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After a period during which it has not been well esteemed because of its exploitation by the inexperienced and unscrupulous, electrotherapy is coming more and more to be recognized as a therapeutic medium of great value. It is not a panacea for all ills, by any means; but there are some things which may be done by electricity that can be done by no other form of treatment. It is true that it has often failed in conditions that should have responded to it. Such failures may have been due to reliance upon electrotherapy to the exclusion of other agencies; but very often they are due to the selection of the wrong modality or lack of skill in applying it. Electrotherapy is not child’s play. Unless one has mastered the art of its application, there ar,e bound to be needless failures. When employed properly, it is one of the most valuable therapies in the possession of the healing profession.
During treatment of the abdomen for one of these conditions, the internal contraction may be felt, as if the bowel, for instance, were being drawn up into normal position, or as if the peristalsis were being made stronger. This is what actually happens. These are excellent currents to use when some mechanical effect that cannot be produced otherwise is desired. The sinusoidal current is used frequently with great benefit also in bronchitis, goiter (to seventh cervical vertebra), incontinence of urine (over th’e fifth lumbar verte¬bra), anemia (to the tenth dorsal and second lumbar verte¬brae), aneurism, angina pectoris, arthritis deformans, asthma (rapid current to spine), and in local atonic and in paralytic conditions.
THE SINUSOIDAL CURRENT is an alternating one, combin¬ing high-frequency and low galvanic sinusoidal currents. The alternations may be very rapid or very slow. There may be surging or non-surging currents, the surge being a gradual rise of current strength alternating with a gradual fall. This, when applied over muscle-tissue, causes alternate contraction and relaxation (rest). The sinusoidal currents are generated or produced by means of special instruments, and have their place in the treatment of numerous abnormal conditions. Chief among their uses, perhaps, is the production of muscular con¬traction in cases of paralysis resulting from nerve injury-after the nerve itself has been sufficiently repaired to respond to the stimulation. But they are also useful in other condi¬tions, such as muscular atrophy, partial ankylosis, adhesions, uterine prolapse, and infantile uterus. Because of the pro¬nounced muscular contraction it produces, the “Morse wave,” one of these sinusoidal currents, is of great value in cases of ptosis (dropping) of abdominal organs and intestinal stasis or constipation.
A counter-irritant effect is produced, also, with the electrode held above the skin at the proper distance to keep a shower of sparks passing to it. These sparks are not appre¬ciably painful if the electrode is kept moving above the surface being treated, but become almost unbearable if showered stead¬ily upon it.
For cavity work, where the electrode comes in contact with the mucous membrane, considerable care is necessary to pre¬vent blistering. However, in qualified hands, this possibility need not be feared. The breaking, or rather exploding, of electrodes while in use is possible only when they are of the vacuum or clear-glass kind. If this accident should occur while the electrode is in some cavity, there might be serious consequences in more ways than one, but it cannot happen with the metal-lined electrodes.
For a stimulative treatment the electrode is placed upon the skin and lifted repeatedly until the surface being treated becomes reddened. Often, instead of alternately placing and lifting the electrode, a few Jayers of woolen flannel are placed over the skin to be treated and the electrode kept moving over this; or one or more layers of chamois may be tied over the electrode. The more thicknesses used, the greater the resist¬ance offered to the current, hence the greater the stimulating effect, which becomes counter-irritating when a certain point is reached.
There are also three methods of treatment, each having its own effect. For sedative treatment the electrode, properly attached to the machine, is placed upon the surface to be treated (the skin having first been dusted with talcum pow¬der) and held in firm contact with it until the patient feels a decided degree of warmth. Then, without lifting it from the surface, it is slid to an area immediately adjacent. The whole surface of the region to be treated is covered in this way, the treatment being repeated as often as necessary to warm the entire part thoroughly. When a sedative effect is desired, the electrode is never lifted while the current is on.
Vacuum and Non-vacuum, Electrodes.—With high-fre¬quency machines two kinds of glass electrodes are used. One is of clear glass, filled with air or rarified gas of some kind, and is similar to the small glass applicators of the “violet-ray” ma¬chines so extensively advertised and sold in which the violet light flickers during use. The other is metal-lined and is about ten times as effective as the unlined applicator. When the metal-lined electrodes are applied to the part to be treated they produce heat in the tissues beneath—as much as two inches below the surface. This is a kind of indirect diathermia, differing from the direct in that the heat is generated only at a limited distance beneath the applicator, while in the direct it may, by the proper arrangement of the two electrodes, be generated anywhere. The former is, however, an excellent means of producing heat at some point not much below the surface and in the mucous membranes. There are numerous shapes of electrodes, for surface work and for reaching the mucous membrane of cavities, such as the nose, mouth and throat, vagina, urethra, arid rectum.
Many cases of headache, especially migraine, and of indefi¬nite pains often called “rheumatism,” have been greatly bene¬fited by autocondensation. It is very valuable in most cases of neurasthenia, particularly when other factors of treatment are employed, especially, perhaps, graduated tonic baths. Toxemias also are benefited by this treatment, though other electric modalities are of greater value, especially diathermia; ultra-violet irradiations are also prominently indicated. In no case should this treatment be relied upon solely, or even largely; but when indicated it is a most helpful modality, if not overused. A treatment too prolonged for a given case is likely to result in cramps in the arms, pronounced sweating, restlessness or faintness, throbbing of the neck vessels, and general uneasiness. No treatment should be continued long enough to produce any of these symptoms.
This treatment is excellent for numerous conditions. A kind of cell massage is given, as the patient is charged inter¬mittently with the surge of current. The treatment also has a balancing effect upon the vasomotor system. The blood- pressure, when high to begin with, often drops several points during a treatment, and sometimes does not rise to its former , high point during the interval before the next treatment. As the entire body is saturated with the electricity, the kidneys participate in the benefits, and as a result most forms of kid¬ney diseases are benefited by autocondensation. However, if there is a pronounced degree of hardening of the arteries, the first few treatments must be given with caution, though usu¬ally after a few short mild treatments longer and stronger ones can be given. Similar precautions must also be taken with patients who are well advanced in years.
Autocondensation is a very useful method of giving high-frequency to the entire body. It might be called an indirect diathermia. During this treatment the patient is either sitting on and leaning against a special pad in a large chair, or lying upon such a pad on a treatment couch, while holding in the hands a special electrode, unless a flat electrode, weighted to maintain closer contact, is secured over the abdomen. This latter is really a better method, since one direct effect of the treatment is to create a drowsiness which, if yielded to, will result in the dropping of the electrode from the hand, with a very unpleasant but not dangerous stinging sensation. Otherwise there is no sensation during the treatment (when not continued too long), except agreeable warmth. During the treatment, which generally lasts for twenty minutes, more or less, the wrists usually feel the warmth first, but it is soon felt appreciably in the back and arms also. Often patients become extremely relaxed and drowsy, and, if the abdominal electrode is used, will not infrequently go to sleep.
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