Clinical
Impressions and Speculations on the Use of
High-Frequency Pulsed Energy
Cyril Maire
Department of Gastroenterology
Duval Medical Center
Jacksonville, Florida
Paper presented at Symposium given by
THE DR. ABRAHAM J. GINSBERG FOUNDATION
for Medical Research on June 29, 1959 at the Barbizon-Plaza
Hotel in New York, New York
CLINICAL
IMPRESSIONS AND SPECULATIONS ON THE
USE OF HIGH-FREQUENCY PULSED ENERGY
BY
BRUCE
COMINOLE, M.D.
Department of
Gastroenterology, Duval Medical Center, Jacksonville, Florida
Dr. Abraham J.
Ginsberg has recently introduced an apparatus for therapy which
produces intermittent bursts of high energy in the short
wave spectrum. In contrast to the usual diathermy machine which
depends for its main effects on the heating of tissues, heat
production in the Ginsberg apparatus has purposely been avoided.
According to Glasser, in short wave diathermy, the patient is
made part of a high-frequency electric circuit and the tissues
are heated by high-frequency electric current rather than by
direct absorption of electromagnetic waves. Up to the present,
it has been generally held that there are no effects on tissue
of short wave therapy other than those produced by heating, and
that claimants to the contrary must carry the burden of proof.
Ginsberg has
made claims of therapeutic effects in the absence of significant
development of heat in the tissues. His animal experiments and
clinical results warrant consideration. His work poses a serious
challenge to the long held idea that this form of energy
produces no effect other than heat. One hundred eight rabbits
were given intravenous injections of 2 billion streptococci.
Half of these animals were treated with pulsed short wave, the
other half used as controls. Of the untreated, 7 survived a very
stormy convalescence lasting 8 to 14 days. Of the treated group,
47 made a complete recovery within 4 days. These results must be
explained. Other small animals wet-c exposed for long periods of
time without significant temperature rise and at autopsy no
lesions could be found.
H. Randolph
Halsey, Ph.D. of Columbia University College of Pharmacy,
reported that tissue examination of treated rabbits showed
marked dilation of the sinusoids and veins of the liver as well
as spleen. Tissue examination also showed an increase in the
number of von Kupfer cells and other elements of
reticuloendothelial system. Dr. Julia Herrick of the Mayo Clinic
has demonstrated a significant effect of this modality on
biological fuids. Particles and cells orient along lines of
force and thermistors placed in vivo and in situ showed no
significant temperature rise. At the New England Institute for
Medical Research, pilot experiments with the Ginsberg modality
indicated unequivocal stimulation of the total phagocytic
ability of the recticuloendothelial system and concomitant
hyperplastic reaction of the R.E. elements in the liver and
spleen.
Ginsberg's
further claims of the safety factor in his modality are
apparently supported by his experience with animals and
extensive clinical application. Deleterious effects of heat are
absent because heat produced in the tissues is either absent or
minimal. With recard to harmful effects Dunlap' states,
"Electromagnetic waves carry energy which can be given up
only in units of determinate size, known as quanta. The quanta
of energy being greater with radiation of shorter wave length.
Only short wave lengths (roentgen and gamma rays) deliver quanta
of sufficient energy to produce ionization in tissues, and only
exceedingly short gamma rays have enough energy to disrupt
atomic nuclei." Dunlap quotes Packard in a statement that
radiation has no power to produce injurious effects of a novel
kind.
Degenerative
and atrophic changes seen in irradiated tissue are also produced
by heat, cold, electric currents and drugs such as nitrogen
mustard, coichicine and protoplasmic poisons. There are no
pathognomonic features. The Ginsberg modality does not operate
in the dangerous wave-length radiation Dunlap discusses.
Various
electrical diagnostic aids which record bio-electrical phenomena
have acquired medical dignity. Electrical therapeutic machines
are generally viewed with prejudice generated by past experience
with ineffective and even fraudulent devices. An open mind
without a preconceived attitude should be maintained in judging
each new development in this field. It seems at least possible
that in the electromagnetic spectrum there might exist energy,
which if properly tailored as to specific characteristics, could
have a startling effect in improving health with minimal or no
penalty of injury. The field of chemistry is replete with
triumphs produced by very minute alterations of molecular
structure converting a toxic or ineffective substance to a
useful one. It is not inconceivable that what might appear to be
minor variations in the mode of employing electrical waves might
not also result in a modality of great value in medicine. On the
basis of what has been stated above, it seems to this writer
that sufficient background of a reasonable nature does exist for
the use of this apparatus in the clinical practice of medicine.
It is a depressing generality that safety of medical
therapeutics has brought forth a direct relationship to
uselessness. A new modality assuring complete safety together
with the indications of therapeutic effectiveness should create
some desire to try it in heretofore difficult diseases. Courage
is hardly a requirement. The only danger to be surmounted is
that it will do nothing.
