Eberhart's Manual of High
Noble M. Eberhart, M.D., Ph.D., D.C.L., 1911
General Technique; Vacuum Tubes; Lubrication; Cautions; Asepsis; Method
of Standardizing Dosage; Authors Unit for Measuring Auto-Condensation; Preparation
of Patient; Technique for Skin Diseases or Surface Lesion; for Relief of Pain;
Cauterization; Orificial Technique; Cataphoresis; Bi-Polar Tesla Technique; Selection of
Most Suitable Form of Current; Fulguration; Constitutional Treatment; Auto-Conduction;
Auto-Condensation; Portable Pads; Home-Made Couches and Pads; D;Arsonval
Surgings; Water Spray; Local Auto-Condensation; Indirect Sparks; Taking the
Blood Pressure; Miscellaneous Suggestions; Diathermy.
One author gives upwards of twenty different methods of using high frequency
currents. This is apt to prove confusing to the ordinary user of these currents, and
I have reduced the headings under which to discuss technique to those methods most
commonly in vogue.
Classification of Technique:
1. Vacuum tube technique. (Tube excited by Oudin or Tesla
3. Constitutional (auto-condensation and auto-conduction).
4. Diathermy. (Direct DArsonval; electro-coagulation;
1. VACUUM TUBE TECHNIQUE.
This involves the use of the tubes by direct contact, by
effleuve (fine spray) and by actual sparks, from the mildest form to the sharp caustic
forms. It may be classified otherwise according to its use as in (a) skin diseases,
ulcers, inflammatory processes, etc.; (b) relief of pain, as in neuralgias, etc.; (c)
Vacuum tubes are employed where an essentially local
effect is desired.
Lubrication of Tubes. Any of the lubricating
jellies, unguents or cerates may be employed on tubes used within the urethra, vagina or
Vaseline answers very well, for, although it is a
non-conductor of ordinary electricity, the thin coating required on these tubes is
absolutely no bar to high frequency currents.
Cautions. 1. As stated in Chapter V., high
frequency currents are capable of producing annoying but not ordinarily serious surface
burns. These effects are especially quick to appear when mucous surfaces are
treated, as in rectal, vaginal, urethral or nasal applications, and also in treating
diseased areas about the lips. On this account the application should be relatively
short and mild if a spark is employed in treating within the various orifices. Make
it a general rule never to allow a vacuum tube to remain in contact with a mucous membrane
for more than seven minutes at one treatment.
2. When the current is one of relatively high
amperage, the spark will set fire to any easily inflammable material. This may be
illustrated by lighting the gas with the spark, as previously referred to. On this
account care must be exercised in treating certain areas.
3. When introducing glass sounds into the male urethra
great care must be exercised not to use any undue force and thereby break off the glass
tube within the canal. These tubes are made of strong glass, but may be broken by
unusual pressure, or by a sudden jerk. If difficult of introduction it is better to
pass steel sounds first to a size larger than the glass sound, as suggested in Chapter VII
under Urethral Technique.
Care of Vacuum Tubes. Asepsis.
Although the spark or effleuve from the vacuum tube is germicidal in character,
still it is the duty of the physician to use the utmost care and cleanliness in employing
it in order to guard against any possibility of spreading infection from one patient to
In other words he would better follow some definite system of
sterilizing and disinfecting the tubes, and the nearer this is to surgical asepsis the
Wiping off the tubes on a cloth or towel or simply rinsing in
water is not enough.
Apply the test to yourself. How would you like to be treated with a
tube that had been used in contact with a specific disease and which had received no
further cleaning than mere dipping in water and then being wiped off with a towel that had
already done similar service an indefinite number of times?
Let your technique be so careful and conscientious that you need
never blame yourself for spreading contagion or infection of any kind.
This is a subject that I have not seen mentioned in any
treatises on high frequency currents.
Do not use the same tube for specific and non-specific
orificial cases. This alone will do much toward lessening the danger of infection.
As these tubes bear heating, they may be sterilized by
boiling, just as surgical instruments are sterilized.
This, however, is not necessary, as immersion in strong
antiseptic solutions will be sufficient.
A tube that is to be used in contact with a mucous membrane,
such, for instance, as a vaginal or urethral electrode, should be immersed in pure
carbolic acid or in pure crethol, benetol or lysol, before again using, if it has been in
contact with the discharge from a specific disease.
In cases such as acne, psoriasis, eczema, neuralgia,
non-specific diseases of the urethra, rectum or vagina, etc., it will suffice if the tube
is immersed for a few moments, or kept permanently, when not in use, in a strong solution
of any one of the three antiseptics mentioned in the preceding paragraph.
For this purpose a glass jar, large enough to take in the
various electrodes, should be filled with a twenty percent solution of carbolic acid (a
five per cent solution is not enough); or as its equivalent, one of crethol, benetol or
lysol containing a tablespoonful of either to the pint of water.
An ideal way would be to have two jars, one containing the
full strength antiseptic, for the tubes employed in infectious cases, and the other for
those used in non-contagious diseases.
Personally I prefer crethol or lysol to carbolic acid,
because equally satisfactory and not caustic if any of the full strength liquid
accidentally comes in contact with the operators hands.
If the tubes are immersed in the pure antiseptic they should
be thoroughly rinsed in alcohol and water, or in water alone before using. From the
weaker solutions, water alone is necessary, but in both cases hot water is preferable.
The conveniences of most of our modern office buildings make the technique of
sterilizing the tubes a simple one in the large cities, but in smaller towns the physician
will find it somewhat more of a task.
In the absence of large jars to keep the two solutions
in, with the tubes constantly immersed, wide mouthed bottles may be employed for use
before and after each treatment.
By sterilizing in this manner both before and after, the tube
not only receives a double sterilization, but also if it has been taken care of
immediately after use, if such a thing should happen that it should be used again without
remembering about sterilizing it, the danger would be slight, and furthermore the tube is
easier sterilized immediately after using, than it is when the secretions or discharges
have dried upon it.
