Revista de la Asociación médica argentina,
Buenos Aires
Rev. d'actinol. Revue d'actionologie, Paris
Rev. de physiothérap. Revue de physiothérapie
Rev. d'oto-neuro-opht. Revue d'oto-neuro-ophtalmologie, Paris
Rev. méd. de la Suisse Revue médicale de la Suisse Romande, Lausanne
Rom.
Rev. méd. franç. Revue médical française, Paris
Rev. méd. germano-ibero- Revista médica germano-ibero-americana, Leipzig
298 ABBREVIATIONS
Riforma med. Riforma medica, Napoli
Riv. di idroclimat. Rivista di idroclimatologia . . ., Milano
Riv. Ban. siciliana Rivista sanitaria siciliana, Palermo
Riv. sper. di freniat. Rivista sperimentale di freniatria . . ., Reggio-
Emilia, Italy
Schweiz, med. Wchnschr. Schweizerische medizinische Wochenschrift, Basel
Skandinav. Arch. f. Skandinavisches Archiv für Physiologie, Berlin
Physiol.
Sovet. vestnik oftal. Sovetskiy vestnik oftalmologii, Moscow
Sovet. vTach. gaz. Sovetskaya vrachebnaya gazeta, Leningrad
Texas State J. Med. Texas State Journal of Medicine, Fort Worth
Ugest. f. laeger Ugeskrift for laeger, Copenhagen
Verhandl. d. deutsch. Verhandlungen der deutschen Gesellschaft f ü r innere
Gesellsch. f. inn. Med. Medizin, München
Verhandl. d. deutsch. Verhandlungen der deutschen Gesellschaft f ü r
Gesellsch. f. orthop. orthopädische Chirurgie, Stuttgart
Chir.
Wien. klin. Wchnschr. Wiener klinische Wochenschrift, Wien
Wien. med. Wchnschr. Wiener medizinische Wochenschrift, Wien
Wisconsin M. J. Wisconsin Medicai Journal, Madison
Zentralbl. f. Bakt. Zentralblatt für bakteriologie . . ., Jena
Zentralbl. f. Chir. Zentralblatt für Chirurgie, Leipzig
Zentralbl. f. Gynak. Zentralblatt für Gynäkologie, Leipzig
Ztschr. f. ärztl. Fortbild. Zeitschrift für ärztliche Fortbildung, Jena
Ztschr. f. Augenh. Zeitschrift für Augenheilkunde, Berlin
Ztschr. f. d. gea. exper. Zeitschrift für die gesamte experientelle Medizin,
Med. Berlin
Ztschr. f. d. gee. Neurol. Zeitschrift für die gesamte Neurologie und
u. Psychiat. Psychiatrie, Berlin
Ztschr. f. d. ges. phys. Zeitschrift für die gesamte physikalische Therapie,
Therap. Berlin
Ztschr. f. Krebsforsch. Zeitschrift für Krebsforschung, Berlin
Ztschr. f. Stomatol. Zeitschrift für Stomatologie, Berlin
Ztschr. f. Tuberk. Zeitschrift für Tuberkulose, Leipzig
Ztschr. f. urol. Chir. Zeitschrift für urologische Chirurgie, Berlin
INDEX
INDEX
Abdomen, treatment technic, 112 Arthritis, 190 ff.

