Diathermy in pelvic diseases.
E. F. SHAULIS, M.D., INDIANA, PA.
To many this title may seem a diversion from Eclecticism, but I hope to convince you that it is truly and thoroughly Eclectic because of its specific application and remarkable results.
Diathermy as a science means nothing more than the use of one modality of electricity. It means heating through and through and not on the surface. In other words, the heat is caused in the deeper tissues by the resistance they offer to the high frequency current, the same as the element in an electric heater. But here we are dealing with living vascular tissues, and they act in a certain definite way. It produces a local vaso-dilatation of the arterioles, capillaries and veins, and a similar effect on the lymph-channels. More blood and lymph flow through a given place in a unit of time than in normal condition. This means, then, we are producing a temporary congestion of the parts because we increase the blood supply to and from the parts we heat. The vessels dilate and attract the blood supply. If we increase the blood supply we have more working power. We, therefore, have more train-loads to carry into our pathological area, more blood with all its equipment to tear down any pathological condition and restore the part to normalcy, barring none save malignant conditions. We then have rushed into this heated area our standing army to fight infection. We have an increased circulation of the blood and lymph-stream, and in order to be cooled off with its cargo it must go to other parts of the body, as it were, and unload the debris or toxins through the organs of excretion. If we increase the blood supply under the most abnormal condition we have more power to restore tissues to normalcy.
We have rivers of red corpuscles and phagocytes to form a line of defense around the pathological area. The battlefield will be more favorable because of the heat and increased blood, just in proportion as will a bright sunny day be the victor of a well-equipped army in a jungled wilderness.
Why all this with electricity? Heat first, then with a question mark we want to add a sterilizing-or germicidal effect. We know that we kill gonococci at about 114 degrees Fahrenheit. We know that a number of other infections or cocci are destroyed at a temperature of 124 degrees Fahrenheit. Whether or not we can raise the tissue to this degree of heat without some injurious effect is doubtful. We can, however, approach it. Diathermy machines will actually procure that degree of heat, but let us be careful in treating living tissue.
Some teachers will say that penned-up pus and hemorrhage are two contra-indications for the use of diathermy. It is with penned-up pus and the use of diathermy as it is with the use of a poultice and the lance. You use the lance with the poultice. Why not use the lance with diathermy so soon as your clinical symptoms and laboratory findings tell you there is penned-up pus? Get drainage and go ahead with diathermy. It is a specific. I have used it successfully in about every form of infection one might apprehend in a large general practice. (I am, however, cautious in sinus infection and rheumatism, arthritis deformans and hemorrhage.)
This paper would have been incomplete had I not given my reasons for the general application of diathermy, but we must proceed to its application to some of the more common diseases of the female pelvis. Do not get the idea as we go along that I depend on diathermy alone, but I use my specific medicines as indicated, though I shall not mention them or parallel them as we apply diathermy. Diathermy is a most valuable adjunct to these pelvic conditions. It is a specific, and its results are as marvelous, and maybe more so, than are specific medicines. Given, then, a diathermy machine with the smoothest and most velvety current and the frequency up to about 1,500,000 to 3,000,000 per second, we are ready to apply our modality in one of two ways. The one I use most commonly is the d'Arsonval, with an active electrode and an indifferent or inactive electrode. The active one is some type of vaginal electrode, depending on the condition I want to treat, or it may be block tin of varying size placed over the area I want to treat. For the inactive or indifferent electrode I use usually a sheet of block tin four by eight or eight by ten, and I want it light weight and very flexible. I like the girdle or belt hook-up for the inactive in cases where the uterus and its adnexa alone is the part in question. By girdle hook-up we mean a piece of block tin or other material made up into a girdle and applied around the waist just above the ilii. This is a very good method for specific application to the uterus, ovaries and tubes, but frequently for general treatment to these parts I use one electrode from four by six to eight by ten inches square on the back for the inactive, and for the. active electrode I round one side of the same size pubes for toward and I place it on the lower abdomen close to the pubes. But if you have a congested subinvoluted uterus or any like condition with bladder and urethral