I have spoken of using the same care that you would with a
surgical instrument, although the danger with these tubes is not as great as with surgical
instruments for several reasons. In the first place, they are not employed
ordinarily in a fresh wound: secondly, the danger is in carrying infection from one
patient to another and not the additional danger which accompanies a surgical operation,
of infecting the wound from the individual as well, and finally, in the majority of the
cases treated there is practically no serious danger of infection.
If one had a sufficient number of tubes it would be desirable
to keep an individual tube for each patient, which was used for no other. Immersion
in the weaker solutions referred to above and rinsing, or even ordinary cleanliness would
be sufficient; but at the close of the course of treatments, before the tube was used for
another case it then should receive vigorous and thorough sterilization, in proportion to
the danger of infection involved in the case.
The sterilizer shown in Fig. 28 is an excellent one.
A basin of formalin solution keeps the tubes always sterile.
Some of my readers may think I am devoting too much space to
this subject, but it is an important one, and my early surgical training has made me a
crank on this point, and really, could you ever excuse yourself if through
your carelessness you spread, say a specific infection, even in one single instance.
Measuring Dosage. One problem that confronts the
physician who is beginning to use the high frequency is a method of measuring dosage.
There is no meter which will measure the output of the vacuum electrode, or in
other words the unipolar current. For auto-condensation and for diathermy the
hot-wire meter is used and proves relatively satisfactory. For the vacuum tube, in
order to convey an idea that would apply, no matter what size or make of apparatus might
be employed, I have made use of the length of spark which it is possible to draw from the
vacuum tube as a simple method of giving some idea of the strength of current employed.
This is a very crude method, and open to some serious objections, but will answer
the purpose in a general way and convey a more intelligent idea than any method other than
With a definite amount of current passing through the
apparatus, there is a positive point near the tube that represents its utmost sparking
distance, that is, the longest spark that can be drawn from that tube, and this will
remain constant as long as the current is constant lessening the current shortens
the spark; increasing it, lengthens it. Therefore, if I say I employ for skin
diseases a tube capable of yielding a one-quarter inch or one-half inch spark, I give to
the physician a definite idea of the amount of current I would employ in the tube.
This does not take into consideration the sharpness of
the spark, which must be adjusted in accordance with individual susceptibility and the
type of machine used.
With the Tesla type of apparatus and particularly with small
machines, the spark is apt to be sharper in proportion, and is designated frequently as a
hot spark. With these outfits it is often impossible to employ a spark
more than a quarter of an inch in length. With other types, a longer spark will be
tolerated, and with the Oudin type of apparatus we have what may be called a
cold spark, and frequently one three-quarters or an inch long may be more
easily borne than a quarter-inch hot spark. The cold spark is
dehydratory and the hot spark caustic. In interpreting my suggestions for dosage in
Chapter VIII, these facts should be taken into consideration. Ordinarily if the dose
is given one-fourth to one-half inch the first would be for the hot and the
second for the cold spark.
The Eberhart. Authors Unit of
Measurement for Auto-Condensation. For a long time both physicians and
manufacturers have felt the need of a standard unit for measuring auto-condensation; one
that would fairly represent the auto-condensation output of any type of machine. I
believe I have solved this problem, and have a standard of measurement that will prove
acceptable to the manufacturers of any form of apparatus. It will be found
convenient for the manufacturer to state with the directions for auto-condensation that
the output of the machine is so many Eberharts per minute to each 100 milliamperes
registered on the hot-wire meter. In this way with the dosage given as a certain
number of Eberharts, it is easy to note by the meter how many Eberharts are passing per
minute and by noting how many times this number will go in the total dose stated the
number of minutes required for the treatment is ascertained.
There are three essential elements entering into
auto-condensation. First, the pressure or potential (voltage); second, the rate or
meter reading (amperage); and third, the time. When the voltage is high the amperage
is correspondingly low, and vice versa. In a general way the effectiveness of any
machine for auto-condensation may be expressed in terms representing the product of the
voltage and the meter reading (equivalent of amperage). Thus 50,000 volts at 500 is
the same as 25,000 volts at 1,000; each representing an auto-condensation effectiveness of
My unit of measurement for auto-condensation is based on the
passage of 1,000 volts at a rate of 100 milliamperes in one minute of time. This
unit I call the Eberhart and abbreviate it E.
We have two types of apparatus for auto-condensation, the one
high voltage and comparatively low amperage; the other low voltage and high amperage.
In a general way I assume that the first represents a current of about 50,000 volts
delivered at a rate of 350 to 500 milliamperes as shown on a hot-wire meter. The
second averages 25,000 volts, potential, and is ordinarily delivered at a rate averaging
750 to 1,200; 1,000 being a frequent rate. Applying our unit it will be seen that
50,000 volts equal 50 E. For each 100 milliamperes meter reading, and if the meter read
500, there would be delivered 5 times 50 or 250 E. For each minute of time, and this would
give 2,500 E in a ten-minute treatment. With the other machine 25,000 volts equal 25
E. Per 100, and with meter at 1,000 would give 10 times 25 E. Or 250 E. Per minute, or
2,5000 E. Would require a ten-minute treatment.
The manufacturer may state the voltage of his machine, if
desired, but the simpler way is to give the number of Eberharts to each 100 milliamperes
meter reading. He should also state the average meter reading at which the apparatus
is to be operated. If he states the voltage, to compute a required dose, multiply
the meter reading by the number of thousand volts, and divide this product by 100.
This is the number of Eberhart units being given per minute, and by dividing the dose as
given in Eberharts by this, we have the number of minutes required. Going back to
our previous example: to give 2,500 E. auto-condensation on a machine of 50,000 volts with
enough current passing to raise meter to 500, multiply number of thousand volts, 50 by
meter reading 500, and product is 25,000. Divide by 100, which is done by cutting
off two ciphers, and we have 250, which is the number of Eberharts per minute250
goes into 2,500 ten times, therefore it takes ten minutes to give the required dose of
It will be seen that it would be much simpler if the
manufacturer stated with this machine that the auto-condensation output was 50 Eberharts
per minute for each 100 milliamperes registered by the meter. Then if the dose to be
given is 2,500 E. And the meter registers 500, or five times the 100 rate, it is easy to
figure then that 500 is five times 50 or 250 E., and this goes in 2,500 ten times,
therefore it takes ten minutes to give that amount.