Abdominal adhesions, 150 Artificial capillary, 61
Abscess, 37, 84; axillary sweat-gland, Aspergillus niger, 32
222-25; Bartholin's gland, 163; brain, Asthma, 125
209; breast, 240; dental, 143; lung, Atoms, effect of wave lengths upon, 67
136, 139; perirenal, 157. See also Atrophic arthritis, 193, 198
Carbuncle; Furuncle Atzler, E., 171
Accidents and their prevention, 98 ff., Auclair, J., 43, 89, 91, 129, 150, 193,
119; safety rules, 111 201, 231, 232
Acetylcholine injections, 180 Autoinoculation, 212
Acknowledgments, vi Autovaccine therapy, 37, 212
Acne, 232 Axillary sweat-gland infection and ab-
Acrocyanosis, 177 scess, 222-25
Acroparesthesia, 177
Actinomycosis, 32, 35, 124 Babin-Chevaye, A., 91, 126, 128, 150,
Adenitis, tuberculous, 181 152, 173, 178, 206, 238
Adnexal affections, electrodes for, 107, Bachem, A., 46, 47, 68
108 Bacteria and other organisms, experi-
Adnexal tumors, 158, 160 ments on, 27-39
Adnexitis, 160, 166 Bacteriophage, 33
Albrecht, W., 66 Bacterium coli, 30, 35, 82, 155
Allergic diseases, 125 Bacterium tumefaciens, 4
Alternating current, 10; flow through Baldwin, W. M., 41, 72
condenser, 11 Bardenheuer, 184
Ammon, 188 Bartholin's gland abscess, 163
Anal region, 151 Bauer, H., 138, 147
Anesthetics, injections, 242 Beans, growth, 38
Angina pectoris, 172 Becker, G., 207
Angiospasm, 176, 177, 178 Beerens, J., 32
Animal experimentation, 4, 31, 33, 40- Bell, W. H., 80
66, 68, 72, 83, 94, 103, 127, 129, 170, Belot, 91
171, 181, 200, 229, 239, 244 ff.; action Benzol thermometer, 66, 166
of different wave lengths on tissue, 45; Berg, 58, 102
biological effects, 49 ¡effect on blood and Bergami, G., 73
serum, 52; growth and reproduction, Berggreen, P., 32, 167, 191, 197
43; heat production in living and dead Berndt, von, 4
nnimftlH) 41; inflammation, 59; local Berry, M„ 85, 131, 194, 199
tissue changes, 58; physiologic effects, Bibliography, 257-94; abbreviations used
48; start of, with short waves, 3, 40; in, 295-98
temperature measurement, 65; tem- Bierman, W., 5, 89, 90, 91, 159, 200
perature regulation, 64 Biliary passages, 151
Animal tissue, see Tissue Binet, L., 91
Anode circuit, 20 Biological effects of short waves, 49
Apel, M., 175 Biological experimentation, start of, 3,
Apparatus, see Machines 40. See also Animal experimentation;
Appendicitis, 85, 150 Human beings
Arsonval, J. A. d', 3, 36, 61 Bipolar method, 104, 106
Arteriosclerosis. 175, 176, 177, 178 Bipolar treatment of seeds, 38
302 INDEX
Bischoff, F., 88 Chemical compounds characteristic of
Bishop, 50, 51 living matter, 58
Bladder, 169 Chest, treatment technic, 112
Blalock, J. R., 88 Chilblains, 178
Blood: after-treatment bleeding, 82, 83, Cholangitis, 152
154; effect of heart treatment upon, Cholecystitis, 151, 154, 199
171 ff.; effects of short waves upon, Cholesterol, 58
48 ff., 52, 68, 88; heating of, 46; lower- Christie, R. V., 41, 72
ing of pressure, 156; reactions of, in Circuits in short-wave machine, 15 ff.
inflammatory disorders, 59 Circulatory system, 171-81; reactions to
Blood sugar, 52, 229 high temperature, 48
Blood vessels, diseases, 176 Cirrhosis, 152
Boak, R. A., 33, 43, 87, 200 Claudication, intermittent, 178, 179
Bogendörfer, 147 Clothing, removal of, 112, 113
Boils, 212, 213 Coagulation, electric, 28, 83
Bones: atrophy, 144; diseases, 187-90; Cobra venom, 36, 37, 61
production, 144; resistance, 94 Cold, common, 120
Bonome, 36 Colitis, 150
Botulinus, toxin, 36 Colloids, action of short waves on, 56
Bovie machine, 83, 84 Colon, bacilli, 30, 35, 82, 155
Brain, 202, 206, 207, 209; abscess, 209; Color, changes under heat, 66
exclusion from electric field, 243 Compère, A., 233
Breast, inflammatory conditions, 240 ff. Condenser: alternating current connec-
Bretschneider, 233 tion, 11; direct current resistance, 10;
Brinch, O., 65 position during treatment, 98 ff.;
Bronchial asthma, 125 variable, 16
Bronchiectasis, 132 Conduction, electronic theory of, 9
Bronchitis, 131 Contraindications to short-wave dia-
Brunori, N., quoted, 69 thermy, 81
Burdette, R. C., 58; quoted, 43 Corneal disease, 238, 239
Bürkmann, 178 Coronary thrombosis, 172
Burns and their prevention, 98-102, 241 Cotton, 91
Bursitis, 186 Cough, 131, 133
Burton, A. C., 52, 68, 93, 153 Coulter, J. S., 47, 70, 72, 94
Coupling in oscillatory circuit, 15
Cacciani, 36 Coxitis deformans, 194
Cahen, R., 232 Cress, experiments on, 37, 38
Calorimetrie method of measurement, 23 Crocker Research Laboratory, vi
Cancer, 82, 244-47 Current: alternating and direct, 10;
Capacity, resistances connected to, 12,13 types generated by tube machines, 21,
Capaldi, B., 223 22, 24. See also High-frequency cur-
Capillary, artificial, 61 rent.
Capillary pressure, effect of, 59 Current concentration in prominent
Carbuncle, 218-22 parts, 78, 99, 103
Cardiovascular disease, 171 ff. Cystitis, 155
Carpenter, C. M., 5, 33, 37, 42, 43, 87,
200 Dalchan, K., 158, 160, 162, 164, 241
Carter, H. A., 47, 70, 72, 94 Dausset, H., 34, 89, 127, 128, 129, 163,
Catarrhal conditions, 240 177, 178, 193, 194, 208, 232
Cattle, lumpy jaw, 124 Davis, M. R., 93, 185, 186, 190, 191,
Ceccaldi, A., 77, 203, 204 194
Cellulitis, 225 ff. "Death ray," 5
Centimeter waves, 70 Debye, 66
Chalkley, H. W., 36 Delherm, L., 178, 193, 207
Charles, D. R., 43 Dementia praecox, 209
INDEX 303
Denier, A., 70 Dondale, M., 41, 73

