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.

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