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The Turn Of The Century
Electrotherapy Museum |
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PHOTOTHERAPY LIGHT as a therapeutic agent has become very prominent during the past few years, and its action is due to the luminous rays, the chemic rays, and the heat rays. It was thought at one time that the heat rays were confined to the infra-red and red of the spectrum, but it is now known that there are heat rays through the entire spectrum. The chemic rays were at one time thought to be confined entirely to the blue and violet-blue portion of the spectrum, but it is now known that they also are found throughout the entire visible spectrum. The heat rays found in the infra-red part of the spectrum are mvisible. Temperature 01 Inca1uJe8cence. DEGREES FAHRENHEIT. 1000. Red rays. 1200 Oranget"ays. 1300 Yellowrays. 1500 Bluerays. 1700 lndigorays. 2000. Violet rays. 2130 Al1colors =whiteIight. The intensity of the light increases faster than the temperature. Platinum wire at 26000 F. gives out forty times as much light as at 1900° F. Gas gives 1 part visible. 24 parts invisible rays. Incandescent filament gives 1 part visible. ..23 " " " The electric arc gives 1 part vIsible. 9 " " " The temperature of the voltaic arc is about 3000° C. for the positive carbon and 2500° C.. for the negative. In addition to the ordinary chemic rays which accompany the visible rays of light, there are what are known as the ultraviolet rays; these are beyond the violet and are also invisible. An illustration of what are known as infra-red rays is the heat effect noticed when the hand is brought near a stove in which there is a fire. These rays are more penetrating than the visible rays of the spectrum. The strength of light varies inversely as the square of the distance; this is an important law to remember; thus, if at a distance of 30 inches the candle-power is 500, then at a distance of 60 inches the candle-power will be only one-quarter , or 125 candle-power. The usual distance from the filament at which the candle-power of an incandescent lamp is measured is 30 inches, so that if the patient is at this distance from the filament, the full rated candle-power of the lamp .is being used. Ariother point to remember is that light is most effective when it strikes the surface at right angles. In order to compare different lamps an actinom~ter such as is used by photographers can be placed on the patient. In order to use thi~ correctly, all other light must be excluded. 633 THE COMPLETE SPECTRUM OF LIGHT (ELECTRICITY ?) Heat ~ Rays. i Visible Rays. Chemically Active Rays. Finsen Rays. ., -After Satterlee. Practical Units of Light.~l Candle-power (British and U.S. standards) is the light of a spermaceti candle t inch in diameter, burning 120 grains an hour. 1 Meter candle-power is the illumination produced by 1 candle-power at a distance of 1 meter. This is useful as a unit, but the light varies so much under different conditions that more exact standards have been devised for making the actual measuren:1.ent.. 1 Bec Carcel (French standard, equal to 9.5 British-Standard candlepower) is the light of a Carcellamp burning 42 grammes of pure Colza oil per hour with a flame 40 mm. high, under conditions fixed by Du~as and Regnault. 1 Hefner is the light from a standard amyl-acetate lamp, burning under conditions prescribed by the late von Hegner Alteneck, and equals 0.88 British standard candle-power . 1 Lux is the illumination produced by 1 Hefner at a distance of 1 meter and equals 0.88 meter candle-power . 1 Lumen is the unit of flux of light in a beam subtending unit of solid angle where the source has an intensity of 1 Hefner; 1 hemispherical lumen, for instance; is the light radiating through a hemisphere of space from a source of 1 Hefner. The Legal Standard of Light.1-The unit of each simple light (blue, green, etc.) is the quantity of the light of the same kind emitted in the normal direction by a square centimeter of surface of molten platinum at the temperature of solidification. The practical unit of white light is the total quantity of light emitted normally by the same surface. The Author's Units of Light Measured Photographically.-l Tousey is a light or other radiation which will produce the same effect upon Kodak film as 1 candle-power of carbon filament incandescent light of the standard brightness. ~ 1 Tousey meter second equals the effect produced as above in one second at a distance of 1 meter . N. B.-In applying this photographic measurement to x-rays or radium rays, in comparison with incandescent electric light, the film should be developed in the regular tray-developing solutions for ten minutes and in complete darkness. The Tests Which are Applied to Electric Lights, Either Arc or Incandescent Lamps.-In the case of an incandescent lamp it is of importance to test its resistance when cold. For this purpose the A B c .. D Fig. 393.-F. Tilden Brown's cystoscope. Wheatstone bridge and the current from one or two voltaic cells are employed. The process of testing a lamp at work employs a voltmeter on the principle of an amperemeter of very high resistance for measuring the difference in potential between the lamp terminals. The lamp ~y 1 Paris Congress, April, 1884. ... be. any sort of an electric lamp: incandescent, arc, or vacuum tube. An amperemeter is also required for measuring the strength of the current, which may be turned on or off by the key. A storage-battery or a large battery of voltaic cells may be used instead of the dynamo. The number of candle-power produced by the lamp must be tested by a suitable photometer. One of the simplest and most accurate is familiarly known as the grease-spot photometer. A sheet of paper with a grease-spot in the center is held up between the standard candle and the light to be tested. Looking at one side of the paper the spot, which has been made partly transparent, appears bright if the light falling upon it from behind is more powerful than the light falling upon the front of the paper around the spot. The paper is moved back and forth between the two lights until the grease-spot appears neither darker nor lighter than the surrounding paper. Both sides are examined to make sure of this. Then the distances from the paper to the standard candle and to the lamp are measured and the number of candle-power varies directly as the square of the distance at which equal illumination is produced. Thus, if the paper is four times as far from the lamp as it is from the standard candle the lamp is giving a light of 16 candle-power . Knowing the number of volts of electromotive power E in the difference of potential at the terminals of the lamp and the current C in amperes we have.the following formulre: p Resistance (hot) of the lamp in ohms --r Electric energy in Watts consumed by lamp -EX C EXC Watts per candle-power = - c. p. (c. p. = number of candle-power.) The smaller the number of Watts per candle-power, the higher is the efficiency of the lamp, and for the same type of lamp the less heat is produced with equal illumination. Fi2. 394.-Incandescent lamp and reflector. The modem '(cold clamps" for cystoscopic and other endoscopic work are simply incandescent lamps of high efficiency. Incandescent Electric-light Therapeutic Lamps.-The most com- mon type of apparatus for the application of light is an incandescent lamp mounted in some sort of a reflecting device. Fig. 394 shows a device of this kind in which the lamp used is of 50 candle-power . Fig. 395.-Treatment of patient with lOO-candle-powerlamp and parabolic reflector. These lamps are made to operate on the 110- or 220-volt current, which may be either direct or alternating. Fig. 395 shows the application of such a lamp. The advantage of this particular device is that it Fig. 396.-Local electric-light bath. can be easily adjusted to any lamp outlet, and can be held either by the physician or, in some cases, by the patient. This style is useful in muscular pains due to cold, such as what is commonly !inowri as muscular rheumatism. It is also useful in mild cases of ne'uralgia. Different sizes of lamps of this type are made with incandescent bulbs of Fig. 397.-Showing a shoulder treatment by electric-light bath. Fig. 398.