Dental structures, 143 ff. Dorst, 168
Dermatitis, infective, 124 Dosage, 63, 77, 78, 252
Devois, 207 Drews. 152
Diabetes, 127. 179 Dreyer, 60
Diathermy, classical: compared with Drouet, M., 206
short-wave diathermy, 13, 91 ff., 233, Drugs, use of, with short waves, 86, 91
247; in heart disease treatment, 172; Dubois, 36, 61
main differences, 94 Du Bois-Reymond, 192
Diathermy, short-wave: accident-pre- Ductless glands, 126 ff.
vention rules, 111; apparatus, see Dysentery bacilli, 33
Machines; combination with surgery, Dysmenorrhea, 164
81, 82 ff., 219, 228, 231; compared
with classical diathermy, 13, 91 ff., Ear, diseases, 239
233, 247 (in heart disease treatment, Eckert, 165
172; main differences, 94); comparing Eczema, 231
results of treatment, 23; contraindi- Eggs, experiments on, 44, 72
cations to, 81; creator of, 5; diseases Electric coagulation, 28, 83
treated, see Diseases; effect on promi- Electric heat production, see Heat pro-
nent parts, 78, 99, 103; electropy- duction
rexia, 87; experiments with, see
Electricity, therapeutic application, 3
Animals, Bacteria, Human beings,
Electrodes: burns caused by, 100; proper
Plants; general and mechanical prin-
and improper application, 79; sinus
ciples in technic, 97-115; historical
electrodes, 108, 237; variation and
outline, 3-6; inconvenient effects of
type, 103 ff. (flexible, 107, rigid, 106,
exposures; safeguards, 79; literature,
shape and size, 109, technic of ap-
v, 4, 5, 257 ff.; opposition to, dis-
plication, 110)
appearing, 251; physical aspects, 9-24;
Electrolytes: action of short waves on,
results evaluated, 251-53; short-waves
56; heat production, 10 ff.; wave-
and other treatments, 77-96; the
length experiments, 68
term, 4, 24; wave lengths for, 22, 45,
Electromagnetic waves, 67, 68
67-74, 197. See also Short waves
Electronic theory of conduction, 9
Dielectric constant, 11, 68, 69
Electronic tubes, 13, 18
Dielectrics, heat production by, 11, 12
Electropyrexia, 87-91, 198, 200, 203,
Dietrich, 152, 155, 157, 159, 205
206
Diphtheria bacillus, 33
Diphtheria toxin, 4, 36, 61 Electrosurgery, 82 ff., 217, 223, 241
Dipoles, 11, 12 Emphysema, 132
Empyema, 122, 133-35, 182, 234
Direct current, 10; resistance to con- Encephalitis, 207
denser, 10 Endarteritis, 176, 177, 178
Diseases, treatment of, 119 ff.; allergic, Endocarditis, 174
125-26; circulatory system, 171-81; Endocrine function, 126 ff., 198
gastro-intestinal tract, 143-54; genito- Energy, transformation of, 9
urinary tract, 155-70; head, 233-40; Epididymitis, 167, 168, 170
infectious, 120-25; locomotor system, Epilepsy, 209
184-99; lymph glands, 181-83; malig- Erysipelas, 123; of the scrotum, 169
nancy; cancer, 244-47; mastitis, 240- Erysipeloid, 124
43; nervous system, 200-210; of Erythema, 179, 233
metabolism and of ductless glands, Esau, 5, 40, 56, 68
126-29; respiratory tract, 130-42; skin, Esophagus, spasm of, 146
211-33 Essential hypertension, 175
Dizziness, 79 Experimentation, see Animals; Bacteria;
Dognon, A., 34, 128, 171 Human beings; Plants
Dogs, experiments on, 42, 44, 45, 47, 48, Exposures to short waves, inconvenience
49, 50, 51, 52, 54, 62, 83, 127 and prevention of damage, 79 ff.
304 INDEX
Extremities, infectious, 225-27 Goiter, 128

Eye, diseases, 238 Gonococci, 32
Gonorrheal arthritis, 191, 197, 198
Fabian, F. W., 30, 155 Gonorrheal infectious of rectum, 151
Facial palsy, 208 Gonorrheal peritonitis, 159
Fat, resistance, 94 Gonorrheal urethritis, 166
Fat tissue, heating of, 45, 46 Gcieset, A., 4
Fedderson, 3 Gout, 126
Fedoroff, 176 Graf, H., 192, 197
Female genital tract, 158-66 Graham, H. T., 30, 155
Fenn, W. O., 50, 72 Granulomas, 143, 144, 145
Ferguson, D., 80 Grosser, H., 31
Fever, induction of, 87 ff., 200 Grebenc, Lucile, vi
Fiandaca, S., 143 Grid, in vacuum tube, 19
Filter, 20 Groag, P., 30, 34, 35, 63, 71, 104, 125,
Finaly, E., 133, 201 145, 182, 207, 247
Fischer, Hermann, vi Growth: animal, 43, 47; plant, 38
Fistula, 151, 158 Grubel, 146
Flexner carcinoma, 245 Gruchella, 126
Flies, experiments on, 4 Grttter, W., 239
Focal-heat theory of effect of short Guinea pigs, experiments on, 31, 42, 55,
waves, 33, 35, 71, 95 181, 239
Formulari, 56 Gumpcrt, M., 167
Fowls, experiments on, 5 Gutsch, W., 239
Frequency, measurement, 22; tee alto
High-frequency current Haas, M., 82, 153, 227
Frogs, experiments on, 46, 50 Haase, W., 28, 29, 30, 31, 34, 35, 69, 72,
Frdhlich's disease, 127 247
Frostbite, 178 Haber, P., 55
Fruhwald, V., 83 Habits and skill of operator, 97, 111, 119
Fuchs, G., 82 Hackemann, 82, 159, 164, 166
Fungi, growth promoted, 32 Haiman, J. A., 233, 237
Furth, 69 Hair, growth, 47, 232
Furuncle, 5, 211-18, 240 Hair-covered areas, 58
Furunculoeis, 211, 212 Halle, 168
Halpert, 176
Galland, Walter S., vi Halphen, A., 43, 91, 150, 193, 201
Galvanic coupling, 15, 17 Hancken, 122, 146, 148, 150, 152, 168,
Gangrene, 177, 178; pulmonary, 138 187
Gastric neuroses, 150 Hasch<5, E., 29, 31, 62
Gastritis, 146 Hayer, E., 121, 133, 135, 178, 207
Gastro-intestinal tract, diseases, 143-54 Head, diseases of, 233-40; ear, 239; eye,
Generator, short-wave: output measure- 238; mastoiditis, 240; sinusitis, 233
ment, 23 Headle, T. J., 58; quoted, 43
Generator circuit, 15, 17, 20 Heart, diseases of, 171 ff.; angina pec-
Genito-urinary tract, diseases, 155-70; toris, 172; functional disorders, 173;
female, 158; male, 166 inflammation of muscle, 174; organic
Georgesco, 208 diseases, 174; exclusion from electric
Gesenius, 94, 162 field, 243
Gingivitis, 143 Heat: coagulation a cause of burns, 99 ff.;
Ginsberg. A. J., 131 dispersion during treatment, 78; focal-
Glands: ductless, 126 ff.; lymph, 181 ff. heat theory, 33, 35, 71, 95; heating
Glass-insulated electrodes, 109, 111, 112 qualities of different wave lengths, 68;
Glaucoma, 239 sensations of, 97 ff. See alto Temper-
Gleissner, 168 ature
INDEX 305
Heat production, 3, 5; fundamentals, Infections, 84, 85, 120-25; axillary