With the other type of machine we will say that the output is
25 E. Per minute per 100 milliamperes; but this machine will ordinarily be operated at
about 1,000 milliamperes, or ten times 100, therefore it is also delivering ten times 25
E. Or 250 E. per minute, and it will also take ten minutes to give 2,500 E. In
Chapter VIII the dosage of auto-condensation will be stated in Eberharts.
It is well to remember that there is essentially no
danger in auto-condensation and therefore no over-dose, so that the dosage stated may be
greatly increased if results are not obtained.
The only cases in which caution is necessary, are those where
a patient is carrying a high temperature or where the pulse pressure is 20 or lower.
Preparation of Patient. When the surface
of the body is to be treated, the question of removing the clothing arises. If no
spark is desired, the electrode must be in contact with the skin, and any clothing
covering the part must be removed.
All metal, such as chains, corset-steels, wire hairpins,
etc., with which the tube comes in contact or within sparking distance of, will be charged
with the current and give rise to sharp and disagreeable sensations. If they cannot
be avoided they should be removed.
Applications to the body, calling for a mild spark, may be
given through thin underclothing, or the patient stripped and covered with a sheet,
through which the spark is employed.
Aside from the reason spoken of above (chains, etc.), when a
sharp spark is required there is no especial need of removing the clothing, in fact, a
definite thickness insures a definite length of spark.
When the tube sticks on the skin, dust on talcum powder or
lay over the surface a very thin cloth, such as a handkerchief. In vaginal
treatments no disrobing is necessary.
General Technique in Skin Diseases and Surface Lesions.
In applying the high frequency spark over the surface of the body, as in acne,
eczema, etc., I employ a current of sufficient strength to produce a spark one-quarter to
three-quarters of an inch in length. The discharge from the smaller Tesla coils is
relatively sharper than from the resonator or larger Tesla outfits, and a shorter spark is
used, as the patient cannot tolerate quite as much current in these instances. With
a vacuum electrode capable of delivering a spark of the length given, I do not try to make
use of the full length spark, but keep the tube in light contact with the skin, thus
giving a sufficient intensity of current, but avoiding the pain that would result if the
tube were held at
Fig. 28b - Vacuum Electrode Technique.
full sparking distance from the surface. The tube is passed rapidly
back and forth over the area treated, and this will be accomplished in the easiest manner
by holding the tube handle lightly with the fingers, with the thumb extended along the
handle. A side to side motion with the wrist will soon become a matter of habit to
the operator and the tube will pass lightly over the surface without any sudden jerks or
elevations to cause annoying sparks.
If the skin is moist and the tube sticks,
it may be dusted with talcum or other dusting powder to obviate this difficulty.
Another method is to place a thin cloth over the surface, which will enable the tube to be
used smoothly and at the same time does not remove it far enough from the surface to make
an unpleasant spark.
Where itching is marked, the tube is raised from the skin and
as sharp a spark applied as the patient will tolerate for a short period of time.
This quickly relieves the itching and also quickly produces the characteristic reaction of
the current (hyperemia, etc.).
In treating epithelioma, lupus and any chronic ulcers, a
spark is employed in the same manner, that is, as sharp as the patient can stand, but not
for a long period, say from two to three up to occasionally five minutes. Unless
cauterization is sought, the tube should be kept moving rapidly over the surface and not
allowed to expend its full effect steadily over any minute area. At the present time
fulguration (caustic) would be employed more frequently for epithelioma and lupus.
Technique for Relief of Pain. In congestive
headaches, neuralgias and other painful conditions, the beneficial action of the high
frequency current seems to be largely the result of counter-irritation. Therefore,
it makes very little difference whether a sharp spark is used with the rapidly moving tube
at full sparking distance, or whether with the same intensity of current, the tube is kept
in contact with the skin. It depends upon the sensitiveness of the patient and also
upon the location of the area treated. A long sharp spark occasionally exerts a
slight caustic effect, and the surface will be covered with tiny blebs, which are followed
by minute scabs, making the skin sore and uncomfortable. Unless the case to be
treated is a severe one, it is not permissible to push the treatment to this degree.
Cauterization. If a hot spark is held steadily
over the spot for from thirty seconds, up to two or three minutes, varying with the
patient, it will have a cauterizing effect. The reaction is severe and the
destruction of the tissue may be carried to a marked degree. Such applications have
been used in the treatment of warts, moles, etc.
I have treated epitheliomas in this manner and have had them
separate from the surrounding tissue and peel out as smoothly as if cut out with a
die. It is too severe a measure, however, for the average case. Fulguration
involves the same principles, and is preferable. The spark is derived from a metal
point and anesthesia may be employed if desired. The technique of this will be
considered in another section.
Orificial Technique. The technique of the
application to the orifices of the body involves the use of tubes suited to the various
areas, and also involves the question of sterilization and lubrication. In these
cases the tube is in contact with the mucous membrane and there is no sensation to the
treatment except usually that of warmth. There is in these cases greater danger of
producing burns, and the tube should seldom be left in contact for a longer period than
seven minutes at any single treatment. (See the section on vacuum tube burns in
Chapter V.) The technique is so peculiarly that of the special organ involved that
it will be given under its appropriate heading in Chapter VII. It is desirable to
remember that tubes should always be inserted before the current is turned on, and the
latter turned off again before the tube is removed, thus avoiding all pain and shock to
Cataphoresis. For cataphoresis a special
electrode is employed. See Fig. 29. The substance to be carried into the
tissues is in solution, and cotton gauze or felt wet in the solution is placed in the
depression on the face of the tube when the latter is placed in contact with the desired
area and the current passes for from five to ten minutes or more as required. I
caution against the use of solutions containing alcohol or other inflammable substance
because of the danger of setting same afire with the current.
