STATIC MODALITIES AND THEIR THERAPEUTIC APPLICATIONS.

BY ARNOLD SNOW, M. D., NEW YORK.

In this age of progress, when it is the duty of every physician to employ every legitimate means known to science for the alleviation of human suffering or be open to censure for such neglect, physical measures are receiving more consideration and their merit and range are being more widely tested. Their use should never be empirical, as is too often the case. Their employment should be rational, the selection being made with due regard to what may be accomplished by each measure respectively, taking into consideration the pathological condition present, and how it may be overcome by the measure or modality best adapted to obtain the desired result. Such selection can only be made wisely when the practitioner is familiar with the therapeutic action of the physical agents. Their physiological action and therapeutic application demand study and thought, and probably no physical agent requires as much careful consideration as the static machine with its varied modalities and their wide range of therapeutic application.

The static modalities are classified according to Snow as disruptive, connective, and conductive, besides auto-condensation, auto-conduction, and the X-ray.

The disruptive discharges include the direct spark, the indirect spark, the friction spark, and the Leyden-jar spark. The indirect and friction spark are the most important.

The direct spark as shown in Fig. 1 is connected and administered as follows:

(1) The balls of the discharging rods should be widely separated and the machine operated usually at a rate of speed relative to the length of spark desired.

(2) The patient on the insulated plaform may hold the shepherd's crook in his hand, the crook being connected with the positive pole of the machine. Instead of holding the crook it may rest on a metal plate on which the patient's feet are placed, his shoes having been removed.

(3) The operator then administers the spark with the large

metal-ball electrode, which is connected to the negative pole of the machine by a wire or short chain, which is held away from the operator and the patient by means of the spiral holder held in the operator's left hand.

(4) Start the machine, the patient being seated or standing as the operator can most easily apply the sparks accord

2

FIG. 1.

1, Shepherd's crook held by patient. 2, Spiral holder. 3, Chain from negative side to ball electrode. 4, Ball electrode.

ing to the part under treatment, that is, for instance, an arm or hip.

The direct spark is very painful, sharp, thin, and burning in character, and is used only in humid weather when the output of the machine is not sufficiently great to give sparks of sufficient length as indicated in the treatment of the condition in question. Its indication and use are the same as that of the indirect spark.

A modification of the direct spark is illustrated in Fig. 2.

The shepherd's crook is placed on the platform under or beyond the patient's chair instead of the patient holding it or standing on the metal plate with which it is connected.

The administration of the indirect spark may be given with or without a discharging spark-gap as in Figs. 3 and 4. If the discharging rods are widely apart the speed of the machine must be comparatively slow, as the length of the spark given will vary the speed of the machine, the position of the shepherd's crook being the same. The length of the spark may

be slightly modified by the operator drawing off the current by placing one foot on the platform, at the same time taking care that it is not near enough to the crook or the patient's feet for a spark to pass from them. The discharging rods may

FIG. 2.

1. Shepherd's crook. 2. Spiral holder. 3. Chain from negative side to ball. 4. Ball electrode.

be but slightly separated, with a spark whose length will regulate approximately the length of the spark administered to the patient, other factors being the same. By this method the speed of the machine need not be varied during a treatment of the entire body, as is often necessary in a severe case of rheumatoid arthritis where the small and large joints of the body are more or less involved, requiring a variation in spark length.

The methods of administering the indirect spark shown in Figs. 3 and 4 are as follows:

(1) With or without a discharging spark-gap, the shepherd's crook or rod should connect the positive pole of the machine with the insulated platform. If the operator wishes to increase the length of the spark by regulating the speed, the crook may rest on a metal plate about 12 by 12 inches which acts as a condenser on the platform.

The nearness of this plate or the crook to the patient's feet, or the rate of speed, will govern the length of spark.

(2) A ground chain should connect the negative pole of the machine to damp earth by a metallic conductor as the gas or water pipe.

(3) A ground chain to a gas or water pipe should also connect the metal-ball electrode with the earth. The operator should then hold the ground chain by the side of the electrode +

2

FIG. 3. 1, Shepherd's crook. 2, Ball electrode held by operator. 3, Ground chain to water pipe. 4, Ground chain to gas pipe.

in the right hand in order to keep the chain from swinging against the patient. In the absence of either a gas pipe or water pipe the groundings may be iron rods driven into damp earth.

Sparks should be administered by a wrist movement. Their length should be governed by the part treated,—a spark half an inch long is applicable to the finger joints, while one three inches long is required for the shoulder. The spark should be fat. Bony prominences, the breasts, nails, and genitalia should be avoided in the administration of sparks. Sparks may be given singly or in rows, which are usually better tolerated over groups of muscles. Single sparks should always be given successively in the treatment of a joint. In giving rows of sparks hold the ball electrode in such a manner that the ball will parallel the part treated as a forearm. Movements should be made as quickly as possible in order to prevent a succession of sparks to one spot, which is decidedly unpleasant for the patient.

Snow's spark director (Fig. 4) is an aid in localizing the sparks. It saves both mortification to the operator and discomfort to the patient, directing the discharges to clefts and cavities.

If the clothing is damp or of a poor quality of material

the patient may hold a woolen cloth or a paper over the part to be sparked, or the spark director may be employed, for otherwise sparks will not pass to the patient.

The therapeutic indication for sparks is unlimited, as they so promptly relieve congestion by getting rid of stasis. They induce contractions which squeeze the fluids out of a part and

FIG. 4. 1. Shepherd's crook. 2, Ball electrode. 3, 'Ground chain to water pipe. 4. Ground chain to gas pipe. 5, Spark director held in operator's left hand.

thus relieve the conditions resulting from a congestive process. They promote absorption and hasten regeneration. They are particularly indicated in the treatment of sciatica, lumbago, rheumatoid arthritis, sprains, synovitis, and edema following fracture. They maintain the tone of an inactive part, relieve rheumatism, gouty diathesis, and pain due to congestion. They are valuable in the treatment of nervous disorders, as locomotor ataxia and hysteria. They are sometimes used alone and sometimes in conjunction with the wave-current when a tonic action is required.

To apply the friction spark the connections are the same as in giving the indirect spark, the operator rubbing the part to be treated with the ball electrode, passing it rapidly over the clothing, it being connected with a ground chain.

This spark produces a superficial effect, giving warmth and a glowing sensation. It relieves pain if not deeply seated and stimulates particularly peripheral circulation. It is indicated