-Electric-Iight bath cabinet, open. various power, and may be used with or without color screens and with different colored bulbs. Fig. 396 illustrates a slightly more elaborate device for applying the light over a much larger area. In this device there are ten incandescent lamps each of 16 candle-power. It is hinged at the central part so that it can be easily placed around a limb or over the shoulder. On the top of it is a selector switch, so that five or ten lamps can be used, according to the requirements of the case. Fig. 398 shows an electric-light bath cabinet. This is arranged so that the entire body, with the exception of the head, is subjected to the influence of from forty to eighty incandescent lamps. On the outside of the cabinet is a switchboard so that various sets of lamps can be used. Although the illustration does not show it, there should be an arrangement holding two strips of colored glass, one of red and one of blue, so arranged that either color can be turned in front of the rows of Fig. 399.-Electric-ligh t bath cabinet, closed. incandescent lamps or, if desired, turned out of the way entirely so that the plain white light is used. Fig: 400 shows a different style, in which the patient is placed in a reclining position. The number of lights is regulated by means of selec- tor switches on the outside of the cabinet. . Fig. 401 illustrates a portable electric-light cabinet having a folding frame and curtains. This makes a very convenient arrangement, as when not in use it does not take up any space. To this can be easily added the red and blue glass scr'C)ens. The patient feels much more comfortable than with his head fastened by a wooden or iron cabinet. Fig. 402 shows a combination cabinet in which are placed a number of incandescent lamps, and on the outside are mounted three arc lights, the object of this arrangement being to obtain whatever benefit there ", Fig. 401, .Beez portable electric-light bath. Fig. 4O2.-Combined incandescent and arc~light bath. may be from the increased quantity of chemic rays which come from an arc light. - Fig. 4O3.-Therapeutic lamp with four 125-candle-power incandescent bulbs. -R~flec'ro.. m~rai .IIOv.or220volr, I Allerl1QrjnlJ or Direct: Fig. 4O4.-500-candle-power incandescent lamp with non-focusing reflector. Fig. 403 shows an arrangement holding four 125-candle-power lamps, so as to make up a total of 500 candle-power. It is also arranged so that in place of using all the lights, anyone or a combination may be used as desired. Figs. 404 and 405 illustrate all arrangement by which a 500-candlepower lamp is placed in a horizontal position so that the patient re- Fig. 4O5.-Incandescent lamp (500 candle-power) with straight filament in the axis of the reflector. Parallel rays of heat and light are produced. They are not brought to a burning focus. ceives the direct radiation from the entire length of the filament and the reflector. The rays are rendered parallel, not brought to a burning focus. Colored Screens.- When colored screens are used, they are generally made of narrow pieces of glass held together in a metal frame (Fig. 406) . The object of this is to prevent breakage, as the amount of heat absorbed in the glass would break it if it was made of one piece. Isolation of Calorific Rays of Great Wave-length by Quartz Lenses} -The hot light from a Pintsch lamp passes through a circular opening in a metal screen, then 26 cm. further through a quartz lens and another diaphragm and a second quartz lens, all at the same distance apart. The lenses have a focal length of 27.3 cm. for visible rays; their ~iameter is 7.5 cm.,thickness at edge, 0.3 cm., and at middle, 0.8 cm. ; diaphragms are 15 mm. ; the central parts of lenses are covered with black paper 25 mIll. The greatest wave-iengths are more highly refracted, and pass Fill. 406.-Rav screen for treatment with colored light. through the different diaphragms and may be demonstrated by a radiometer. Extremely great wave-lengths up to 300 mm. have been isolated by H. Rubens and 0. von Baeyer2 from the light produced by a mercury vapor lamp filtered through black paper. Electric Arc Therapeutic Lamps.-Fig. 407 illustrates the original Finsen arc-lamp arrangement. In order to protect the eyes of the assistants from the irritating effect of the chemic rays, they use blue glasses. The apparatus contained an electric arc which used 80 amperes; this has been improved and simplified, the most important modification being one in which practically all the heat rays are absorbed, so that the action is due entirely to luminous rays, the chemic rays which accompany luminous rays, and some ultraviolet rays. The condenser is made of quartz, which allows practically all of the ultraviolet rays to pass. The metal section is filled with water; the section nearest to the arc is arranged for a continual circulation of water. In addition to this, Dr . Finsen had special compressors made of quartz, which were in firm lH. Rubens and R. W. Wood, Le Radium, Paris, Feb., 1911, p. 44. 2 Le Radium, April, 1911, p. 139. contact with the diseased area. These compressors were also either filled with water or arranged for a continual circulation of water. With a lamp such as is shown in Fig. 408 and which requires 25 amperes of current, the time required for a single treatment is one hour and ten minutes, and, as a rule, improvement is not expected in less than three months. / Numerous modifications of this lamp have been made with the idea of increasing its efficiency. Fig. 408 illustrates the latest improvement in the Finsen ray lamp. This is known as ~he Finsen.;Reyn lamp. With this apparatus only one case can be treated at a time, but instead of using 80 or 100 amperes for the arc, the apparatus requires only 20 or 25 amperes. It has an automatic arrangement for maintaining the arc and an adjustment, 1~ Fig. 407.-Original Finsen lamp. 80 amperes. so that the length of the arc can be regulated. It is mounted on 1\ heavy iron pedestal and arranged with a counterweight, so that it can be easily raised or lowered and brought into the most convenient position. In this apparatus the lenses are made of quartz, so that all the ultraviolet rays which are generated by the arc are transmitted to the patient. with very little loss. Fig. 409 illustrates one of the best forms of arc-Iight apparatus made in this country; all the adjustments are easily made. The automatic arrangement for maintaining the arc is particularly nice, and requires practically no attention upon the part of the operator. There is a blue glass window so that the arc can be readily seen without discomfort to the observer. This lamp is made to take from 10 to 30 amperes, according to the special requirements of the case. The small diagrams illustrate the three ways in which the rays can be reflected: Fig. 4io, a, shows the arrangement for focusing the rays upon a particular point; Fig. 410, b, shows the arrangement to cause the rays to diverge; Fig. 410, c, to throw all of the rays into one parallel beam. Fig. 4O8.-Finsen-Reyn lamp. Iron Electrode Lamps.-It was found that by employing electrodes which were made of iron instead of carbon the proportion of ultraviolet rays was very much increased, and a lamp of this style is shown by Figs. 411 and 412. This was devised by Dr. Bang, and in order to operate it, it was found necessary to have the electrodes and the entire casing arranged for a continual circulation of water. While this device is very efficient, it is a rather inconvenient one to use. c. " Fig. 4O9.-Bogue's arc lamp for therapeutic use. -- --. ~ -.. :J::=:: =-- ~ .=:.- :;. --7;. .. ~ ,. --.:'.. \ -. - -- - _.. a b c Fig. 410.--a, Arc too far away from mirror; b, arc too close to mirror; c, arc in focus. Fig. 413 illustrates a modification of the Bang lamp. This was devised by Dr. Henry G. Piffard, of New York City, and its construction is such that no water circulation is required. Owing to the fact that the arc is only 3 inches away from the tissue to be treated, it makes a most efficient apparatus. Iron electrodes, however, cannot be used on an alternating current, so that in order to use this lamp on an alternating current carbon electrodes which have iron filings in them are used. The carbon arc is not nearly so rich in ultraviolet rays as the iron arc, and this is very prettily demonstrated by the following experiment : Place apiece of solio paper in front of the carbon arc for one minute. You will notice that it will become slightly discolored; now place another piece of solio paper in front of the iron arc, and in the same time you will find that the paper has become absolutely black, this indicating that with the iron Fig. 412.