Fig. 29 - Cataphoresis Electrode.
In one form an insulating ring prevents loss of current and is a great
improvement on the older style of tube.
See Chapter XII for special electrodes used by dentists.
Although strong claims have been made concerning the value of high
frequency currents for the purpose of carrying substances into the tissues, I believe they
are so far inferior to the galvanic current for use for these purposes that they are
entitled to comparatively little consideration.
The principle upon which cataphoresis depends is the separating of the
particles (ions) composing the fluid by reason of the attraction possessed for them by the
poles of the battery; thus all positive elements remain at or are drawn through the
tissues toward the negative pole, and vice-versa. Now, in using high frequency
currents, which are alternating, the attraction would be first in one direction and then
in the other and as a result practically nothing would be accomplished.
The claim is made that the high frequency current drives substances into
the tissues by molecular bombardment. I maintain, however, that the
cataphoric action of the high frequency current is too feeble to commend it for general
use, for which purpose nothing takes the place of the galvanic current.
The use of dental electrodes for cataphoric purposes has given good
results. See Chapter X. It is really an electrical diffusion, rather than
Bi-polar Tesla Technique. Ordinarily the vacuum tube is
attached to one pole of the Tesla outfit. In some coils the sharpness of the spark
is regulated by drawing off a certain amount of the current from the active pole by
bringing the sparking rod near it, thus lessening the available current.
If it is desired to intensify the action of the Tesla coil, the
indifferent pole should be attached to the patient or grounded by connecting to a gas or
Selection of Most Suitable Form to Use. Where a local effect
is more essential, vacuum tubes, metal electrodes, etc., are employed, but if a systemic
or constitutional effect is desired, auto-condensation is to be selected, or the
diathermic treatment may be used.
Fulguration. A long sharp spark for escharotic
or destructive purposes was employed for a long time by high frequency operators, but the
use of a metal electrode devised by Keating-Hart for this purpose, which he termed
fulguration, gave an unusual impetus to the method.
Fulguration as employed at the present time may be considered
under two forms: 1. Caustic or hot fulguration, employed with
DArsonval or Tesla apparatus, and giving a hot, caustic or cauterizing spark.
The DArsonval fulguration is particularly suitable in orificial work, such as
papilloma of the bladder, etc. The Tesla is especially advantageous in surface work,
such as moles, warts and other superficial growths.
2. Dehydratory or cold fulguration, employed
with Oudin apparatus. The destruction of tissue is through a drying process and
there is no sloughing. There is essentially no pain, but its range is necessarily
Dr. W. F. Clark of Philadelphia employs a method of cold
fulguration with the static machine, to which he has applied the term dissication.
General Caustic Fulguration. The technique
which I employ for warts, moles and small growths is as follows:
The fulguration electrode is attached and the current turned
on gradually, while the length of spark
Fig. 30 - An Outfit Combining High Frequency with Numerous Other
Modalities, Twenty-one in All.
Fig. 31 - Application of Vacuum Electrode to Chest.
from the metal point (Fig. 33), is tested by bringing the point nearly in
contact with a piece of metal, such as a coin. Without an anaesthetic it is
impossible to employ one more than one-thirty-second to one-eighth or occasionally
three-sixteenths of an inch in length. This spark is hot, and actually sears or
burns the tissue, as noted by the eye and usually by the odor.
It is not desirable to keep this spark in steady
contact, as it is too painful, but if the point is
Fig. 32 - Fulguration Electrode.
Fig. 33 - Fulguration Electrode.
touched to the surface and quickly brought away beyond sparking distance,
the patient is better able to stand it, and by a series of rapid sparks produced by a
tapping motion of the point, thorough fulguration my be achieved without unbearable pain
to the patient. Ordinarily I pass around the margin of the growth first, and then
fulgurate the center. It should be done thoroughly, and the growth will present a
brown, burned appearance. There is seldom any hemorrhage, but usually some serious
oozing. A crust or scab forms which separates in a week or ten days (average eight),
leaving no scar. It is well to bear in mind that if you do not get it all off the
first time you can fulgurate again, but if you remove too much you cannot place it back
For more extensive work, local or general anaesthesia is
It is fair to state that very satisfactory caustic (hot)
fulguration may be accomplished with small machines.
In papillomata of the bladder, fulguration has been
Fulguration of Papillomata of Bladder. The hot
or caustic fulguration may be employed, using wire insulated with rubber tubing, or the
DArsonval method, which is bi-polar, may be used, as follows: One terminal of
the apparatus is connected to the fulguration wire, which is passed through the
cystoscope, and the other terminal is connected to an indifferent flat metallic electrode
placed on the abdomen. The fulguration wire or electrode consists of a steel wire
insulated with pure gutta-percha. As this wire is to be passed through the channel
of an ordinary catheterizing cystoscope, it should not be larger in gauge than No. 6
The patient is prepared with green soap and water and
bichlorid, and the bladder distended with water. After the cystoscope is introduced,
the tumor is brought in view and the fulguration wire passed through the catheter channel
of the cystoscope until the end of the wire is in view. The wire is then plunged
into the tumor and the current turned on. (Before introducing the wire into the
cystoscope, cut the wire so that the insulation is flush with the end of the wire.)
Just as soon as the high frequency current is turned on, bubbles (presumably hydrogen) are
seen emanating from the tumor. If the tumor is small, or the electrode has been
placed near the top of the tumor, an immediate blanching of the tumor is seen. This
treatment can readily be carried out under the guidance of the eye, providing the
insulation of the fulguration wire is intact; unless the insulation is intact, a
short-circuit in the cystoscope and subsequent burning out of the cystoscope lamp may
After allowing the current to pass into the tumor for about
twelve to fifteen seconds, the current is shut off, the fulguration wire withdrawn and
re-applied to another part of the tumor. In large tumors, this procedure can be
repeated until many different areas of the tumor have been treated in one sitting.
As long as five or six minutes may be consumed in one sitting. Naturally, the
duration of each treatment will depend on the size of the tumor. For example, in one
case, one sitting consisting of three 12-second applications was enough to completely
destroy a small papilloma.
