Progress in Physical Therapeutics.

CURRENTS OF HIGH FREQUENCY AND HIGH POTENTIAL.

EDITED BY WALTER H. WHITE, M. D.

The High-Frequency Spark in the Treatment of Premature Alopecia. By Geo. M. McKee, M. D., New York Medical Journal, July 28, 1906.

The writer calls attention to the confusion in the classification of alopecia, but recognizes three types-the congenital, senile, and premature, only considering the latter in his article. He divides premature alopecia with reference to its origin, into idiopathic, neurotic, and seborrheic, but finally considers but two forms of premature alopecia in his paper. (1) Loss of hair by systemic and neurotic disturbances. Under this heading he includes all cases of alopecia in which there is no evidence of the desquamative. It also includes all grades of alopecia areata. (2) Loss of hair primarily due to bacterial invasion. This includes all the cases presenting evidence of local disease, with the exception of tinea, favus, etc. In short the conditions usually known are recognized as pityriasis, seborrhea sicca, and seborrhea oleosa.

The treatment presents three indications: (1) The use of. parasiticides, (2) the internal remedies and hygienic measures, (3) the improvement of local circulation. The writer considers the various measures that have been employed in the past, and then treats of the employment of the high-frequency current. The fact that the resonator spark produces a hyperemia which persists, suggested the idea that it might be applied to the scalp in cases of persistent alopecia with gratifying results. He considers the sparks beneficial both as a stimulant and bactericide. Their prime action in the treatment of alopecia rests in their power of inducing the physiological hyperemia which lasts for several hours, during which period it is marked from six to twelve hours. The hair follicles receive an increased blood supply and also an increased resistance to germ invasion. He considers the fact that hyperemia ceases after a few hours to be very important, as otherwise it might become a chronic congestion. The method of employment is the unipolar discharge from a high-frequency resonator in connection with the static machine, or a Ruhmkorff coil. He says in cases where a hyperemia is produced it may be produced by a mild treatment. He prefers to employ the resona

tor in connection with the static machine, as it is less disagreeable. The electrode should be attached to one of the terminals of the secondary coil, the current strength to be regulated by the length of the spark-gap with an 8- or 10-plate static machine running at full capacity. It is usually possible to employ a spark-gap of one inch. If the gap is too long, the effleuve from the electrode tends to condense into a heavy spark which is unpleasant to the patient.

When hyperemia is not readily produced by this method, it is desirable to attach the transformer to the coil, reducing the spark-gap about 1-4 to 3-4 of an inch. Any interrupter may be used with from 2 to 7 amperes passing into the primary. Although the effleuve is much less when used with the coil, the sparks are very much stronger than the static and the reaction obtained in about one-half the time. The writer emphasizes the fact that the important object of the treatment is the producion of hyperemia without which very little is accomplished. To obtain best results, the cases should be treated two or three times each week. While applying the sparks the electrode should be kept in contact with the hair, and in motion so as to avoid the heat effects, which are strong enough to burn the hair if allowed to remain stationary for several seconds. The choice of electrodes is a matter of small importance, vacuum tubes of any type serving the purpose. The writer reports results in the treatment of nine cases.

Case 1. Female, under treatment for four months; hair was very thin on the top of her head, on the right side of median line almost denuded, probably due to overwork and worry. Within a month the hair had ceased to fall out. Treated three times weekly. Within two months a heavy growth of down was in evidence. Though the patient was irregular in attendance, she now has a new growth of hair which appears perfectly healthy. In cases of alopecia due to seborrhea the results of this treatment depend both upon the severity and duration of the disease. Good results, however, are always obtained if the treatment is continued long enough. In this the writer has become confident.

Case 2. Female, twenty years of age, suffering from seborrhea, hair falling and very thin. For ten months has had unsuccessful treatment by other methods. Sparkings were begun and administered twice a week. At the end of two months a heavy growth of hair had begun to grow. Treatment was continued irregularly for eight months, the hair became very thick and steadily growing in length. The oily condition was much less marked and the hair fell out very little.

Case 3. Female, aged thirty-three, alopecia due to seborrhea. Hair very thin and short. Solutions of sulphuric sodium, resorcin, etc., greatly improved the oily condition, and

lessened the loss of hair, but there seemed to be no tendency for the hair to grow. The high-frequency sparks proved efficacious in three months.

Case 4. Male, aged twenty-five, suffered from alopecia and seborrhea sicca. Alopecia had progressed for about two years until the hair at the top of the head was extremely thin. Sparkings were applied to this patient twice weekly for three months, and the hair ceased to grow and a new growth was in evidence. The treatments were then reduced to once weekly, and a mild antiseptic and stimulating solution advised for daily use. At the end of seven mouths the patient had entirely recovered his hair.

Case 5. Male, aged twenty-three, hair very thin on top of the head. Patient made no improvement for 5 1-2 months, then the hair finally ceased to fall and is now growing abundantly.

The two following cases indicate that there is encouragement for apparently hopeless cases.

Case 6. Male, aged thirty-eight. The patient had been gradually losing hair until the vertex and temporal regions were practically denuded. High-frequency treatment was applied twice weekly for nine months, resulting in a good growth of the hair.