-Application of water-cooled arc a greater proportion of chemic iron electrode arc lamp. rays are generated. ... Condenser Spark-gap Lamps.-One therapeutic and physiologic use of condenser discharges is in the production of visible and ultraviolet rays. A Leyden jar 2 inches in diameter a~d with a totallet;lgth 0! 10 inches may have one armature connected WIth one pole of an rnductlon- - Fig. 413.-Piffard's hand arc lamp for phototherapy coil or transformer regulated to give a spark about 4 inches long. The other armature of the jar is connected with the other pole of the coil or transformer. Besides the above connections an insulated conducting cord passes from each pole of the coil or from each of the ~den jar armatures connected with it to each terminal of a series spark-gap made up preferably of iron knobs. The sparks are very much louder and more brilliant than they would be if the discharge from the coil passed through the series gap unmodified by the condenser. The light is very rich in ultraviolet rays. Such a lamp has been made with magnesium knobs, but this metal volatilizes readily and a constant shower of sparks is produced which unfits it for this use, although the light produced is especially rich in ultraviolet rays. About the time that the.iron arc devised by Dr. Bang was introduced, Dr. Gorl described a lamp based upon this principle for the production of ultraviolet rays. A lamp of this character is the richest source of ultraviolet rays that we have at the present time. As originally constructed it was rather inconvenient to use, and .Dr . Henry G. Piffard, of New York City, devised an improvement in its construction. Fig. 414 illustrates this improvement, which consists in making the spark-gap so that the distance between it and the patient is adjustable. In addition, there is a handle on the side of it, so that the operator can easily and safely handle it. Dr. Piffard now uses this Fig. 414.-Gorl ultraviolet ray lamp, modified by Piffard. lamp without the quartz window, as was used in, the original lamp, as he finds that it is very much more active without the quartz window. He was led to use it in this way by .noting the difference in time that an electroscope discharges when the rays from this lamp are directed upon it; when the quartz window is in front of the lamp it discharges the electroscope slowly; when the quartz window is removed the electroscope is discharged instantly, thus showing that there is a radiation from this lamp which the quartz does not transmit. An exposure of five minutes with this lamp produces a very intense hyperemia. mtraviolet Rays of Exceedingly Short Wave-length.-P. Lenard and c. Ramsauer have discovered rays of less than 90 mu. wavelength in the light from a condenser spark-gap with a tremendously powerful current. They use an induction coil, in which the primary is of copper wire 3 mm. in diameter, around an iron core 110 cm. long and 9 mm. diameter. The~ are three layers of 330 turns each. The secondary is divided into four sections, in each of which are 32 layers of copper wire I mm. in diameter, and there are 90 turns in each layer. The primary will stand a current of 90 amperes for fifteen seconds. The primary 1 Le Radium, 1911, p. 115. condenser has a variable capacity of 6 microfarads. There is a Wehnelt interrupter with a nickel electrode and a jar holding 60 quarts of liquid. There is a secondary conden~er in shunt to the spark-gap. The sparkgap has aluminum terminals 7 mm. in diameter and are only 0.8 mm. apart. The current regularly employed is 60 amperes and 200 volts. The energy at each discharge is 1000 times that of the uniform flow of an arc lamp. The light from such an apparatus is relatively weak in visible rays.. Fig. 415.-Mercury vapor lamp. rich in ultraviolet rays, especially those of the shortest wave- "uv. u ~ v~ ~.&. rays have the property of causing certain chemicals to fluoresce. The most common test for the presence of ; is the fluorescence they produce when falling upon a ~. Willemite. When the ultraviolet rays strike a piece of Willethey cause a most beautiful green fluorescence. In order to whether the fluorescence is due to ultraviolet rays, it is only place a piece of glass between the Willemite and the source -If the fluorescence is due to ultraviolet rays, the glass the fluorescence to disappear entirely; if, however, the appar- -..due to the blue-violet color of the light, then,the the piece of glass between the source of light and the Wille- mite will not cause the apparent fluorescence to diminish. Another simple way of testing is to take ~ piece of solio paper and put a piece of glass over part of it and expose the covered and uncovered portions to the source of light. If the radiation is. principally ultraviolet, the solio paper uncovered by the glass will blacken in a short time, whereas the paper under the glass will b.e hardly discolored. Now in place of the glass put apiece of quartz, and you will find, if the radiation is principally ultraviolet, that the paper under the quartz will be nearly as black as the paper not covered by the quartz. Fig. 416.-Mercury vapor lamp in use in a case of pulmonary tuberculosis. Fig. 415 illustrates a Cooper Hewitt mercury vapor lamp as used by the author. The light from this lamp contains no red rays. It is a 450-candle-power light when run by the 110-volt direct current with a rheostat to reduce the current to 4 or 5 amperes. Fig. 416 shows this lamp in use in the treatment of a case of pulmonary tuberculosis. , A modification of this lamp is what is known as the uviollamp (Fig. 417). This is also a mercury vapor lamp, but instead of using ordinary glass the glass used is one which will transmit higher frequencies of vibration and hence more of the ultraviolet ray than the ordinary glass. This has been used in Europe, but it is too early to state what its therapeutic value will be. Kromayer's Mercury Vapor Therapeutic Lamps.-Professor Kromayer, of Berlin; has devised mercury vapor lamps of suitable form and dimensions for contact application in the treatment of the skin or of the mucous membrane of the mouth, urethra, etc. Th~ tube carrying the incandescent mercury vapor is made of quar1z) so-'as to transmit 1 MUnch. Med. Woch., 1906, No.10, p. 577, reviewed in Le Radium, April, 1906. Fig. 418.-The Kromayer lamp: a, Lamp connection-plug; b, current direction-indicator; c, plug connection; d, tube connection; e, winged nut for fixing lamp in fork g; I, Kromayer quartz lamp; g, fork lamp-holder (may be fixed in any position) ; h, j, in- and outlet for cooling water; k, switch; l, rheostat lever; m,line connection; n, rheostat (Hanovia Chemical and Manufacturing Co.. Newark). Fig. 419.-The Kromayer lamD {Hanovia Chemi"al "nrl M"m,(""hlrina ~n N"",Ar1r\ As this is also a new type of lamp, it has not been used sufficiently to give an idea as to what its ultimate therapeutic value will be; the only disadvantage is that it can only be operated satisfactorily on the alternating current ~t the present time. The heater coil of platinum wire alone transmits current at first and, becoming incandescent, heats the glower, which is a small rod of such materials as zirconium and thorium. - b Fig. 420.-a, Westinghouse-Nernst lamp: b, Westinghouse-Nernst lamp, with globe removed (heater and glower). This becomes a conductor of electricity when hot, but though its resistance is diminished, it is still so great that it becomes incandescent itself. Ultraviolet rays are generated by a Crookes tube or an x-ray tube, and a special construction has been devised by H. Bierry , Victor Henri, and Albert Ranc.1 The tube has a sort of pocket of quartz tubing in which substances may be placed very near the anticathode. Carbohydrates undergo the same changes as when exposed to the ultraviolet rays from a mercury vapor lamp. A bum appearing within twenty-four hours after an x-ray exposure is doubtless due to ultraviolet rays generated by the x-ray tube. This source of injury may be suppressed by interposing any screen opaque to ordinary light- ' Effects of Ultraviolet Rays Upon Gases.