As long as the intra-vesical electrode remains in contact
with the tumor no pain is experienced by the patient. When working near the base of
the tumor, or if the electrode comes in contact with the bladder-wall, the patient
frequently complains of pain. So that during the first fulgurations there is no
pain, whereas, toward the end f the treatment, while working near the bladder in treating
the remaining tags, the patient at times complains of pain. It is also necessary to
consider the pain incident to cystoscopy. This is variable in different persons, so
that some of the patients cannot tolerate long sessions as well as others. The
number of treatments or sittings, as previously stated, is determined by the size of the
tumor, some cases requiring as many as six sittings.
Attention is called to the burning off of the insulation near
the end of the fulguration wire. After the current has been turned on and the
treatment carried on for a little while, sometimes only ten seconds, the insulation
becomes soft, and falls off or burns off from the end of the wire, so that it becomes
necessary to withdraw the wire and cut the end off squarely. Unless this is done,
there is danger of the bare wire causing a short-circuit in the cystoscope.
Usually when the high frequency current is applied the
tissues become white and shrivel up. Sometimes the tumor surface appears dark, as
though it were baked. Not infrequently after an application a larger or smaller
piece of the tumor adheres to the end of the fulguration wire. At other times these
small pieces may be passed at the next urination, and often they are obtained from the
wash water. These are carefully saved and examined microscopically.
It is suggested that papillomata should be considered
malignant in all cases; that in all cases of long standing cystitis which has persisted
even in the presence of careful treatment, or with the history of frequent relapses,
papilloma should be suspected, and the diagnosis confirmed or contradicted by
cystoscopy. It is the consensus of opinion that the fulguration method is followed
by remarkable results, but as yet sufficient time has not elapsed for us to make a
definite statement as to an absolute guarantee that this treatment will prevent
recurrences. (Abstracted from an original article, Fulguration Treatment of
Bladder Tumors, by Herman L. Kretschmer, M. D., of Chicago. Illinois Medical
Journal, April, 1913.)
Fig. 34 - Portable Outfit.
3. CONSTITUTIONAL (AUTO-CONDENSATION AND
Auto-conduction. In auto-conduction the patient
is placed within a large solenoid or coil, constituting a cage. The patient is not
in contact with this cage at any point and the high frequency currents in the
patients body are produced by conduction.
The cages are of several types, some in perpendicular form,
and others in a horizontal position. In the latter the patient is either placed on a
board which slides into the cage, or the top of the latter is hinged like the cover of a
basket. Some of the perpendicular forms are collapsible, others are fitted with a
door, the patient standing or sitting on a stool.
Small cages are also made into which the arm or leg may be
introduced, thus producing localized auto-conduction effects.
The dosage is the same as with auto-condensation.
Fig. 35 - Horizontal Auto-Conduction Cage. Now Seldom Used.
Auto-condensation. In auto-condensation, one of the terminals of
the apparatus is attached to the metal forming one plate of a condenser and the other to
the patient, who becomes in this manner the other condenser plate.
The patient is insulated from the metal plate
by silk floss, rubber, mica, glass, or other form of dielectric.
In Figure 36 is shown a cross-section of a plate
condenser. In Figure 37 the body of a woman is substituted for the upper plate, thus
showing the principle involved in auto-condensation.
Auto-condensation is administered by means of a couch or pad
designed for the purpose and may include the whole body or be constructed to influence
only a part of it.
The original couch was in a form similar to that of a Morris
chair (Fig. 38), the plates of zinc being under the cushions on back and seat, the
cushions themselves being stuffed with silk floss or with Spanish moss. The plates
connect with one binding post of the apparatus, and the other is connected to a rod from
which wires run to metal handles on each side, which are held by the patient, who receives
the charge whether one or both handles are grasped.
In that part of the circuit that is connected to the handles
a hot wire meter is placed to measure the dosage. No other form of electrical
treatment gives so high an amperage, except diathermy, the dose running from 150 to 1,500
milliamperes, with occasional reports of the use of even a stronger dose.
It is well to remember that there are two types of machines
used in producing auto-condensation. One has high voltage, but comparatively low
amperage, requires a cushion at least three inches thick and has great penetration, so
that a vacuum tube will light up within an area of several feet surrounding the
patient. With this type the average meter reading to obtain satisfactory result is
350 to 500. It is seldom necessary or desirable to secure a higher reading.
Lower readings, 150 to 200, would be used where it was desired to influence nutrition
without particularly lowering blood-pressure.
Fig. 37a - Portable High Frequency, Telatherm Type.
The other type machine has comparatively low voltage, but
high amperage. It may be used with a thin pad if desired. The meter will read
750 to 1,000 on an average, and up to 1,200 or 1,500, according to the potential of the
apparatus. Auto-condensation is measured in Eberharts, as stated in a preceding
section in this chapter.
Fig. 38 - Auto-Condensation couch with Oudin Resonator and Induction
Coil. Original Type. Now Obsolete.
As long as the patient is in electrical contact with the
handles, that is, perfect contact, no sensation is felt except occasionally a slight
tingling or sensation of warmth. Sparks may be drawn from the patient, and these may
be quite painful. In type No. 1 a vacuum tube held in operators hand will draw
a spark from patient which is known as one form of indirect spark. In general, a
feeling of warmth pervades the body after a few moments, and the temperature is shown by
the clinical thermometer to be from one-half to one degree higher than before the
Fig. 38a - Portable Outfit.
The couch or cushion is connected to one terminal of the
apparatus, the patient to the other. The static machine with hyper-static
transformer does not give a sufficient amperage for the satisfactory operation of a couch;
neither does the average portable outfit, although the latter has more amperage than the
static machine. Both of these may be used for charging small pads for restricted
areas, and some types of the larger portable coils I have found capable of operating a
good-sized pad, if the dielectric is thin.
In 1903 I designed the first portable body pad, which folded
together when not in use. It consisted essentially of the top of the couch and was
intended to save the space required for the latter.