9 ff.; in living and dead animals, 41 sweat-glands, 222-25; extremeties, 225-
"Heat stroke," 42 27; joints, 190; pelvis, 158; skin,
Heat therapy, 87 ff., 252 211 ff.; wounds and lacerations, 199
Heat waves, 67 Inflammation, 49, 59-64, 84; heart
Heating capacity of tissues, 45 muscle, 174; joints, 190; pelvis, 158;
Heinle, R. W., 72 the sinuses, 233-38
Heinrich, 79 Infra-red waves, 67, 179
Heller, R., 29, 30, 33, 46, 72 Injections of anesthetics, 242
Hellfors, 156, 173, 187 Insulating material, 80, 106 ff.
Hematoma, 198, 199 Insects, experiments on. 4
Hemiphlegia, 207 International Congress of Radiology,
Hemostasia, 83 196, 207
Hempe, K., 173 Intestinal diseases, 150
Hepatitis, 152 Investigations, early, 3-5
Herpes zoster, 232 Iridocyclitis, 239
Hertenstein, 239 Irradiation therapy, 67, 86
Hertz, 3 I to, S., 79, 83, 244
Herzum, A., 38, 193 Izar, G., 32, 33, 51, 54, 55, 56, 69, 73
Heurard, 43
Heymann, 155, 170, 195 Jacobson, V. C., 44, 47
Hiccup, 209 Jacquet, 238
Hicks, R. A., 29, 30, 33, 36, 61, 72 Jellinek, S., 43, 44
High-frequency current, 3; an alternat- Johnston, M. M., 33
ing current, 10; characteristics, 9 ff.; Joints, diseases, 190-98
difference between diathermy and Jörns, Gr., 38, 47, 49, 54, 56, 61, 129, 190
short-wave, 13; frequency measure- Joule's law, 10, 12, 95
ment, 22; oscillations, 4, 5. See also Journal of the American Medical As-
Short waves sociation, 102
Hinsie, L. E., 5, 55, 88, 92, 200,
Hoarseness of singers, 131 Kahler, H., 36
Hoeffler, H., 183, 211, 240 Kaudere, O., 201
Hoff, H., 207 Kataura, S., 79, 83, 244
Hoffman, H. F., 205 Kellner, D., 48, 69, 91, 208
Holmquest, H. F., 105 Kidney, 169; functional activity, 156
Holzer, W., 72 Kiesselbach, A., 80
Horn, L., 209 Kiewe, P., 239
Horowitz, E . A., 159 Killerich, J., 65
Horsch, 72, 79, 194 Kling, D. H., 31, 58, 102
Horse, experiments on, 52, 56 Knudsen, A., 42, 44, 51, 54
Hosmer, H. R., 42; quoted, 5 Kobak, D., 56, 93, 150, 152, 178. 186,
Hosoi, K., 44, 47 191; rules for administration of treat-
Hot-water bath, 31, 34 ment, 111
Hunermann, T., 233 Köhler, E. von, 79, 143, 227, 239
Human beings, experiments on, 4, 5, 46, Kohler, H. W., vi
Korb, 66, 166
51, 54, 56, 58, 68, 69, 83, 147 Koväcs, R., 96
Humphris, 91 Kowarschik, J., 62, 79, 80, 105, 171, 227
Hutter, K., 158 Krause, J., 239
Huwer, 82
Kroll, W., 200, 203, 204, 205, 206, 210
Hypertension, 156, 175
Kronfeld, 169, 201, 207
Hyperthermia, 88, 202
Krusen, F. H „ 201
Hypertrophic arthritis, 194, 198
Laqueur, A., 79, 85, 121, 126, 131, 133,
Inductive coupling, 15, 16 150, 152, 158, 159, 177, 188, 192, 194,
Inductotherm, 105, 106 197, 199, 202, 204, 230, 241
306 INDEX
Lambrecht, 133, 152, 173 99, 102, 119, 142; principles of spark-
Laryngitis, 131 gap construction, 17-21, 24; unethical
Last, E., 49, 81, 129, 144, 167, 168, 177, sales practices, 114
178, 193, 194, 196, 203, 218, 227, 232, McKinley, G. M., 43
240 McLennan, T. G., 52, 53, 57, 68, 69,
Loszlo, A., 240 93, 153
Latchford, W. B „ 50, 72 Mahlo, 147, 149, 154, 157, 168
Lauber, 190 Mahn, G., 233
Laudat, M., 91 Maier, 174
Lecher system of measurement, 22 Malaria, 91
Leichner, 235 Male genito-urinary tract, 166-70
Lentze, F. A., 29, 31, 32, 34, 35, 36 Malignant diseases, 82, 244-47
Leopolde, 152 Mann, 174
Lesions, 198, 199 Mannes, 193
Leunig, H., 29, 31, 62 Marinesco, 69
Liebesny, P., 29, 30, 31, 32, 80, 122, 124, Marvin, H. M., vi
125, 133, 136, 137, 140, 143, 158, 167, Massage, 86
168, 169, 170, 172, 177, 178, 188, 195, Mastitis, 183, 240-43
201, 202, 205, 206, 207, 212, 220, 223, Mastoiditis, 240
227, 235 Maxwell, James C., 3
Light therapy, 67, 86 May, E., 56
Lippelt, H., 29, 30 Measurements, 22-24
Literature on diathermy, v, 4, 5, 257 ff. Mechanotherapeutic measures, 86
Liver, heating, 153 Melancholia, 209
Living tissue, see Tissue Mellon, R., 36, 61
Lob, A., 62, 72, 81, 82, 85, 122, 123, 124, Menstruation, 128, 129, 160, 164, 177
125, 135, 151, 153, 178, 181, 184, 185, Mental disease, 209
192, 195, 199, 202, 203, 221, 227, 247 Mercury thermometer, 166
Loch, 87 Merriman, J. R., 105
Locomotor system, diseases, 184-99; Metabolic diseases, 126-29
bones, 187; joints, 190; muscular Metallic substances, 80, 111, 112
system, 184; traumatic injuries, 190, Metritis, 162
198 Meyer, J., 172, 232
Lohrig, 160, 195 Mice, experiments on, 4, 40, 42, 43, 44,
Loiseleur, 162 245
Loomis, A. L., 41. 72; quoted, 69 Micrococcus melilensis, 33
Ludwig, F., 38, 59 Microorganisms, experiments on, 27-39
Lumbago, 184 Microwaves, 70
"Lumpy jaw," 124 Migraine, 206
Lung: abscess of, 136, 139; tuberculous Mikulicz' disease, 181
disease, 122, 135 Moretti, P., 32, 33, 51, 54, 55, 69, 73
Lupus, 232 Moricard, R., 161
Lux, A., 144, 187 Mortimer, B., 5, 41, 52, 72, 93; quoted,
Lymph, extravasation of, 199 42
Lymph glands, 181-83 Motility, impairment of, 208
Lymphadenitis, 218 Mouth, infections and inflammations,
Lymphangitis, 218 143 ff.
Müller, R., 147, 190, 204
Machines: a cause of accidents, 99, 102, Muscle, heart: inflammation, 174
119; Bo vie machine, 83, 84; construc- Muscular system, diseases, 184-86
tion of short-wave, 13 ff.; current Myalgia, 184
generated by tube machines, 21, 22, Myocarditis, 174
24; electropyrexia apparatus, 87 ff.;
high-output, 99; how developed, 4; Nagel], H., 32, 167, 191, 197
need for reliable apparatus, 77, 78, 96, Nagelschmidt, Franz, 4, 91, 92, 227
INDEX 307
NUT, 52 Pansinusitis, 235