-l. There are produced unch?rged centers of condensation which are due to impurities in the gas. 2. Both positive and negative ions are produced in the gas. 3. There may be changes in. the gas itself, as when oxygen is changed to ozone. The effect upon chlorin has been especially studied by Ludlam,2 who finds that the presence of a trace of chlorin increases .the ionization of under the influence of ultraviolet rays, but that above 1 per cent. ' -~v.v vll.V._-' is added the feebler the ionization becomes. The ultraviolet rays in sunlight ionize the air, rendering it a conductor J and, as might be expected, Dember3 has found that this 1 a. R. de la Societe de Biologie, lxx, 523, April1, 1911. I Phil. Mag. we, 1912, 757. a Phys. Zeitschr., 13, 1913, 207. It is a well-known fact that light favors oxidation outside of the body, and as it penetrates the body it should and undoubtedly does promote oxidation and chemic changes in the fluids of the body. According to Freund, light is capable of changing a passive congestion into an active one, so that light is indicated in chronic congestive conditions where the light can be applied in sufficient power . Chemic Effects of Ultraviolet Rays.-Ultraviciet rays bring about loss of nitrogen in certain chemic compounds and in others the reverse, changing nitrates to nitrites or vice versa.1 Ultraviolet rays change starchy solutions into maltose and dextrin ~ and, according to the same experimenter, inulin is changed into glucose and levulose. Ultraviolet rays destroy the properties of diastase in solution. Rays of a wave-length greater than 3022 Angstrom units do not have this effect.3 Effect of Ultraviolet Rays Upon the Digestibility of Mi1k.-A short exposure has no effect, a longer exposure lessens tryptic digestibility, and a still longer exposure restores it.4 Ultraviolet rays change saccharose into glucose and levulose; their more prolonged action produces formaldehyd and carbonic oxid.5 Ultraviolet rays from a quartz mercury vapor lamp change a small proportion of chlorophyll dissolved in alcohol and water into urobilinogen. 6 Ultraviolet rays, three hours and a half exposure, destroys the hemolytic action of saponin.7 . Ultraviolet rays destroy amylase and invertase (in malt and yeast) ; the former is more sensitive, and in a mixture it may be destroyed and the invertin be only attenuated.8 Biochemic Effects of the Ultraviolet Ray.-Ultraviolet rays in thirty minutes to two and one-half hours reduce the toxicity of Strophantines. 9 Ultraviolet rays quickly destroy the venom of the cobra, but have much less effect upon antivenomous serum.1° Ultraviolet rays have an effect upon the Wassermann reaction for syphilis analogous to their effect upon tuberculin. They do not effect the properties of sera rich in antibodies, but antigens and antibodies no longer fix alexins.11 Bacteria killed by ultraviolet rays preserve their agglutinins intact, and can be used, for serodiagnosis.12 I C. R. de I' Academie des Sciences, clii, 522, Feb. 27, 1911. 2 L. MassoI, Ibid., 902, March 27, 1911. 2 H. Agulhon, Ibid., 398, Feb. 13, 1911. ' J. Telarico, C. R. de la Soc. de BioI., I xix, 324, Nov. 5, 1910. 6 Henri Bierry, Victor Henri, and Albert Ranc, Ibid., Ixx, 900, June 3,1911, and C. R. de I'Acad. des Sciences, 1629, June 6,1911. 8 H. Bierry and J. Larguier des Bancels, C. R. de I' Acad. des Sciences, cliii, 124, July 10,1911. 7 Tr. Solacolu, C. R. de la Soc. de BioI., lxxi, 204. 8 A. Chauchard and B. Mazonie, C. R. de la I' Acad. des Sciences, clii, 1709, June 12,1911. 9 D. Danielopolu, C. R. de la Soc. de BioI., Ixxi, 200, July, 1911. 10 L. MassoI, Ibid., 183~ July 23, 1911. 11 Maurice Breton, Ibia., Ixx, 507, April 1, 1911. 17 H. Stassano and L. Lamatte, C. R. de I' Academie des Sciences, clii, 6~3, March, 1911. - Ultraviolet rays destroy the antitryptic properties of human bloodserum} Effect of mtraviolet Rays Upon Anaphylaxis.-Horse serum, exposed to the radiation for two and one-half to three and one-half hours, shows a destruction of its antisensibilitins without loss of its precipitogenous properties.2 Effect of mtraviolet Rays Upon Tubercle Bacilli and Tubercu!in.- A short exposure attenuates the bacilli in a culture and a long exposure kills them. Tuberculin loses its properties, and this effect is more rapidly produced in the air than in a vacuum.3 Effect ~of mtraviolet Rays Upon Tuberculin and Antitubercular Sera. -It renders tuberculin inactive, but does not modify its precipitogenous property. Serum, however, quickly loses its precipitant property.4 Influence of Light in Causing Hyperglobuly at High Altitudes.- The accumulation of blood-cells in the peripheral vessels which ordinarily takes place at high altitudes may, according to T. Gayda's experiments upon rabbits, be prevented by exclusion of light.5 The effects of ultraviolet rays upon micro-organisms have been exhaustively studied by Mme. V. Henri Cernovodeanu and Victor Henri, at the physiologic laboratories of the Sorbonne and of the Pasteur Institute.6 As far back as 1877 Downes and Blunt7 experimented upon the bactericide effect of light and found that the- most refrangible was the most active. Among others Roux, Geissler, and Marshall pursued further studies, which preceded Finsen's work. The latter in 1899 to 1905, with his pupils, S. Bang, V. Bie, A. Larsen, G. Dreyer, H. Jansen. 0. Jensen, G. Busck, Schmidt-Nielsen, A. Reyn, and R. Kolster, studied the effect upon yeasts, fungi, amebre, infusoria, and different animal tissues. Finsen and his pupils showed that our sunlight is quite poor in ultraviolet rays, due to absorption by the air. The arc light is rich in ultraviolet rays, and with the positive carbon 24 and the negative 12 mm. in diameter and 35 to 80 amperes, with an average of 50 volts, the light being concentrated upon a surface 12 mm. in diameter by a quartz lens 7 cm. in diameter, and with the heat filtered out by a layer of water in a vessel with quartz walls, this light kills the Bacillus prodigiosus in two or three seconds. Arc lamps with metallic electrodes, espe'" cially iron, are many times more effective than thbse with carbons. The interposition of even a thin sheet of glass, and the admixture of bouillon, pepton, albumin, gelatin, or any ?ther organic .colloids to the water, arrests the major part of the ultravIolet rays, whIle perhaps perfectly transparent to the visible rays. Various germs s~ow different degrees of susceptibility, young cultures are more sensitIve than old ones, and the spores are three to five times as resistant as the germs. But cultures of any of them may be sterilized by exposure to the. ultraviolet ray. The time required is from a few seconds to a few mInutes. 1 M. Weinberg and M. Rubinstein, C. R. de la Soc. de Biologie, I xxi, 258, July 29, 1911. 2 V. Baroni and C. Jennesco-Migaiesti, Ibid., I xix, 273, Oct. 22, 1910. 8 V. Henri-Cernovodeanu, Victor Henri, and V. Baroni, C. R. de l' Acad. Sciences, cli, 724, Oct., 1910. 4 A. Jousset, C. R. de la Soc. de BioI., lxix, 459, Nov. 26, 1910. 6 Archives Italliennes de Biologie, liv, 197, 1911. 8 Journal.de Physiologie et de ~athologie generale, xiii,_1911, 865. 7 ProceedIngs of the Royal SocIety, 26, Dec., 1877. These experiments also showed that the effect was due directly to the light, and takes place in the absence of heat or oxygen. A later development dates from 1905, with the discovery of the sensibilization of animal tissues by means of substances like anilin dyes containing iodin or bromin, which is liberated in the tissues b~ t?e. ult.raviolet ray and adds to the effect. For example, a hypodermIc lDJectIon of 2 milhgrammes of hematoporphyrin into a white mouse produces no inconvenience while in the dark, but kills in three hours' exposure to arc light. And the final process consisted in the introduction of the mercury vapor arc in a tube of quartz, like Kromayer's, generating the ultraviolet ray much more powerfully than any of the open arc lamps. The therapeutic use of the ultraviolet ray is due to Finsen, Preisz, Seiffert, and others, who applied it to the sterilization of milk, and Courmont and Nogier to the sterilization of considerable quantities of water. It has long been known that the most rapid vibrations among the ultraviolet rays are the most active, and Thiele and Wolfl proved this by the use of a screen of blue rock salt, which arrested the heat rays, the visible rays, and the ultraviolet of a wave-length greater than 330 mu., but which was perfectly transparent to ultraviolet rays of a wavelength from 330 to 219 mu. Measurement of the Intensity of the Ultraviolet Rays.