About the same time Piffard produced a condenser pad for the
set of an ordinary chair (Fig 41).
It is a well-known fact that the thinner the di-electric is,
as long as it is a perfect di-electric, the greater the corresponding charge that may be
held on each layer of condenser. This caused me to substitute flexible mica for the
material used in the ordinary pad and thus produce a portable auto-condensation pad only
half an inch thick, and capable of being slipped under the leather cushion of the ordinary
office treatment table, converting the latter into an auto-condensation table. At
the same time a much greater charge of electricity may be condensed in the patient than
with the thicker pads.
Pads less than three inches thick have been condemned by the
standardization committee of the American Electro-therapeutic Association, therefore, at
the present time I employ only the thick cushion.
Many ingenious operators construct their own chair or couch,
and from an article of mine on this subject in Popular Electricity, November, 1909, I make
a few excerpts:
A glass slab, four or five feet in length, twenty
inches wide and about one inch thick, such as is used in a glass-topped operating table,
is fitted in a wooden frame and to the under surface is attached a strip of zinc or of
sheet lead 1/32 of an inch thick. This strip should be about ten or twelve inches
wide, so that when placed on the
Fig. 39 - Portable Coil.
Fig. 40 - Portable coil.
lower surface of the glass it will leave a margin of about four or five
inches between the edge of the zinc and the edge of the glass. It should extend
lengthwise to within six inches of either end of the glass slab. The zinc or lead
plate is connected by an ordinary covered conducting wire say, not smaller than No. 10 or
12, to one pole of the high frequency apparatus and the patient connected by an ordinary
metal electrode to the other pole. The patient may be placed directly on the glass,
but it is preferable to place him on a thin cushion upon the glass, for sake of comfort.
Fig. 41 - Condenser Cushion for Chair.
Another method is to take a wooden table long enough
for the patient to lie on and place underneath the table top a layer of plate glass the
full size of the top of the table with a strip of lead or zinc attached to the under
surface of this glass, always bearing in mind that the essentials of an auto-condensation
pad are to have a di-electric with a layer of condenser below it, and the patient attached
to the apparatus to form the upper layer. Thus, an ordinary Morris chair or
steamer-chair may be used and a layer of lead or zinc fastened underneath the back and
seat of the chair, the two strips being fastened together with metallic connections (chain
or wire) and underneath the ordinary cushion of the chair, four or five layers of rubber
are placed to serve as the di-electric, although the cushions themselves, if they remove
the body beyond the sparking distance of the charge on the zinc plate, would really make
the air space intervening serve as a di-electric. This is not as satisfactory as
when the layers of rubber are placed between. The patient then is connected by the
ordinary metallic hand electrode and conducting cord or metallic handles may be fastened
on the arms of the chair, the two connected by a bifurcated conducting cord to the one
pole, the zinc plates to the other.
Lastly, a pad may be constructed on the same plan as
the one which I have designed, using one or more layers of sheet mica large enough to
permit the body of the patient to rest on and making use of a layer of condenser either
lead or zinc underneath the mica, taking care that it does not extend near enough to the
edge of the mica to allow the charge to leak over. On top of the mica place three or
four layers of felt or cover with leather as desired. Should the mica be
insufficient to prevent some sparking through, it may be obviated by placing another thin
cushion on top of this pad.
The patient is placed on the couch or pad and connected to
the apparatus before the current is turned on, and then the current turned off before the
patient lets go of the handles, thus avoiding all shock.
If the patient questions whether he is getting any current or
not a few sparks drawn from his body readily convinces him.
Another form of treatment which the patient feels to the
extent of strong muscular contractions may be made by introducing a spark-gap into the
patients circuit. This I describe in another section as DArsonval
The value of auto-condensation depends upon its remarkable
effect upon general metabolism (see Chapter V). In nearly all cases of hypertension
the blood-pressure is lowered.
Auto-condensation treatments average ten to thirty minutes in
duration (2,500 to 7,500 Eberharts), and should be given daily, or six times a week at
first, in nearly all cases, gradually decreasing as improvement takes place. Less
than three treatments per week at the start are, in my opinion, practically useless.
Longer treatment may be given if the physician desires.
Cautions. There is practically no danger of an
over-dose of auto-condensation, the only danger being in cases where the patient has a
high temperature that will be raised still higher, where a small dose, if any, is given,
and in case of a pulse pressure below 20. See section Taking the Blood Pressure, and
under Arterio-sclerosis, Chapter VIII. In low pulse pressure there is danger of
obliterating the pulse by auto-condensation.
Authors DArsonval Surgings. I have
alluded to the fact that placing a spark-gap in the patients circuit causes strong
muscular contractions. The similarity between this and static surging
caused me to apply the term of DArsonval surging to this form of
I first noticed it when adjusting the sliding rod on a
DArsonval-Oudin resonator. This rod enables the operator to balance the
current between the coarse solenoid and the resonator, or tune the coil.
Doing this with the patient on the auto-condensation couch caused the latter to exclaim at
the resulting muscular jerks.
Fig. 42 - Authors DArsonval Surgings. Separating the Sliding
Rod at A or Introducing a Spark-Gap Anywhere Between A and the Patient, Produces This
The effect of separating the point of this rod from the solenoid is to
introduce a spark-gap in the patients circuit and to lower the frequency to the
point of causing gross muscular contractions. An outline of the method is shown in
It really is in line with the original experiments of
DArsonval, who first doubled the number of solenoids, thus producing
auto-conduction; then doubled the condensers, as in auto-condensation; and now this form
doubles the spark-gap, the only remaining element employed in the DArsonval circuit.
High Frequency Water Spray. V. Laughter has devised an
ingenious method of connecting the high frequency current to hydro-therapeutic apparatus
in such a manner that the stream or spray of water emerging from the latter is charged
with the current and when this strikes the body of the patient he receives the effect of
the high frequency current as well as that of the water.