Nasset, E. S., 49, 50, 51, 52, 73 Paralysis, 5, 88, 200, 201, 207
Necrotic tumor, 245 Paramecium candalum, 36
Neon light, 114 Paratyphoid B, 33
Neon tubes, 16, 22 Parkinson's disease, 208
Nephritis, 156 Parodontitis, 144
Nervous irritation, 79 Paronychia, 225 ff.
Nervous system, diseases, 200-210 Parotitis, 182
Neuber, 125 Parrot eggs, 44
Neumann, W., 135 Paschetta, V., 192
Neuralgia, 203 ff. Pasteur, F., 37
Neuritides, 202-6 Patient circuit. 15, 17
Neurologic conditions, 89 Patzold, J., 5, 13, 40, 46, 57, 66, 68,
Neuroma, 210 93, 166
Neurosyphilis, 200-202 Pavax treatment, 179
Neutralization by spark, 3 Peemoller, 85, 152, 162, 173, 194, 235
Noack, 92, 146, 193 Pelvic inflammation and infectious, 158
Noller, 54 Penis, plastic induration, 169
Noma, 143 Peptic ulcer, 147-50
Nonconducting material, 80, 106 ff., 166 Peri-arthritides. 199
Novocain injection, 241 Periodontitis, 143, 144
Periosteal pain, 111
Obesity, 126 Periostitis, 187
Ocular muscles, 239 Peripheral circulatory system, 176-81
Oettingen, K. von, 37, 44, 54, 147, 181 Perirenal abscess, 157
Ohm's law, 94 Peritonitis, 150, 151, 159, 160
Operations, see Surgery Perityphlitis, 150
Operator: dangers in exposure to short Pernios, 233
waves, 79; habits and technic, 97 ff., Personnel administering short waves:
119 safeguards for, 80; technic and habits.
Optic nerve, 238 97 ff., 119
Oral cavity, 143-46 Perspiration, 99
Orbital phlegmous, 239 Peters, T., 132
Organic compounds, heating, 58 Peterson, 150, 184, 203
Orias, O., 48, 72 Pflomm, E., 42, 48, 51, 54, 55, 60, 61,
Osborne, S. L., 72, 93, 105, 126 62, 123, 173, 176, 181, 190, 191, 196,
Oscillations: damped, 13, 14, 24; high- 197, 211, 232, 247
frequency, see High-frequency cur- Phelps, K. R., 72
rent; undamped, 13, 18, 24 Phlegmon, 227-30, 239
Oscillatory circuits in short-wave ma- Photometric method of measurement, 23
chine, 15 ff. Physalix, M., 37
Osseous structures, 94, 144, 187 ff. Physical aspects of short-wave dia-
Osteomyelitis, 187-90 thermy, 9-24
Ostertag, B., 45, 72 Physiologic effects of short waves, 48
Otitis, 239, 240 Physiotherapeutic measures, 67, 86
Otosclerosis, 240 Pieper, 201
Output measurements, 23
Pierce, G. W., quoted, 244
Overgaard, K., 247
Piffault, C., 171
Pituitary, treatment of, 128, 129
Padding, 97, 98, 102, 112 Pitzen, 204, 205
Page, A. B., 37, 42 Plants, experiments on, 4, 5, 37
Paladini, P., 162 Plasma, heating of, 53
Palmar abscess, 229 Plate, in vacuum tube, 19; voltage, 20
Palsy, 208 Pleurisy, 133
Pancreatitis, 153 Pneumococcal, 33
308 INDEX
Pneumonia, 121 152, 158, 159, 177, 188, 192, 194, 197,
Polarization, 11 199, 204, 230, 241
Poliomyelitis, paralysis following, 207 Reproduction, animal: effect of short-
Polyneuritis, 206 wave treatment on, 43
Fordes, 161 Resistance connected to capacity, 12, 13