- The intensity of the different wave-lengths generated by an ultraviolet lamp may be measured by a delicate thermopyle and a quartz lens or differently absorbent screens. A relative measure of the entire ultraviolet radiation is obtained by measuring the ionization of gases and electrification of metallic surfaces very much as radio-activity is measured. Becquerel's method, modified by Eder, is based upon the amount of calomel precipitated from a mixture of ammonium oxalate and bichlorid of mercury ? The sterilizing effect upon a twelve- or twenty-four-hour-old culture of colon bacilli ul>on agar is employed by Henri Cernovodeanu and Henri (I. c.). The bacilli are carefully scraped off without any lumps of agar and are emulsified in distilled water and exposed at a distance of 20 cm. from the lamp. This reaction is almost exclusively limited to the invisible ultraviolet rays, and the interposition of a sheet of colorless glass 1 mm. (..}r; inch) thick makes it take 1000 or 2000 times as long to sterilize the emulsion of bacilli. An exposure of one second with a certain mercury vapor lamp with 140 volts and 4.7 amperes produces complete sterilization, while 300 seconds are required with 23 volts and 2.3 amperes. The photographic effect upon Ditrate of silver paper (solio matt) is employed by the same authors. This paper, when exposed to the light from a mercury vapor lamp, is chiefly acted upon by th~ ultraviolet rays, only one-eighth of the effect being due to the visible rays. The time required to produce an equal discoloration is inversely proportional to the bactericidal activity. A means of arriving at the proper color of the paper is by comparison with the action upon iodid of potassium. Henri-Cernovodeanu and Henri place 9 c.c. of 5 per cent. solution of 25 per cent. sulphuric acid in a glass dish, 3 cm. in diameter, at a distance of 20 cm. below the lamp, and determine the time required to liberate 0.15 milligramme of iodin. 1 Arch. fUr Hygiene, 59, pp. 29-55, 1906. ~ Eder. Acad. Vienna, October 16, 1879. ... 42 Water is very transparent to the ultraviolet ray, even more so than air, and through either medium the time required to produce an equal effect increases about as the square of the distance from the lamp. The bactericidal effect is neither slowed nor hastened materially by the temperature at which the ultraviolet ray is applied. In this it follows Goldberg'slaw regarding true photochemic reactions} This is entirely contrary to ordinary chemic reactions, which are many times more active at high temperature. The bactericidal effect of ultraviolet rays is the same whether the emulsion is a liquid or is frozen into ice, providing the latter is transparent. It was formerly supposed that the bactericidal effect of the ultraviolet rays was due to peroxid of hydrogen generated by the rays, but bacteria are killed just as quickly in the absence of oxygen or even in a vacuum, and Henri-Cernovodeanu and Henri have measured the quantity of peroxid of hydrogen generated during the few seconds required to sterilize an emulsion of colon bacilli and find it to be an infinitesimal trace. Different organic substances are variously susceptible to change under the influence of ultraviolet rays. Glucose is much more resistant than levulose, and some fatty acids are more ,quickly saponified than others. The cancer cells in mice are more susceptible than the normal cells. (Cernovodeanu and Negre.) The visible effect (with the ultramicro- .. ~ ,.. ~ ~-- :=:..=== -- ~ ~d ~ .~ ~~ ~ 'FA ~- ," Fig. 421.-Interior view of mercury vapor lamp water sterilizer (Evans).2 scope) upon protoplasm is coagulation. Micro-organisms of considerable size, like parameces, and the white blood-cells and the white of egg and the blood-plasma, all show this effect when exposed to the ultraviolet rays. Microbes and animal cells of all kinds are fixed by exposure to ultraviolet rays. Thus, the red blood-cells no longer lose their hemoglobin on the addition of water. The microbes are more difficult to color with different stains; and if the exposure has been prolonged, the microbes undergo granular disintegration. Gram's staining no longer takes effect and the acid resistance of tubercle bacilli is lost. Sterilization of Water and Milk by the mtraviolet Rays.-Water, which has been rendered perfectly transparent by filtering, can be 1 Zeit. fUr wiss. Photogr.. Photoph. und Photochem., 4, 67, 1906. 2 Transactions of Illuminating Engineers Society, January, 1914, p. 19. (The Mercury Vapor Quartz Lamp, W. A. D. Evans.) ,'- Ir completely sterilized by passing through an apparatus in which it must come in contact three separate times with the quartz plate separating it from the space in which a mercury vapor quartz lamp is in operation. The lamp in the apparatus shown in Fig. 421 requires a current of 725 watts and will sterilize 130,000 gallons of water per day. Milk cannot be sterilized by the ultra violet rays except in such thin layers as to be transparent, and no very practicable apparatus is yet in use for this purpose. The Physiologic Effect of a Local Application of the Ultraviolet Ray.-The effort is chiefly confined to the skin, and consists of an erythema with a papular swelling which often develops into a blister in the course of twelve to twenty-four hours. The blister dries and when the crust falls off no scar is found. Meironskyl finds that the ultra-' violet light stimulates epithelial cells and increases their metabolism, but strong applications cause degeneration and blistering. There is a congestion of the blood-vessels with emigration of leukocytes and extravasations of blood into the tissues. There is the increase ill fibrous tissue cells already noted and a swelling of the connective-tissue stroma. A deposit of pigment granules may take place in all the different layers of epithelia. , Granulating surfaces heal much faster if treated by ultraviolet light. Blood circulating in the tissues limits the effect of the ultraviolet ray to the most superficial layers of the skin. Finsen blanched the skin by pressing a quartz lens upon it, and others have injected adre- nalin or introduced the latter by electroiysis. . Sensibilization of the Tissues to Light.-The tissues may be rendered more sensitive to light rays by the injection of substances like erythrosin. This substance renders the tissues sensitive to the rays, from the greenish-yellow to the yellow-orange inclusive, which ordinarily do not affect the tissues. The effect of a Finsen treatment is thus obtained in one-fourth to one-third the ordinary time. Dreyeri introduced the uSe of this substance following the experiments of Tappeiner and Raab upon protozoa and animal tissues. The value of the method, however, has been seriously questioned. Eosin has been used in the same way as erythrosin a with favorable results in tubercular, syphilitic, and cancerous conditions of the skin. Straub's theory is that eosin generates hydrogen peroxid under the influence of light. Morton's method of sensibilization of the tissues to light and other radiations by the internal administration of quinin or fluorescin is still sub judice, and the author's own observations do not confirm its value. Sorrentino4 paints the surface of the lupus with an arseniate, which seems to allow the rays to penetrate the tissues. Forschhammer6 used the following solution: ~. Erythrosin.' , 1. Sodiumchlorid "...",..." ,..0.85 Distilledwater.,..., 100. 1 Monatshefte f. Dermatologie, xlii, 1906. ~ Dermatol. Zeitsch., jv, No.10. a Tappeiner and Iesjonek, Munch. Med. Woch., 1903, No.47 4 Giornale ital. delle malatti vener. idella pelle, 1906, No: 1. ~ Deutsch. Med. Woch., Sept. 15, 1904. It was injected 350 times altogether in 23 cases of lupus under phototherapy at Copenhagen. It produced no discomfort until the exposure to the powerful light took place, four to eight hours after the injection. The reaction to Finsen light was very violent, more lik~ a case of phlegmon than like the ordinary reaction after a similar exposure. Experiments with different doses produced either no effect or a most violent one. The therapeutic effect seemed to be bad. The Effect of Ultraviolet Rays Upon the Eye.