Local Auto-Condensation. The Plate Glass
Method. Various methods have been devised for applying auto-condensation
locally over small areas. Sheets of rubber with a pocket in which to slip a flat
lead or zinc plate are one form. A very popular way, known as the
plate-glass method, consists in using as an electrode a metal point or ball
and applying the sparks through thick plate glass held in contact with the patients
body. The glass is the di-electric, the electrode corresponds to one plate of a
condenser, and the surface of the body next to the glass the other.
Indirect Sparks. If a resonator is connected
directly to a patient with a metallic electrode and a vacuum tube is then brought near the
patients body sparks will fly from the latter to the tube. These are called
indirect sparks. See Figure 43.
Attaching the patient in a similar manner to one pole of the
Tesla coil, while the tube held by the operator is grounded by connecting to water pipe or
gas jet, accomplishes the same result.
Another method of deriving an indirect spark and one with
which I have been experimenting considerably during the past few years is obtained from
the patient when lying on the auto-condensation pad.
Fig. 42a - Local Auto-Condensation.
I use a high-voltage, low-amperage type of machine with a
thick pad. Enough current is turned on to give a meter reading of about 250 (125
E.). A vacuum electrode is held in the operators hand and the length and
strength of spark tested by touching the metal handle which the patient is holding, before
the tube is applied to the patients body. The current is then raised or
lowered to provide a suitable intensity and length of spark, after which the electrode is
applied to the portion of the body to be treated. The spark is drawn from the
patients body, is disruptive in character, and is particularly suitable for various
skin diseases, having also the advantage of the patients nutrition and general
metabolism being benefitted by the auto-condensation which accompanies it. In other
words, it is both local and general in its effects.
Taking the Blood Pressure. As a knowledge of the
patients blood pressure is vitally necessary to the physician using high frequency
currents it is important that he should have an instrument for its rapid and accurate
determination. The instrument used for this purpose is called a sphygmomanometer
and a number of satisfactory machines are on the market. The diaphragm type is shown
in Figs. 44 and 44b
The mercury type is shown in Fig. 44a. Its action
depends on opposing the pressure of a column of mercury with the pressure of the blood in
an artery. For this purpose the brachial artery, in the arm above the elbow, is
A cuff or band containing a rubber sack is fastened around
the arm above the elbow, with that part from which the rubber tube emerges lying in front
over the artery. Ordinarily the sleeve is rolled up before the band is applied, but
if the clothing is thin this is unnecessary. A small rubber hose runs from the cuff
to the machine, which has a U-shaped tube containing mercury, with a gauge between.
The zero mark on the scale is placed on a level with the top of the mercury.
A rubber bulb is attached by a small tube to the machine, and
the physician holds this bulb in one hand, while with the other he keeps a finger on the
pulse in the patients wrist. The bulb is now compressed and immediately air
fills the cuff and the column of mercury begins to rise. The operator continues to
slowly inflate the cuff until the pressure of the latter shuts off the blood in the
brachial artery and the pulse can no longer be felt at the wrist. When this occurs
the pressure of the column of mercury has balanced the pressure of the blood in the artery
and the reading on the scale opposite the top of the column is the patients blood
In using the instrument it is customary to force the mercury
a little above the point where the pulse ceases to be felt and then wait two or three
seconds until the column settles to the point of the reappearance of the pulse. By
doing this one, two, or three times an absolutely accurate reading may be depended on.
Fig. 43 - Indirect Sparks.
The scale reads from 0 to 300. The normal is 120.
The numbers refer to millimeters of mercury. A variation of 10 millimeters up
or down would not necessarily imply abnormal pressure, but 140 or more would be
presumptive of the presence of or tendency to arteriosclerosis.
Fig. 44 - Taking Blood Pressure with Diaphragm Type of Sphygmomanometer.
Fig. 44a - Taking Blood Pressure with Mercury
Another instrument for accurately determining blood pressure is the tycos
diaphragm type of instrument, shown in Fig. 44.
This is not a mercury instrument, but the readings are
obtained by indirect, internal pressure on sensitive diaphragm chambers, so sensitive
indeed that every action of the heart is shown plainly by the hand on the dial, as the
hand works co-incidently with the heart.
With this instrument the observer can accurately determine
complete blood pressure, by that we mean maximal or systolic; minimal or diastolic, and
pulse pressure (the difference between the two). This is not easy with a mercury
instrument, because the great inertia of mercury renders it difficult to obtain a
diastolic pressure, for mercury requires one and one-half seconds to recover itself, while
in one second we have had one and one-fourth heart impulses, so you can see that mercury
does not act quickly enough to accept the second impulse. Diastolic pressure with a
mercury machine may be obtained by the auscultatory method described later on.
The minimal or diastolic pressure is fully as essential as
the maximal or systolic, for without an exact diastolic to subtract from the systolic we
cannot get the most important thing in blood pressure, that is the pulse pressure, for by
pulse pressure alone can it be determined whether a pathological condition is compensated
for or not.
Fig. 44b - Portable Outfit with Novel X-Ray tube for surface Treatment.
The normal pulse pressure (difference between diastolic and
systolic) should be from 20 to 55 millimeters.
The determining of pulse pressure by those using the high
frequency current is absolutely essential, for, as said before, by this we can tell
whether a condition is compensated for, and whether the use of high frequency current is
indicated or contraindicated.
As an illustration, we will say that we have a case with a
systolic pressure of 170, and a diastolic pressure of 140. This shows, by
subtracting one from the other, that the pulse pressure is 30, therefore normal. No
matter then if the systolic be 170, for the pulse pressure being normal shows that the
condition is compensated (or the pulse pressure could not be normal), and in these cases
any further reduction of systolic blood pressure must be accompanied by a corresponding
decrease in diastolic pressure or compensation will be interfered with.
Of course, if the systolic was reduced to 160 and the
diastolic remained 140, compensation would still exist, but would be at its low limit, and
the patient would probably not be as comfortable as with 165 or 170, with 140 as the
diastolic. If however, under auto-condensation both systolic and diastolic pressures
decreased, if not always the same reduction, at least without the pulse pressure going
below 20, the treatment may be persisted in until the systolic pressure is normal.
