Page 8 P H Y S I O T H E R A P Y September, 1959 EVALUATION OF DIATHERMY B Y D IS R A E L I K O B A K , M .D . This interesting pa p er never appeared in a M e d ic a l Journal b ut was p rin te d as a p riv a te publication a fte r K o b a k ’ death b y C ecil B irtcher, P resident o f the B irtcher Corporation, who was k in d enough to p e rm it us to reprint it. IN S e p tem b e r, 1955, 1 h a d d in n e r a t the B lac k sto n e H o te l in C h ica g o w ith D r. D isra eli K o b a k . D r. K o b a k h a n d e d me a p a p e r w hich he sta te d h e in te n d e d to p re sen t b e fo re a m ed ical g ro u p in the n e a r fu tu re . A s it m u st to all m en, d e a th cam e to D r. K o b a k a few s h o rt m o n th s la te r and his p a p e r w as n ever p resented. A s e d ito r fo r seventeen y ears o f th e M a g a zin e, A rch iv es o f P hysical M edicine, X -ra y and R a d iu m , th e official jo u r n a l o f the A m e ric an C ongress o f Physical M edicine, th e wise, k in d ly , th o u g h t-p ro v o k in g , a n d som etim es v itriolic w o rd s o f D r. K o b a k w ere re ad th ro u g h o u t th e w orld. I t is th ere fo re in d eep respect a n d m em o ry o f D r. D isra eli K o b a k t h a t p e rh a p s w h a t is his last p a p e r is now p riv ately pu b lish ed th a t his goo d w o rd s m a y a gain b rin g th o u g h ts to th e m any, m a n y th o u sa n d s o f p h y sicians a n d th e ra p ists th ro u g h o u t th e w orld w h o w ere his frien d s a nd follow ers. C e c i l B i r t c h e r , President, T h e B irtc h e r C o rp o ra tio n . b lo o d th ro u g h th e h eated p a rt. I t has been re aso n e d th e re ­ fo re th a t all clinical value o f d ia th e rm y is d u e to w hatever v alu e exists d ue to th e m ate ria lly increased b lood c irc u la tio n in th e trea te d p a rt. T h a t in itself is good b u t it d oes leave m any q u e stio n s u n answ ered. H e a t is g e nerated in tissue w hen th e excess e nergy m ust be d issipated. H o w a b o u t the e nergy th a t is in tro d u c e d in to the tissue th a t is a t a level less th a n h e at p ro d u c in g ? T h e re a re m an y sincere a n d c o m p e te n t m edical m en w ho h a v e regularly observed excellent clinical resu lts em ploying h igh freq u en cy energy fro m a d ia th e rm y m ac h in e at such low levels o f e nergy th a t th ere has been n o m ea su ra b le te m p e ra tu re rise in th e tissue w hatsoever. W h y does d ia ­ th erm y a t a high level o f e nergy a n d h e at p ro d u c tio n a g g ra ­ v a te som e p a in fu l sy m p to m s a n d alleviate o th e r p a in fu l sy m p to m s ? D ia th e rm y a t a h igh level o f e nergy seem s to m ate ria lly increase the p a in in n e u ritis a n d yet at a very low level very often seem s to give am a zin g re lief to th e p a tie n t. W h a t d osage d o we give to a p a tie n t w ith d ia th e rm y ? H o w m a n y w a tts o f electrical energy do we in tro d u c e in to tissu e ? A s o f this w ritin g th ere is n o d ia th e rm y m achine w hich even indicates th e a c tu a l a m o u n t o f e nergy being delivered in to a p a tie n t. M e ters o n d ia th e rm y m ach in es on ly in d ic a te a relative increase o f energy o u tp u t b u t even this w ith n o degree o f acc u rac y in term s o f w atts, th e elec­ tric a l u n it o f m easurem ent. W h at chem ical changes ta k e p lac e in tissue w ith a d iath e rm y tre a tm e n t? I f any, is th is the effect o f the h e a t p ro d u c ed o r d u e to som e a ctiv atio n c reated by th e flow o f th e electrical e n erg y ? T h is q u e stio n is still a c o n tro v e rsial issue in view o f th e in ad e q u ac y o f a c c u ra te m ea su re m e n t o f energy delivered in to tissue and b ecause o f the diverse o p in io n s by e q u ally distinguished m edical investigators. T h e b ro a d use o f d ia th e rm y d oes n o t c o n tra in d ic a te the use o f d ru g s o r o th e r physical m easures. In fa ct unless m ak in g a special c o n tro lle d study a ll o th e r m eth o d s sh o u ld b e em ployed w ith d iath e rm y each an a d ju n c t to th e other. L e t us see w h a t som e o f the m o st c o n servative p u b lic a tio n s h a v e re cently said a b o u t d iath e rm y . T h e C o u n c il on P hysical M edicine o f the A m e ric an M edical A sso c ia tio n re co m m e n d s th e u se o f d iath e rm y o n the fo llow ing diseases very o ften in c o n ju n c tio n w ith o th e r th era p y , drugs, o r som etim es alone. I t has been re p o rte d to m e th a t re ce n tly a n e m inent p h y sic ia n w hile ad d ressin g a sizeable g ro u p o f registered P hysical T h e ra p is ts on th e m any aspects o f