Pratt, C. B., 5, 30, 45 Resonance, 15-17, 22
Primary circuit, 15, 17, 20 Respiratory tract, diseases, 130-42
Proliferative arthritis, 196 Rheumatism, 184
Prominent parts, current concentration Rhinitis, acute, 120
in, 78, 99, 103 Richards, W. T., 72; quoted, 69
Prostate, disease of, 168, 170 Ries, J. von, 38
Proust, R., 161 Roentgenotherapy, 182, 222
Pruritus, 232 Rollin, 126, 150, 155, 187
Psoriasis, 232 Rözsa, L., 82, 125, 145, 178, 194, 207
Publications dealing with diathermv, v, Rubber-insulated electrodes, 109
4, 5, 257 £f. Rubin, H. M„ 31
Pulmonary disease, 130-42 Ruete, A., 178, 217, 233
Pulmonary gangrene, 138
Pulmonary tuberculosis, 122, 135 Saidman, J., 5, 81, 177, 207, 232, 233
Pulsford, J., 161 Salpingitis, 159, 162
Pustules, 228 Sarcoma, 245
Pyelitis, 155 Scalp, 232
Pyelonephritis, 156 Schaefer, H., 45, 55, 56, 68
Pyogenic infections of the extremities, Schaffler, J., 82, 125, 145, 178, 193, 194,
124, 225 ff. 207
Pyoealpingitis, 160 Schaible, P. J., 42, 44, 54
Schedtler, O., 81, 122, 132, 133, 150
Raab, Ernst, 53, 81, 82, 109, 122, 123, Schereschewsky, J. W., 4, 5, 41, 42, 43,
126, 127, 132, 133, 136, 138, 141, 143, 53, 68, 244, 245; quoted, 40
144, 146, 148, 152, 155, 159, 160, 161, Schittelheim, 121, 133, 135, 191
166, 167, 168, 174, 182, 188, 193, 194, Schliephake, E.: creation of short-wave
203, 204, 206, 211, 218, 219, 233, 237, diathermy, 5; quoted, 72, 78; men-
238 tioned, 28, 29, 30, 31, 34, 35, 42, 45,
Rabbits, experiments on, 31, 33, 43, 45, 46, 47, 50, 53, 54, 55, 57, 59, 62, 63,
47, 49, 50, 68, 72, 129, 200 64, 65, 68, 69, 70, 71, 72, 78, 79, 80,
Radio transmission, beginning of, 3 93, 95, 106, 112, 122, 123, 127, 130,
Radium, effect upon atoms, 67 132, 133, 134, 136, 138, 140, 141, 143,
Rahlwes, 53, 184, 232 144, 145, 147, 148, 150, 153, 155, 157,
Rahnenführer, 174 159, 167, 174, 178, 181, 184, 188, 190,
191, 193, 197, 200, 201, 202, 203, 206,
Rats, experiments on, 5, 41, 42, 43, 44,
207, 209, 211, 212, 218, 221, 226, 227,
59, 68, 72, 103, 245, 246
231, 232, 234, 237, 238
Rausch, Z., 92, 156, 172, 173, 174, 175
Schmidt, W. H., 235
Ravault, P. P., 77, 83, 203, 204, 244
Schmidt-Hoensdorf, F., 30
Raynaud's disease, 177
Schors, 193
Rays, effect upon atoms, 67
RSchou, 126, 150, 152, 177, 193, 201, 231 Schultze-Rhonhof, F., 55, 147, 181
Rectifier tubes, 20 Schumacher, P. H., 163, 166
Rectum, 151 Schütz, 73, 148
Regenerative circuit, 19 Schwarzkopf, Erich, vi
Rehn, 194 Schwarzschild, M. M., 159, 200
Reiter, T., 45, 49, 68, 72, 93, 121, 133, Schweitzer, G., 93, 123, 133, 143, 146,
144, 145, 239, 247 150, 152, 155, 184, 205
Remier, 232 Sciatica, 203, 204
Remouchamps, L., 32 Scleritis. 239
Remzi, R., 79, 85, 121, 126, 131, 150, Scleroderma, 232
INDEX 309
Sclerosis, 207 Stieböck, L. H., 4, 82, 83, 92, 145, 178,