Case 7. Male, aged forty years. Hair very thin over temporal region, and only a light downy growth on the vertex. Patient received high-frequency treatment and stimulating lotions. Within six months not the slightest improvement had taken place. He had no confidence in the treatment and was irregular in the treatment. It was only by discontinuing his hair tonics, and assuring him of ultimate success, that he could be persuaded to continue his treatment. A few weeks later, however, a heavy growth of white down made its appearance and treatments henceforth were taken with great regularity. Now a good growth of hair is in progress. Time, patience, and persistency are required, then gratifying results will follow.

Case 8. Female. Scalp appeared healthy. Hair although thick was very short. Almost every hair was split at the end, and short pieces breaking off constantly. The high-frequency treatments were given for four months, when the hair, though still splitting at the ends, was growing longer.

Case 9. Female, aged twenty-eight. Neurotic and in poor general health. Total alopecia areata. Sparkings were applied to the right side of the head every second day for four months, at which time a good growth of hair was in progress on the side treated, while on the opposite side while the hair showed some tendency of growing, it only amounted to a white down. Sparkings were then applied to the entire scalp. At the end of seven months the hair on the side treated was about 2 inches

in length, while on the opposite side it was about 2-3 of an inch in length.

PHOTOTHERAPY.

EDITED BY MARGARET A. CLEAVES, M. D.

Electric Baths in Heart Disease. By G. Zimmermann, Munchener medicinische Wochenschrift.

The capability of the heart to respond to stimuli is the criterion as to the possible efficacy of the hydro-electric procedures. There must be a reserve force to call on, and this is the main point, not how much the organ is hypertrophied. As general indications for the alternating current baths, he accepts disturbance on the circulation with low blood pressure, signs of incipient failure of compensation, moderate fatty infiltration with general corpulence, and atonic conditions of the heart muscle and arteries. In advanced cases of sclerosis of the heart and arteries, the indications are more for the Nauheim baths. A combination is excellent in certain cases.

The Treatment of Burns and Skin Grafting. By Haldor Sneve, Journal of the American Medical Association.

H. Sneve advocates the open method in the treatment of burns, that is, the disuse of occlusive dressings and reliance on strict surfaces. The dangers in extensive burns are (1) from shock; (2) from toxemia; (3) from loss of function of absent skin covering, and (4) from exhaustion. For shock, the first indication is to combat the vasomotor paresis, and the only drug at present to be recommended for this is adrenalin, cautiously administered; whisky, morphin, strychnin, etc., are warned against as poisons to the susceptible and already overburdened nervous system. The symptomatic treatment of the resulting conditions is far better. To drive the blood out of the abdomen, he gives drinks and enemas of cold normal saline solution, which add volume to the circulating medium; chafes the hands and feet, and applies local warmth to the extremities and especially to the nape of the neck. To meet the fall in body temperature, he uses the hot bath and maintains a high temperature in the room. Finally, to give the heart more fluid to work on, he uses saline infusion or hypodermoclysis. Toxemia, he believes, is directly favored by occlusive dressings, which retain the discharges and prevent perfect drainage. The dangers of air infection are Sneve considers, negligible, the surface is at first well sterilized by heat, and later, the granulations and crusts protect against invasion. It is to toxemia that he attributes the sudden deaths occurring after severe burns, and the importance of insuring free escape of the secretions is emphasized. The functional activity of the uninjured skin is

also of the greatest importance and for this reason the continuous full bath of Hebra is not the best treatment of burns. Cold spongings and friction are perhaps the best stimulants to skin function, and should be frequently practiced in treating burns. Supplying artificial heat is an important indication, especially during the first few weeks of a severe burn. Exhaustion from constant discharge from burned surfaces is best met by grafting skin as soon as possible in those that have suffered a burn of third degree. He remarks on the slight amount of pain in cases treated by the open method. Another astonishing feature of the open treatments is the favorable character of the cicatrices, which are smooth, flexible, and skin-like.

RADIOTHERAPY.

EDITED BY J. D. GIBSON, M. D.

Effects of the X-ray on Living Tissue. By H. E. Robertson, in the Scientific Review.

Reviews the observations and conclusions of numerous workers with the X-ray during the past few years.

The effects of the ray upon the skin, Carl Beck considers are due to its action in producing an impairment of the nutrition of the cells, especially those of the blood vessels. Newcomet compares the effect with the granular and fatty degeneration of fever. Scholtz believes that the changes in the skin produced by the ray consist in a slow degeneration of all the cells in the various structures composing it. Codman believes the lesion to be trophic, due to the degenerative action of the ray on the trophic nerves. Rollins looks upon it as a process of ionization of the molecular structures of the tissues.

As to its effects upon bacteria and lower forms of life, observers differ. Some state that the rays inhibit or actually kill bacterial cultures; others have concluded that they stimulate bacterial growth, and act adversely only by producing attenuation from overgrowth. Rieder found that an exposure of several hours had no effect upon bacterial growth. The rays are said to stimulate the germination of seeds, though markedly altering their biologic and physiologic properties. Upon amœbæ and other lower forms of animal life they show an inhibitory and devitalizing effect.

In reviewing the work done to determine the effect of the ray upon diseased tissues, he finds: that as upon normal tissue the effect is one of degeneration; that experimentally, in the decomposition of proteids by the ray, the lecithin is broken up; that those tissues which are developing or actively growing contain much lecithin, which, he believes, plays an im