irritation, there is no hook-up quite so good as a piece of block tin about six inches square, with one side rounded to fit up close to the pubes, and plaice a flat sand bag over it or a large rubber sponge held in position with a Turkish towel. Now place a vaginal non-vacuum electrode, or at least an electrode that would get your high frequency from the urethral meatus up through the urethra, the bladder, and the body of uterus, to your inactive electrode and be careful about the dosage. By using good judgment this will give you a wide range of treatment for practically all pelvic conditions, and will relieve many cases of amenorrhea, dysmenorrhea, gonorrhea, leucorrhea, endocervicitis, endometritis, salpingitis and ovaritis. In many idiopathic conditions and certain states of psychic neuroses great benefit is to be looked for. This is also true in ovarian dysfunctional conditions. Light fulguration to an ulcerated cervix will bring good results. But usually, however, the active electrode especially the Chapman type, will produce enough heat to stimulate the healing process without fulguration. Given a case with a non-vacuum electrode or a Chapman electrode in vagina and a piece of block tin six inches square, with one side rounded off, I use from 500 milliamperes to start with for five minutes and 1,000 to 1,200 milliamperes for fifteen to twenty minutes and reduce to 500 milliamperes for the last five minutes, or a total of about thirty minutes.
If I use an anterior and posterior pad, say six by eight inches square, I use 1,000 milliamperes for the first five minutes and 1,500 to 2,000 milliamperes for the next twenty minutes and reduce to 1,000 for the last five minutes. Bear in mind the size of the active electrode in the vagina, and keep below the coagulation dose, because you cannot compare the square inches of surface of our inactive electrode on the back with that if the vaginal. Why? Because you are not using all the surface of the vaginal electrode on account of the current following the shortest path to the inactive electrode. It would require some close figuring to show the ratio between the round electrode and the square one, and, therefore, use good judgment. I like the use of the girdle for most of this work for the uterine condition, because the course of electricity is so well directed into the right area. One must now begin to use your judgment to direct your current to produce the heat just where you want it. Another hook-up for vulvitis would be to place a girdle around the pelvis or a plate on the abdomen and with a sponge press very thin sheet lead or mesh, thickly covered with K. Y. lubricant, tightly against the vulva, and your current will travel in about the right direction.
I usually use well-insulated cords for this treatment. You need not worry about a positive or a negative. There is really none. You need not worry about the active or the inactive, because they are simply designated as such from the fact that you arrange the size and shape a little more definitely to try to get greater condensation nearer to where you want your heat, and it is called the active. In my own mind when the electrodes are of equal size there is no confusing active and inactive electrodes.
Some one is ready to ask about the number and frequency of the treatments. I give a treatment every second day for from three to four weeks, and depend on what the patient tells me from that time on, but do not allow myself to be persuaded to give up the treatments until the pathological condition is restored to normal if they are responding to the treatment.
I am going to tell you something here I never heard discussed. I frequently used to use the unipolar method, taking the cord from the Tesla outlet and attaching it to the vaginal electrode. Frequently the patient would, on her return, tell me she did not sleep any the night after her last treatment. This electrified my patient and their minds were exhilarated and they would not quit thinking. I tried the d'Arsonval current with the bipolar method on the same patient and found it did not give them the mental exhilaration because it did not electrify the whole body as did the one pole from the Tesla outlet. This is well worth remembering.
I want to say that with ten years of experience in this work I am most highly pleased with the use of diathermy. In conjunction with this, however. I use a pesserole I have made and pack the vagina with wool tampons saturated with one of a number of boro-glycerole preparations immediately following each electric treatment.
A patient comes to us for consultation disgusted with herself and her condition, unhappy, probably, because she imagines no one cared for her or everyone in the household and community is doing mean things to her. These conditions are nearly always sequelas of the pathological condition. Now in the course of two months your picture is changed, face brightened and tension relieved, and a new and happy relaxation exists. Your pathological condition always is changed.
National Eclectic Medical Association Quarterly, Vol. 19, 1927-28, was edited by Theodore Davis Adlerman, M.D.