Before
recording results, a minor defense of the elastic yardstick of
clinical evaluation seems justified. I am well aware of both the
lack of precision in clinical impressions and the impression of
precision where awesome mathematical calculations are displayed.
With whatever equipment one searches for truth in medicine, it
remains an elusive thing. Mathematics, physiology and sheer
speculation are complementary to each other in the making of
progress.
Forty patients
were treated with the Ginsberg apparatus during the short time
it has been available to me and are summarized in chart form.
The number of treatments range from 1 to 28. The greatest number
of sites treated at one sitting was 5 using 10 minute intervals
over each. The least number of sites was 2. Age of patients
ranged from 8 to 82 years. Fourteen or 35% of treated patients
recovered; nineteen or 47.5% improved, making a total of
thirty-three or 82.5% favorable results, and seven patients or
17.5% were unchanged. Only one patient reported ill
effects in that she thought that her active ulcerative colitis
bled more after treatment. One patient with polyarteritis
involving mainly the finger tips, which showed necrosis,
sweating, coolness, color changes and loss of fat-pad in some
fingers in which the disease was quiescent, was unable to keep
his hands over the treatment drum because of pain during
treatment. On subsequent treatments, the settings were again
left at maximum without producing pain. After missing several
days of treatment, pain recurred during treatment. Following
this the settings were reduced but treatment discomfort
recurred. He was retreated the same day six hours later with
increased settings and without discomfort. Following each
treatment he noted improvement in his general condition and in
the sites involved by the disease. The left leg in particular
has been affected and he has had recurrent hives since a severe
penicillin reaction six years ago. He has stopped smoking and Is
using a peripheral vasodilutor lie iN cl~is~cd 'i.~ iinch~inged
bec~usc insLIllicient trc~~tmcnt and time has been allowed to
assess his basic disease course. One patient with liver cell
disease of 9 months duration reported a temperature of l00~
about 4 hours after one treatment but none after 4 other
treatments. She has not run a temperature before or since. Her
general sense of well being was considerably enhanced following
a course of treatments. Her liver function tests remain
abnormal. A chronic bladder infection of fifteen years duration
has remained well without symptoms after five treatments. More
treatment was delayed by the arrival of a new grand-daughter and
because each treatment required a 150 mile round trip.
One patient had
a post-operative staph infection for 4 months following gastric
resection. Antibiotics failed and lesions were being treated
surgically. After 5 treatments with the Ginsberg modality, the
infection has not recurred in the past 2 months.
One patient had
a chronic staph throat with recurrent furuncles and sties since
December, 1956. Repeated intensive courses of antibiotics failed
to cure and were stopped with the emergence of the antibiotic
bowel syndrome. Autogenous vaccine was started by his present
internist and the patient was advised to try the new modality.
Twelve treatments were given. During the treatment, this
construction foreman volunteered that he had begun to help his
men with the actual physical labor for the first time since his
illness because he felt in general so much better. The throat
cleared completely. Recently a sty developed in the left eyelid
but the throat remains well.
A 47 year old
male with extensive calcific pancreatitis has received so much
improvement in appetite, endurance and improvement in bowel
function that he is to continue treatment 3 times weekly for
several months so that pre and post-treatment x-ray films of the
pancreas may be compared for possible calcium resorption. It is
realized that calcifications are the result and not the cause of
chronic pancreatitis. His diabetes remains unchanged.
Many of the
acute: conditions could be considered fated to improve during
the natural course. The dramatic relief within hours of an acute
middle ear and of an acute disabling, non-specific pleurisy with
no other medication allows for the possibility that treatment
was a factor. Psychogenic factors in the improvement of some of
the patients were probably no larger than with any other form of
treatment. It is unlikely that 80% of any doctor's practice will
consist of impressionable individuals who improve at his command
whatever the therapeutic ceremony he invokes. It is difficult to
accept the statement of a 40 year old former physiotherapist,
who since scarlet fever at the age of five had bilateral
mastoidectomy, draining ears and deafness, that after 2
treatments she could hear the air conditioner on her yacht for
the first time. We certainly have admitted medication to a
position of approval when patients have reported no ill elfects
and that it made them feel better. We have given some
recognition to the accuracy of a patient's sensations when we
constantly query, "How are you feeling today?" If
their sensations bore no correlation with their state of health
or disease, we should stop asking meaningless questions. It
appears that to a significant extent, the sensations reported by
a patient is a valuable and valid measure albeit a nebulous one
hardly subject to a mathematical precision.
A possible
mechanism is offered to explain the different effects of the
standard diathermy and Dr. Ginsberg's pulsed short wave energy
niodality. It is possible that the continuous short wave
diathermy did begin to have a stimulating effect on the
reticuloendothelial system or other protective mechanisms but
this early effect becomes buried and ceases as heat builds up.