Scrotum, diseases, 168, 169, 170 204, 227
Seborrheic conditions of scalp, 232 Stomach diseases, 146-50
Secondary circuit, 15, 17 Streptococci, 29, 32, 36, 61, 137
Seeds, growth, 38 Surgery, combination with short-wave
Self-inductor, variable, 16 diathermy, 81, 82 ff., 219, 228, 231
Self-rectifying circuit, 20 Sweat, 99
Sell, 147 Sweat-glands, axillary, 222-25
Sennewald, 194 Syccosis vulgaris, 233
Serpigenous ulcer, 239 Syphilis, 200
Serum, effect of short waves on, 52, 68 Syphilitic endarteritis, 178
Sexual powers, 129 Syphilitic mesaortitis, 174
Sheard, C., 5, 30, 45 Syringomyelia, 209
Short-wave machines, see Machines Szymanowski, W. T., 29, 30, 33, 36, 37,
Short waves: curative properties, 77; 61, 72
defined, 24; different effects of high-
frequency currents and diathermy, 13;
Tabes, 201
focal-heat theory of effect of, 33, 35,
Tadpoles, experiments on, 43
71, 95; inconvenient effects of ex-
Taylor, H. J., 247
posure to, 79; treatment with, 24;
value as therapeutic agent, v. See also Technic, short-wave: general anu me-
Diathermy, short-wave; High-fre- chanical principles, 97-115; treatment,
quency current 77-96
Siegen, H., 173 Technician, see Operator
Singers, hoarseness, 131 Teeth, infections, 143 ff.
Singultus, 209 Tegethoff, W., 132
Sinus, dental, 143, 144 Telkes, Läszlo, vi
Sinus following nephrectomy, 158 Temperature: measurement, 65; record-
Sinusitis, 233-38 ing, 34; regulation, three types of
primary disturbance, 64. See also Heat
Skin diseases, 211-33; axillary sweat- Tendovaginitis, 184
gland infection and abscess, 222; car- Tenney, C. F., 90
buncle, 218; furuncle, 5, 211, 240; Tentanus, toxin, 36
infections of the extremeties, 225; Tesla, Nicolas, 3
miscellaneous diseases, 231; phlegmon, Testicles, 169
227, 239; pyogenic infections, 124, 225 Therapeutic measures to be employed
Skin sensitivity, 97 ff. with short waves, 86
Snake venom, 36, 37, 61 Thermocouple needles, 23
Solenoid, 105 Thermocouples, temperature measure-
Spark, neutralization by, 3 ment with, 65
Spark-gap construction of machines, 17- Thermometers, 66, 166
21, 24 Thompson's formula, 14, 20
Spark-gap system, 13 ff. Thorax, 199
Spark-gap transmitter, 3 Thromboangiitis obliterans, 178, 179
Sparkenberg, 144 Thyroid diseases, 128
Spasm of the esophagus, 146 Thyroid gland, 49
Spastic conditions, 150, 184 Tissue, animal, 10, 12; action of differ-
Specific effect, or specificity, of short ent wave lengths on, 45; effect of re-
waves, 70 ff. sistance to curreijt, 71; heat measure-
Spinal cord, 59 ment, 23; Ioeal chängte 56
Spondylo-arthritis, 194 Tomberg, V , 30,34, 36, 68, ?1, 1Ö4, 125,
Sprains, 198, 199 207, 247
Staehler, 166 Tomberg methdd of unipolar appli-
Staphylocci, 29, 32, 137 cation, 222
Stefanesco, 208 Tonsen, 60
Stein, R. O., 232 Tonsillitis, 145
310 INDEX
Tonsils, 82, 85, 145 Vincent's angina, 145
Toxins, 4, 36, 61 Viola, 36
Transformation of energy, 9 Viruses, 37
Transmitter, spark-gap, 3 Visible light rays, 67
Traumatic arthritis, 192, 198, 199 Voegtlin, C., 36
Traumatic injuries, 190, 198 Vogt, E., 160, 161, 162, 191
Treatments by short waves and other Voltage, in vacuum tube, 20
methods, 77-96 Von Seemen treatment, 218
Treponema pallidum, 33 Votz, 121, 133, 155, 156
Trichophyton tonsurans, 35
Tronside, 121 Wagner, E., 143, 144
Tube, vacuum, 18, 19 Wagner-Jauregg, J., 91, 202
Tube machines, current, 21, 22, 24 Wallace, 50
Tubercle bacillus, 31, 32 Walter, 152, 155
Tuberculosis, 81, 122, 135; of breast, 242 Warm-water bath, 31, 34
Tuberculous adenitis, 181 Warren, S. L., 43, 50, 51
Tuberculous colitis, 150 Watson, 175
Tuberculous cystitis, 155 Wave lengths for short-wave diathermy,
Tuberculous fistula, 158 67-74, 197; action of different wave
Tuberculous disease of the osseous tis- lengths on tissue, 45; different heating
sues, 195, 198 qualities, 68; measurement, 22; mi-
Tuberculous disease of the testicles, chrowaves, 70; specific effect, on
bladder, and kidney, 169 specificity, of short waves, 70 ff.
Tuberculous peritonitis, 151 Wavemeter, 22
Tubes, rectifier, 20 Weigel, L., 191
Tumors, 68, 72, 244-47; adnexal, 158, Weight reduction, 127
160; animal, 5; plant, 4 Weinmann, J., 143
Turrell, W. J., 184, 187, 193, 199 Weise, 152
Typhoid bacillus, 32, 33, 56 Weissenberg, E., 50, 72, 77, 123, 125,
128, 132, 143, 145, 146, 149, 150, 151,
Ulcer, 154, 177, 181, 232; corneal, 238; 153, 157, 164, 168, 170, 173, 176, 177,
peptic, 147-50; serpigenous, 239 178, 188, 191, 195, 203, 206, 207, 208,
Ultraviolet radiation, 67, 86, 179 209, 211, 221, 231
Unicellular organisms, 36 Weisz, H., 203
Unipolar method, 104, 113 Wertheimer, 204
Unipolar treatment of seeds, 38 Wessely, E., 125
Uremia, 156 Wetzel, G., 80
Urethritis, gonorrheal, 166 Wheat, growth, 38
Urinary incontinence, 210 Whitney, W. R., 79, 87
Urinary tract, 155-58 Wiggers, C. J., 48, 72
Wilson, J., 91
Vaccination, see Autovaccine therapy Wittenbeck, F., 87, 160, 161, 166
Vaccines, 222 Wolf, H. F., 193
Vacuum tube, 18, 19 Wolf, R., 152, 154
Vaginal electrodes, 107, 108, 165
Vaginal route, treatment by, 164 Wolfrum, 133, 146, 152
Variable condenser, 16 Wollbach, S. B., quoted, 244
Variable seli-iudvjctor, 16 Wood, Francis Carter, vi
Varicose veins, 81 Woods, E. A., 181
Vascdlar system-, 176 81 ; essential hyper- Wounds, infected, 199
tension, 175; peripheral circulatory
system, i ? 6 X-rays, 86, 102, 233; effect upon atoms,
Vasodilatation 173 176. 206 211 67
Vatican, short-wave experiments, 5
Vewrm, 36, 37,• 61 Zeyneck, von, 4