Whenever the pulse pressure reaches 20 and stays there, after
carefully giving one to three additional treatments auto-condensation should be
abandoned. It has been carried as far as it can be of benefit to the patient, no
matter what the systolic pressure then may be, and I would suggest spinal sparks to raise
it slightly, that pulse pressure may be at least 25.
Where the systolic reading is high it sometimes happens that
the pulse pressure will, when auto-condensation is employed, drop to 20, or even 18, but
after a few days the diastolic will reduce enough to give an increased pulse pressure, and
thereafter both systolic and diastolic keep reducing in proportion, in which case the
treatment is kept up. See further discussion and examples under Arteriosclerosis,
There are two methods of determining blood pressure with the
tycos type, which I have taken from Dr. Cowings book, Blood Pressure Technique
First, the method of oscillation.
Place the bag over the arm with the two tubes well under the
arm and over the brachial artery. Wrap the remainder of the sleeve around the arm
much the same as you would apply a bandage, tucking at least six inches of the sleeve
under the last fold. Then place the sphygmomanometer in one tube and the bulb in
another and you are ready for reading. Care should be taken not to put the sleeve on
tight enough to cause any apprehensive feeling in the patient. Place the fingers
lightly over the radial artery and send the pressure in the cuff up to the point where the
pulse disappears or is obliterated. This is the systolic or maximal reading.
It is desirable that the patients wrist be supported
from below by the palm of the doctors hand, while the first and second fingers lie
with their tips over the artery. Thus the weight of the hand is prevented from
shutting off the pulse too soon.
Second, the method of auscultation. This is, by far,
the most practical method of accurately determining blood pressure, as the dangers of
personal equation are greatly lessened. See Fig. 44c.
Bare the arm, adjust the sleeve well up (as above described),
place the stethoscope over the brachial artery. Now gradually inflate the bag, and
the first and second sounds of the heart will become audible. Increase the pressure
in the bag to the point where all sounds cease. At this point will be the exact
systolic or maximal pressure.
Fig. 44c - Auscultation Method.
Having obtained this, gradually release the air by means of the valve, and
the first and second sounds of the heart will become apparent, increasing in volume as
they approach the diastolic point, at which point the second sound will entirely
The above method cannot be employed where aortic insufficiency exists or
where there is a dilatation of the vessels. These conditions being observed, when
the pressure is first increased on the brachial, as soon as a slight pressure is placed on
the artery, a pistol-shot tone is heard, and will continue with but little variation
throughout the observation. When this condition exists it is absolutely necessary to
resort to the oscillatory method. It is also necessary to use the method by
oscillation when the pulse is feeble.
Having now accurately determined both systolic and diastolic pressure, we
compute the pulse pressure.
Pulse pressure is obtained by subtracting the diastolic from the systolic,
Systolic pressure, 120; diastolic pressure, 90; the difference, pulse
pressure, 30, and, as previously stated, it should not be less than 20, and would also
indicate a pathological condition as probable if over 55.
In about 7,000 cases Cowing obtained the following average normals:
Children from 10 to 17, 85 to 110 mm.
Adults from 21 to 40, 120 to 130 mm.
Adults from 40 to 50, 120 to 135 mm.
Adults from 50 to 60, 135 to 145 mm.
It is well to remember that there is an ever increasing hardening of the
arteries as one grows older, and a person of 65 or over can very easily have a blood
pressure of 160 and still be a comparatively healthy individual. At the same time if
these changes were not taking place the blood pressure would remain the same, no matter
what the age of the patient might be. Female pressure is 10 mm. Lower than that of
males. Any blood pressures, however, between the ages of 21 and 50, lower than 100
or higher than 150,can safely be termed pathological cases.
Leading life insurance companies now insist on the examiner taking the
blood pressure. Most of them reject applicants whose pressure is 160 or higher,
whether any other reason is apparent or not; just as they do where the pulse is
persistently above 90.
An easy method of keeping the range of blood pressure in mind, which I
have employed in my classes, is as follows:
Consider 120 the normal. At 20 above or below that is 140 or 100,
the warning signal is out, and at 20 more either way (160 or 80) the brink of the
precipice has been reached and a pathological condition, and probably a dangerous one,
It has been noted that enlargement of the heart or degeneration of the
kidneys cause a comparatively high blood pressure and when both are present the pressure
may be extraordinarily high, often (280-325), or higher than is provided for on many of
the instrument scales.
One observer reports a study of the blood pressure in seventy men.
At forty years of age the average pressure was 115; at sixty it was 135, and at eighty it
Another physician found the average in 100 men to be a little over 118.
An increased determination of blood to the surface of the body lowers the
pressure, and, conversely, driving the blood from the surface raises the blood pressure.
It is important that the sphygmomanometer be used, as in one series of
1,000 tests it was observed that abnormal pressure existed in many cases that a competent
and experienced observer failed to detect without.
In taking the systolic pressure I have occasionally found that just as I
had determined the pressure there would be a sudden increase, running up 5 to 20
millimeters. This I have concluded is due to a spasm of the artery, causing sudden
Miscellaneous Suggestions. When a resonator is employed in
connection with an induction coil on the direct current and a mercury interrupter is used,
if it is difficult or impossible to secure a steady spark in the spark-gap of the
resonator, it is a sign that the mercury in the interrupter is dirty and needs cleaning.
With this same apparatus, the spark may be made sharper by increasing the
number of turns of wire in use in the coarse or primary coil of a resonator. This
increases the size of the solenoid and consequently its induction. This is true of
any Oudin resonator having the sliding rod to regulate the size of the coarse coil.
When using vacuum tubes care should be exercised to prevent the connecting
cord from touching the patient, as annoying sparks will result. It is almost
impossible to find a cord so well insulated that the high frequency current will not soon
find its way through.
Diathermy. The fourth division of my classification of
technique involves the methods known under the several terms, electro-coagulation,
thermo-penetration, direct DArsonval current and diathermy. The method of
employment is given in Chapter XI.