-This is a subject which has been studied in detail by Birch-Hirschfeld.l The rays in his experiments were from a variety of sources; a powerful arc lamp with carbon electrodes; a dermo lamp with iron electrodes; sparks from an electrostatic induction apparatus; sunlight. Quartz lenses were used to concentrate the rays in the eye. The ultraviolet rays are largely arrested by the crystalline lens, and this protects the retina from ahy marked effect. An eye from which the crystalline lens has been removed, for experiment or for the cure of cataract, loses this natural protection. The especial changes in the retina from exposure to a powerful arc lamp under these circumstances are a loss of chromatin in the ganglionic cells and the development of vacuoles in the protoplasm of these cells. The nuclei of the same cells are large and clearly defined and have a vacuolar appearance with a very distinct nucleolus. Every other part of the retina is affected to a slight extent. These changes may be noticed at once or may.take twenty-four hours to develop. They are recovered from in a few days. Exposure of the normal eye to the powerful arc lamps used in phototherapy produces also important changes in all the ocular media except the crystalline lens, which remains transparent. There are conjunctivitis; cloudiness of the cornea arid partial desquamation and sometimes karyokinesis and vacuolization of its epithelium; iritis and fibrinous exudation in the anterior and posterior chamber~ of the eye. These conditions disappear after a few days, but slight corneal trouble, hypere.:. mia, and the vacuolization of the ganglionic cells of the retina may remain for a long time. Sunlight is very rich in ultraviolet rays under certain special conditions. The reflected glare from snowfields upon high mountains in winter affords an example, and the eyes often suffer in consequence. The ultraviolet rays in the blinding flash of light to which electricians are sometimes exposed from accidental short-circuiting produce important effects upon the eye: There is often temporary blindness lasting a few minutes or a few hours, and sometimes there is erythropsia; all objects, especially bright ones, appear red. After a few hours the conjunctiva becomes red and swollen with a feeling as if the eyes were full of sand. Keratitis and iritis develop. These conditions all disappear in a few days, but in some of these cases there are also changes in the retina which may last for a long time or even be permanent, and which are perhaps not due to the ultraviolet rays alone. The effect of a stroke of lightning upon the eye is often very severethe crystalline lens may become opaque (cataract), and there may be atrophy of the optic nerve or slighter nervous changes. These do not appear to be due to the influence of light alone. Ordinary eyeglasses protect the eye perfectly from the rays which 1 Arch. f. Ophthalmalagie, val. lviii, p. 469. are, strictly speaking, ultraviolet (beyond the visible extremity of the spectrum) , but some of the visible rays near the violet end of the spectrum produce similar effects. These rays may be guarded against by smoked glasses or yellow glasses, but not by blue glasses. The ultraviolet rays destroy bacteria in the eye either in front of or behind the crystalline lens, but the eye would be badly injured by the necessary length and strength of exposure. Conjunctivitis Due to Electric Light.-This occurs quite frequently among those who regulate or repair arc lamps, and under conditions which make it evident that the trouble is caused by the light and not by the heat rays. We believe also that it is due to the rays at the violet . end of the spectrum and to the ultraviolet rays. The affection is only temporary and the t~eatment is by cold affusions of boric acid solution. More serious cases have been observed by Fuchs and are complicated by myosis, slight opacities, and erosions of the cornea, but these also are recovered from In a few days. Harold Grimsdalel has given detailed reports of several cases. One case was in a workman who had profuse lachrymation and redness and edema of the conjunctiva with several little papules. Vision was notably diminished. He had repaired an arc lamp which remained lighted while he was working at it. Photophobia and the other symptoms enumerated p,bove had come on within a few hours. Rapid recovery followed the use of cocain and cold affusions of boric acid solution. Smoked glasses had to be worn for some time afterward. Another of Grimsdale's cases followed an instantaneous exposure. .An engineer was arranging some incandescent lamps and a short circuit occurred. There was a flash of light laating an exceedingly short ,time. The man felt blinded, but was able to see directly afterward. There was severe pain lasting for a few minutes, but toward night all the symptoms had disappeared for the time. He awoke in the night, however, with an intolerable itching of the eyelids, as if their mucous sul"- face were covered with sand. There was lachrymation, but no blepharospasm or marked photophobia. The'l?alpebral conjunctiva was congested and covered with papules. VisIon was normal. Cocain and cold affusions of boric acid solution effected a cure in two days. The present author once performed an experiment in which a heavy steel finger-nail file held in the hand was used to short "ircuit the 110- volt direct current. There was a wonderful flash of light and about 1 inch of the steel was, actually consumed; not merely melted, but vaporized and dissipated. The author's face was about 15 inches from the powerful arc thus produced, but there was no perceptible effect upon his eyes. Unfortunately, he is unable to recall whether he had eyeglasses on at the time or not. Plain glass does not arrest much of the visible light, but it does stop a great part of the invisible ultraviolet rays, which are highly actinic. Physiologic Effects of Ultraviolet Ray Baths.-Those baths in which arc lights are the source of illumination give the patient the benefit of the ultraviolet rays as well as of the light rays and the radiant heat. The effect is a vasodirator one upon the skin and a reduction in general blood-pressure, which is of sufficient duration to make the application valuable in many cardiovascular diseases, including angina pectoris. 1 Presse Medicale, Apri122, 1902. The effect of an electric arc-Iight bath has been studied, principally upon himself, by Hasselbach of the Finsen Institute of Cope.nhagen.1 Le Radium, April, 1906, formulates the results of these observations as follows: 1. The cutaneous hyperemia produced by the intense actinic light slows the respiratory movements, and this slowing may persist for several days. 2. This may be caused by partial paralysis of the muscular walls of the cutaneous blood-vessels. 3. The slowness of the respiratory movements is offset by their .increased depth, so that the amount of air inhaled per minute is unchanged. 4. The chemic respiratory exchanges are slightly increased the following day. 5. The frequency of respiration even under normal conditions is subject to regulation by variations in the cutaneous vasomotor innervation. 6. Such a light bath generally lowers the arterial tension about 8 per cent., and this reduction sometimes remain§ for a month after a course of baths. 7. The pulse-rate is increased in some patients and reduced in others. 8. There is sometimes a temporary mental stimulation. Physiologic Effect of Incandescent Electric-light Baths.- The most marked effects are profuse sweating and superficial vasodilatation which increased tissue changes and lowered arterial tension. As commonly applied the effect is due chiefly to the radiant heat, but there is suffi.- cient evidence that the light itself is also beneficial. The Temperature of Incandescent Electric-light Baths.-The statement is sometimes made that electric-light baths at about the temperature of the body will cause profuse perspiration in five or ten minutes. Experiments by Pariset2 with different kinds of thermometers show that thermometers exposed to radiant heat in the open air register very differently (a difference of 31° C.), according to ;: 422 St ~'ht whether the mercury bulb is a dull black or is of fila~~nt I;c-;nd~:~~nt the usual polished glass. Even after fifteen minutes lamp witlr parabolic in a closed electric-light bath the two thermometers reflector for concen. h d diff f 9° C ( b t 17° F ) It . trated electric -light s owe a erence o .a ou ..IS baths (Wulff's patent. essential that the temperature the patient is exposed Relniger, Gilbert & to should be known and that the thermometer bulb Schall, Elangen). should be blackened and should be exposed to the direct rays of the light at the same distance as the patient. Sweating may be produced by dark heat, but it requires a higher temperature and lacks the other effects produced by the penetration of radiant heat from a luminous source. It is not always necessary or desirable to have the electric-light bath closed up practically air-tight. It is sometimes pleasanter to the patient to have the light bath ventilated so that the patient is not in as hot an air bath as in the other case. To make this equally effective the light should be concentrated upon the patient and not wasted in heating the walls of the cabinet and the ~ir corttained therein. 