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SHORT-WAVE DIATHERMY

New York : Morningside Heights

DURING the past eight years approximately 7 5 0 articles, books

PART III. EXPERIMENTATION WITH

surgical, physiotherapeutic, mechanotherapeutic measures, irradia-

V I I . GENERAL AND MECHANICAL PRINCIPLES IN SHORT-WAVE

V I I I . INFECTIOUS, ALLERGIC AND METABOLIC DISEASES . 119

I X . DISEASES OF THE RESPIRATORY TRACT 130

X . DISEASES OF THE GASTRO-INTESTINAL TRACT . . . . 143

X I . DISEASES OF THE GENITO-URINARY TRACT 155

X I I . DISEASES OF THE CIRCULATORY SYSTEM AND THE LYMPH

X I I I . DISEASES OF THE LOCOMOTOR SYSTEM 184

X I V . DISEASES OF THE NERVOUS SYSTEM 200

X V . MISCELLANEOUS CONDITIONS 211

X V I . MALIGNANT DISEASE 244

PART VI. CONCLUSION

1. Molecular Dipoles between Condensor Plates; Electric Field

E L E C T R I C I T Y as a phenomenon has intrigued man since the

oscillations. In the fancy of the daily press, this was in-

THE PHYSICAL ASPECTS OF

T H E PHYSICAL ASPECTS OF SHORT-WAVE

FROM the medical point of view, a brief review of some well-

deflection while charging, and also while discharging takes

1. Molecular Dipoles between Con- 2. Molecular Dipoles between Con-

produced by both mechanisms, providing the frequency is high

3. Schematic Representations of Elec-

the positive and negative plates of the condenser, the anions

The different effects of diathermy and short-wave high-

at a specific frequency. In other words, for every tissue there is

PRINCIPLES OF CONSTRUCTION OF S H O R T - W A V E MACHINES

In the so-called "short-wave machines," the commercial

tralize in a simple way; but, as experiments have shown, the

6. Schematic Spark-Gap Oscillatory

amount of self-induction ¿_and capacity C is necessary in the

In each short-wave machine at least two oscillatory circuits

7. Damped Electric Oscillations

close to the induction coil / 2 , and the oscillations are transferred

8. Inductive Coupling between Two Electric

(3) the frequency of the generator circuit may be varied, and

The state of resonance may also be determined by hot-wire

The principle of construction of a spark-gap machine is

9. Galvanic Coupling; Generator (primary) and Patient (secondary)

The generator circuit for the high-frequency current con-

10. Undamped Oscillations

possible the generation of stable, continuous oscillations. The

The electronic current flowing through the tube is a function

Three types of current generated by different tube machines

12. A Typical One-Tube Electric Oscillator

Obviously, the same average power may be delivered in

The determination of frequency is of great importance from

One way of measuring wave lengths is by the Lecher system.

The output of a short-wave generator can be measured in

FROM the very beginning of experimentation with short waves,

Tribute should be paid to the numerous experiments of

wave exposures kill bacteria at a lower temperature than does

STAPHYLOCOCCI AND STREPTOCOCCI

Haase and Schliephake conducted in vitro experiments on

Hasch£ and Leunig reported negative results with strong as

In guinea pigs and rabbits inoculated with tubercle bacilli,

Izar and Moretti noted great attenuation of the para-

The reports of Liebesny on the injurious effect of the 4-meter

A variety of bacteria have been subjected to short-wave

rapidity the growth of the controls. A possible explanation of