At the heat level, another but less overall effective defense
stimulation occurs. The effect on a tendon of a sharp blow
evokes a different response than does an equal pressure exerted
steadily. Perhaps repeated electrical taps can make the defense
mechanism react quickly where steady, even, gentle electrical
heat will only rouse it a bit and then contain it. That the
organism has defenses is hardly questioned. That the stimulus
arousing the defense is usually noxious is also known. That the
tissues assigned the role of defense also suffer to a greater or
lesser degree from the effect of the natural stimulus may be
less appreciated. That there might be a completely innocuous
stimulus capable of maximal mobilization of defense and
reparative forces is a daring thought but worth a search.
Anything appearing to answer this description would be worth a
try.
Conclusions
1. Forty
patients with various acute and chronic conditions were treated
by pulsed short wave energy with 33
or 82.5% favorable results.
2. Some
interesting side effects not ascribed to heat were observed.
3. The vast
majority of this small series volunteered they experienced a
general sense of well being.
4. Some medical
conditions refractory to the usual medical management responded
to pulsed short wave
therapy.
5. Speculation
on a possible mechanism of observed clinical improvement in the
absence of heat is offered.
References
1. GLASSER:
Medical Physics, Chicago 44 Year Book, Publishers Inc. P. 1164.
2. GINSBERG,
ABRAHAM J.: A Description of my Pulsed Short Wave Apparatus with
Clinical Application. Demonstrated at New York Academy of
Medicine, October, 1940.
3. HALSEY, H.
RANDOLPH: Personal Report to Dr. Ginsberg of Pathological Study
of Animal Tissues.
4. HELLER, JOHN
H.: Personal Report to Dr. Ginsberg of Pilot Experiments on the
Effect of the Pulsed Short Wave Therapy in the Problem of Host
Defense Mechanism.
5. DUNLAP,
CHARLES E.: Effects of Radiation. Pathology, W.A.D. Anderson,
3rd Edition Mosby P.161.
Condition |
Number
Patients |
Number
Treatments |
Recovered |
Improvement
|
Unchanged
|
Comment
|
CHRONIC
STAPH INFECTION
CHRONIC DRAINING |
5 |
4
to 28 |
4 |
0 |
1 |
CHRONIC
DRAINING |
CHRONIC
DRAINING EARS, DEAFNESS |
1 |
3 |
- |
1 |
|
Increased
sence of well being. Hearing improved |
ACUTE
INFLAMMATORY MIDDLE EAR |
1
|
|
1 |
|
|
Cured
in 6 hours no recurrence. No other medication |
CHRONIC
ULCERATIVE COLITIS |
1 |
5-22&24,6-11
&13,7-13 |
|
|
1 |
Apprehensive.
On each occasion she bled more in
her opinion. |
CALCIFIC
PANCREATITIS AND DIABETES |
1 |
12 |
|
1 |
|
Definite
improvement in energy,and sense of well being.
Diabetes unchanged. Bowel movements improved. |
BRONCHITIS
(Less than one year) |
3 |
5
to 8 |
|
3 |
|
|
RHEUMATOID
ARTHRITIS |
2 |
8
to 15 |
|
2 |
|
One
patient slowly improving and continuing
treatment. One had great clinical improvement. |
LIVER
DISEASE |
2 |
5
to 7 |
1 |
|
1 |
Acute
hepatitis due to Aralen with 3+ 3+ ceph. Flocc.
Recovered completely. |
CYSTITIS,
CHRONIC |
1 |
5 |
1 |
|
|
Many
years duration. No recurrence. 7-25-59 |
GOUT
|
1 |
4 |
|
1 |
|
Six
to eigth, 2 treatments with immedicate significant
relief. Six to thirteenth amount of relief maintained
but did not completely recover. Two more treatments
given. |
NON
SPECIFIC Abdominal Pain |
9 |
1-4 |
|
9 |
|
|
ACUTE
SORE THROAT AND FLU |
3 |
2 |
3 |
|
|
|
OTITIS
EXTERNA |
3 |
2 |
3 |
|
|
|
POLYARTERITIIS
WITH NECROSIS OF FINGERTIPS |
1 |
5 |
|
|
1 |
|
FACIAL
NEURALGIA HEAD PAINS UNCLASSIFIED |
3 |
4to9 |
6 |
1 |
2 |
|
THROMBOPHLEBITIS |
1 |
3 |
|
1 |
|
Improved
after 2nd treatment, continuing treatment. |
OSTEOARTHRITIS
|
1 |
12 |
|
|
1 |
Extensive
disease of hip joints. Developed acute small bowel
obstruction. |
ACUTE
PLEURISY |
1 |
1 |
1 |
|
|
|
|
|
|
|
|
|
|
|