1 Munch. Med. Woch., Jan. 16, 1906. 2 C. R. de la Soc. de BioI., July 5, 1907. An incandescent lamp with a long straight filament placed along the focus of a parabolic mirror (Fig. 422) yields parallel, not divergent, rays, which are directed toward the nearest surface of the body. All the light from a sufficient number of such lamps distribut~d uniformly over the surface of the body will produce the effects of light and radiant heat without the disagreeable effects of a hot-air bath. The temperature of the air in the ordinary closed electric-light bathcabinet is about 800 C. or 177° F . The concentrated electric-light bath with ventilation causes perspiration to beg~n at a temperature of 77° F ., and the maximum temperature of the air need not be over 112° F: A thermometer with a blackened bulb placed at the surface of the body and directly exposed to the rays of light and heat would register a considerably higher temperature, probably about 177° F . Treatment by Concentrated Incandescent Electric Light.- Five hundred candle-power applied locally for about fifteen minutes is very effective in sciatica, lumbago, dyspepsia, colitis, pruritus vulvre, rheumatoid arthritis, and cases upon the border-line between gout and neuritis. Some of the latter have finger-joints which are red and shiny and swollen and exquisitely tender. The application should be strong enough to redden the skin and cause the patient to move about to prevent overheating, but not stroDg enough to blister. Static electricity is a valuable adjunct in the treatment of these conditions. Treatment by Red Light.-This is effective in smallpox, where it prevents pitting, and in scarlet fever, measles, erysipelas, and noma. It is ordinarily applied by keeping the patient in a room where only red light is admitted. There seems to be reason to think that the same results would not be obtained in complete darkness, that they are not due alone to the exclusion of the other colors, but that the red light has a specific effect upon the skin and renders it resistant to bacterial and other morbific agents. The cure of recurrent sunburn by wearing a red veil; and of eczema by sunlight, while the affected parts are covered by red cloth, are along the same lines. Freckles, seborrheic eczema, and rosacea seborrhreica have been treated by ointments containing a red pigment (U nna) . Blue-light Anesthesia.-The claim is made that blue light exerts a calmative and sedative influence and produces a sense of well-being, and that fixation of the eyes upon this light for a few seconds produces insensibilityof the face. This is said to permit of the painlesl!performance of minor operations, particularly the extraction of teeth.2 The patient's face is covered with a light blue veil; and there is a 16-candle-power incandescent electric-light bulb with a reflector at a distance of about 7 inches. The patient looks steadily at this for two or three minutes and at .the end of that time is usually found in a dazed condition, with dilated pupils. Dr. Redard, of Geneva, developed this method for the painless extraction of teeth, and finds it successful in two-thirds of the cases. He and others who have used it successfully think the effect is a direct one upon the nervous system and not an example of hypnotism. The anesthesia is limited to the cranial nerves. Blue-light Treatment.-Blue spectacles have long been used for the protection of normal eyes from the excessive sunlight at the seashore 1 Veiel, Vierteljahrsch. f. Dermatologie, 1887, p. 1114. "' 2 Redard and Cavalie, Gazette Sciences medicale de Bordeaux. N 0:"88. and for the protection at all times of eyes rendered sensitive by some disease. Smoked glasses seem to do equally well and it seems probable that the effect is due to the obstruction of a large proportion of the light, including practically all the ultraviolet rays rather than to the particular color of the glass. The effect of blue glass windows upon the growth of plants and the health of persons in rooms thus illumin8:ted were studied some years ago, but the method has been abandoned. The Minin Lamp.-This is an incandescent lamp with a blue glass bulb and a'reflector. Its effect is almost exclusively due to heat and is favorable in joint injuries and inflainmations, and in eczema, superficial dermatoses, neuralgia, and rheumatism. Kaiser's method of blue-light therapyl employs a carbon arc lamp actuated by a direct current of 15 amperes and 110 volts, with a parabolic reflector and a screen of strips of blue glass or a screen made of a glass-walled cell full of water in which methylene-blue and a little alum are dissolved. The latter makes the best screen because it arrests most of the heat rays. The patient is at the focus of the rays about 2 meters (6 feet) from the lamp. Good results are reported in tuberculosis of the joints and of the sJ<:in (lupus) . , Blue-light with moderate heat has been used by the author in the treatment of pain and swelling of the face from irritation of the nerve leading to a tooth. Such a condition may occur after a crown is applied, and if it is simply from mechanic and chemic irritation without Infection the author has Been it subside under this treatment. The lamp employed was a 32-candle-power incandescent blue glass bulb with a parabolic reflector. The face was protected by cardboard with a hole 3 inches in diameter which exposed the swollen cheek. The rays were not br~t to a sharp focus, but concentrated upon the area, and the heat was entirely endurable, but still sufficient to redden the skin. Only one application was made, lasting ten minutes. The cas~ did not progress beyond the stage at which the light treatment was applied, and in a short time the irritation subsided without having to remove the gold crown. How much the light treatment had to do with securing this result is a matter which the dentist (Dr. Gillett) is unable to decide. The patient herself did not think the light had produced much effect. Blue-light Baths.-General baths of blue light at a temperature of from 104° to 122° F. and lasting for twenty or twenty-five minutes may be given every day at first and later every two or three days and each light bath may be followed by a bath in tepid water. They have a sedative and analgesic effect in such cases as neuralgia and rheumatism. Local baths of blue light in the open air, not a cabinet, have been found very effective in different cases of neuralgia. Albert- Weil2 reports the cure of a case of severe intercostal neuralgia of two months' duration by fifteen treatments lasting ten minutes each; and in a case of sciatica, in which other means had failed, blue-light baths effected a cure in fifteen days. The apparatus required ,is a 32-candle-power blue glass incandescent lamp with a large parabolic reflector. 1 Wiener klin. Rundschau, 1906, No.4. I Jour. de Physiotherapie, Bept. 15, 1905. EXAMPLES OF THE THERAPEUTIC USE OF ELECTRIC ARC LIGHT Ultraviolet light has been used in the treatment of ulceration of the cornea and of conjunctivitis, and in treating x-ray dermatitis. The Ultraviolet Ray in Locomotor Ataxia.-Liebermann has reported beneficial effects from the ultraviolet ray applied alternately to the cervical, lumbar, and the sacral regions. Improvement took place in the pain and the coordination. Its Use in Lupus.-This is extremely important and is described on page 601. Electric-light baths with either incandescent or arc lamps are among the best means of treating rheumatism and gout and a variety of cardiovascular affections. Angina Pectoris.-Fifteen patients treated by Jacobaeusl showed the following results: 4 very grave .cases showed some improvement, but later succumbed to the progress of the disease; 3 old se.vere cases were improved and the severity of the attacks was reduced; in 3 milder cases the attacks of precordial pain disappeared entirely, and this was the case also in 3 moderately severe cases. That the effect was due to the treatment is shown by the recurrence of pain in 2 cases when the treatment was stopped and its disappearance when the treatment was resumed. Hasselbach and J acobaeusJ have pursued the same line of treatment somewhat further. They use powerful carbon arc lamps in the baths and obtain a dermatitis which from repeated applications becomes a chronic hyperemia lasting perhaps as long as a year and may be acco~- panied by .a lasting effect in relieving internal congestion and the like. Respiration exchanges are unaltered, but respirations become less frequent and deeper, inspiration being prolonged. A patient with cardiac distress breathes much more freely. Arterial pressure begins to diminish after the third treatment. Both the diastolic and the systolic pressures are reduced, but the difference between the two becomes greater than before. The pulse-rate is unaffected. Dilatation of the heart is usually reduced during a course of treatment. Fifty ",cases of various neuroses treated in this way showed great improvement. One hundred and thirty-one patients with chronic or organic heartdisease were treated. In some cases the valvular insufficiency was only moderated, but even then the sense of fulness and tension was reduced and so were, the dyspnea and palpitation on exertion. Cardiac dilatation was usually reduced; 44 cases of true angina pectoris gave rapid and strikingly favorable results which were quite lasting. Combined Electric-light Baths and Hydro-electric Baths in Obesity.-The electric-light bath is followed by a general warm water bath which is progressively cooled, while at the same time a sinusoidal current of 100 to 120 ma. is applied through it for twenty to thirty minutes; this is one of the most effective modes of treatment. Fatty degeneration of the heart is a contra-indication to this treatment. Examples of the Use of the Mercury Vapor Lamp.-The author has empluyed the Cooper Hewitt lamp with benefit in a case of laryngeal and pulmonary tuberculosis. A lamp of 450 candle-power, to which is added the influence of a reflector Dack of it, is placed horizon- 1 Semaine Med., May 22, 1907. ~ I Second International Congress of Physiotherapie; Rome, Oot. 13, 1907. tally in front of the bare chest at a distance of 5 or 6 inches from the skin. An exposure of ten minutes reddens ~he skin temporarily. The treatment was combined wit4 the use of the x-ray and high-frequency currents and resulted in the healing of the ulcerated vocal cords and a marked increase in weight, appetite, and strength. Financial difficulties then caused the patient to discontinue the treatment and she died of pulmonary tuberculosis about a year later. Nogier and Thevenot have shown by their experimentsl that applied in this way the light from the Cooper Hewitt lamp does not kill or apparently influence bacteria with an exposure of seventy-five minutes. But in a more highly concentrated form the mercury vapor light has a bactericidal effect and may be used in the treatment of lupus (Kromayer) . As an electric-light bath the light from the Cooper Hewitt mercury vapor lamp produces a general tonic effect, improving the appetite and digestion and removing insomnia. .N ogier has seen long-standing cases of amenorrhea become normal under the treatment. He obtained satisfactory results in cases of anemia and chlorosis by combining this treatment with general measures. Locally, it has the usual analgesic effect of radiant heat combi~ ed with light, and relieves gouty and rheumatic and muscular paIns. Pelvic pains of various natures are often relieved by applying this or similar lights over the hypogastrium. Nogier has shown by actual dynamometric measurement in 12 patients that there is an increase in muscular power. Vacuum Bulbs of Pure Quartz.-These can be made up to about 2 inches in diameter by fusing quartz sand with scarcely any otheradmixture. They transmit the ultraviolet ray perfectly and mercury vapor lamps so constructed are very active physiologically. The uviol .lamp is practically the same as the Cooper Hewitt lamp, except that the tube is made of glass which is supposed to transmit high rates of vibration and hence more of the ultraviolet rays. The effect of the uviollamp has not been fully tested, but it has been found to be very active superficially, and Pellizari has not found it to produce as deep an effect upon lupus as the Finsen lamp. Diagnostic Uses of the Cooper Hewitt Light.-The ndrmal face presents a strikingly unnatural appearance by this light which is devoid of red rays. Every red blood-vessel looks almost black and the lips are a dark purple. The skin of the chest and abdomen may be examined in cases of suspected syphilis before the eruption; the latter being visible by this light several days before it is perceptible by ordinary light. In the same way at a later stage the eruption may be found after it is no longer noticeable by ordinary light. The Cooper Hewitt mercury vapor lamp may also be used to watch for the earliest evidence of Rontgen dermatItis. Therapeutic Uses of the Kromayer Lamp.-This light may be applied to the treatment of recent trachoma. One end of a quartz rod is in close contact with the quartz tube of the , lamp, and all the light passes to the other end of the rod and affects the tissues without any lateral diffusion. This is a successful method of treatment. With the lamp at a distance of at least 4 inch~s froti1 the skin, an application of five to fifteen minutes is effective in'"a wide range of skin 1 Second Conr!ress of Phvsiotheranv. RomA. O"L 1~ 1~O7 diseases. Alopecia areata, alopecia pityrodes, pityriasis rosea, superficial mycoses, pruritus, vitiligo, acne, furuncle, carbuncle, lupus erythematosus, folliculitis decalvans capitis, folliculitis barbre, cutaneous tuberculosis, ulcers may be treated in this way. . With the lamp in close contact and the tissues blanched by compression or by adrenalin, but protected from excessive heat either by the water circulating in the lamp itself or by a blue screen of uviol glass to arrest the superficially acting chemic rays, the effect is a penetrating one, and the longer applications should only be made after considerable personal experience with the milder ones. The dosage for lupus vulgaris is fifteen to forty-five minutes; lupus erythematosus, one to thirty minutes; epithelioma, thirty to sixty minutes, lupus erythematosus, one to thirty minutes; epithelioma, thirty to sixty minutes; nevus vasculosus, thirty to sixty minutes; telangiectasis, five to thirty minutes; acne rosacea, five to thirty minutes; ulcers, five to. thirty minutes. A quartz mercury vapor lamp, suggested by Bach and N agelschmidt, is intended for application at a distance of 20 inches or so for a reflex effect Ozone Exit Wall Plug Switch Rheostat Quartz Burner '="' ~""'"'_.- ~=~ Lamp Connection . Fig. 423.-MiIiiature alpine Bun {Hanovia Chemical and Manufacturing Co., Newark). upon blood-pressure and for the treatment of a long list of skin diseases: lupus, chancroid, lipoma, nevus, alopecia areata, acne vulgaris and rosacea, eczema, frost-bites, intertrigo, erythrasma, chronic ulcers, psoriasis, eczema seborrhoica, falling of the hair, vitiligo. The dosage for a constitutional effect is three minutes front and back at a distance of 28 inches for the first treatment, gradually increased at subsequent treatments as the skin becomes tanned. Finally, the exposures may be as long as twenty minutes at a distance of 15 inches. The dosage in eczema is one minute at 16 inches, gradually increased at subsequent treatments to a maximum of five minutes at a distance of 8 inches. Acne, eczema, and other diseases of the face should receive at first one minute at 20 inches and gradually increased to a maximum of three minutes at the same distance. Closing the eyes protects them sufficiently. Many of the indications for electric-light treatment in medical gynecologic and surgical cases are met by this lamp. Sunlight in the Treatment of Tuberculosis.--"-A. host of observations show that exposure of the part to the direct rays of the sun...produces benefit in tuberculosis of the bones and joints.
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