physical m edicine, passed lightly o ver th e subject o f d ia th e rm y w ith th e re m a rk , “ D ia th e rm y never c u red a n y th in g ” . Such a re m a rk m ig h t well have been directed to a ny m eth o d w ith in physical m edicine o r fo r th a t m a tte r to th e m illion a n d o n e d rugs in th e P h a rm a c o p e a . Surgery c a n re m o v e a diseased o rg a n and th e p a tie n t reco v er suffi­ c iently to seem to e n joy a fu ll m ea su re o f h e a lth b u t the diseased o rg a n w as n o t “ c u re d ” n o r is th e p a tie n t a w h ole m an. Such a re m a rk fro m a sp e a k e r’s p la tfo rm to the ty ro in physical m edicine is u n fo rtu n a te . T h e sp e a k er w as d am ned w ith fa in t praise. Such a re m a rk discourages th e use o f a m eth o d w hich has p ro v e d itself fo r o v e r fo rty years in the h a n d s o f ov er 200,000 p h y sicians th ro u g h o u t the e n tire w o rld . ' I n spite o f th e sh o rtc o m in g s o f d ia th e rm y a n d o f th e m an y w h o e m p lo y it th ere is n o o ne m e th o d in physical m edicine, n o r a m o n g all th e d ru g s so re liab le o r so b ro a d ly indicated in daily u se o f a p h ysician th a n d iath e rm y . N o , the often sta rtlin g resu lts achieved by o u r m o d e rn m ira cle d rugs have n o t in any w ay tarn ish e d th e b rillia n t achievem ents o f d ia th e rm y so long estab lish e d , d o in g its d aily p e rh a p s u n sp e c ta c u la r jo b a m illion tim es e ach day. B ecause d ia th e rm y h a s becom e so fa m ilia r in th e daily p ra ctic e o f th e p h ysician a n d th e train ed p h y sic al th e ra p is t it d oes n o t fo llo w t h a t th e old a d ag e “ F a m ilia rity breeds c o n te m p t” sh o u ld m ire the scientific th in k in g and pra ctic e o f th o se tra in e d in physical m edicine. T h e fa c t th a t th e early e n th u sia sm s fo r th e vita m in s, the a n tih istam in es, th e m o d e rn h o rm o n e d ru g s a n d th e a m azing a n tib io tic s h a v e now been m o st m o d estly a n d conservatively e valu ate d d oes n o t re fu te th eir respective im p o rta n c e n o r sh o u ld it d isc o u rag e th e c o n tin u e d u se o f th ese d ru g s by the m ed ically train ed . T h e fa c t th a t it h a s been e stablished th a t c e rta in virus have developed stra in s re sista n t to a n tib io tic s even in p a tie n ts n ever p re v io u sly trea te d w ith th ese d ru g s d oes n o t suggest th a t th e a n tib io tic s be discarded in p ra c tic e n o r in fu rth e r research. B y th e sam e to k e n d ia th e rm y m u st n o t, a n d c a n n o t be d isc o u n te d by th e th in k in g e arn e st p h ysician. D ia th e rm y is fa m ilia r a n d c o m m o n p la c e b u t m u ch as yet m u st be learned a b o u t it. T h e re is a great o p p o rtu n ity fo r research a s well as clinical usage. A d ia th e rm y m a c h in e in tro d u c es h igh freq u e n c y electrical e nergy in to tissue. W h en a sufficient a m o u n t o f energy is in tro d u c e d it m an ifests itself b y th e d issip a tio n o f th e energy in th e fo rm o f h e a t d eep in the u n d e rly in g tissues. T e m p e ra ­ tu re s a re re g u la rly c rea te d w ithin th e tissue a t 102°F , 105°, 106 ° o r m o re, o r less as directed by th e o p e ra to r. I t h as been e stablished th a t th is h e a t d ilates th e a rte ria l, v e n o u s and cap illiary passages a n d m a te ria lly increases th e flow o f C o n tu sio n s M uscle Sprains M yositis O ssifications S p ra in s a n d D islo c atio n s B ursitis T en o sy n o v itis C h ro n ic A rth ritis M yositis a nd M yofascitis F ib ro sitis F ra c tu re s G e n ito -U rin a ry C o n d itio n s Pelvic In fec tio n s R e sp ira to ry D iseases G a s tro in te stin a l D iseases In fla m m a tio n o f the P e rip h era l N erves A c u te and C h ro n ic Sinusitis Eye D iseases S u p p u ra tiv e Processes T h e J a n u a ry 7, 1950 issue o f th e J o u rn a l o f th e A .M .A . c arried a c o m prehensive a rticle on m edical d ia th e rm y by R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) September, 1959 P H Y S I O T H E R A P Y Page 9 G o rd o n M . M a rtin , M .D . a n d D o n a ld J. E ric k so n , M .D . o f th e Section o f P hysical M edicine o f th e M a y o Clinic and h a v e re p o rte d th eir usage o f m edical d ia th e rm y on the fo llow ing: R h e u m a to id A rth ritis O s te o -a rth ritis o r H y p e r­ tro p h ic A rth ritis B u rsitis T enosynovitis F ib ro sitis a n d M yositis S prains and stra in s F ra c tu re s N e u ritis P e rip h e ra l V a sc u lar D isease Sinusitis O titis M edia Pelvic in fla m m a to ry D isease Pleurisy D iv e rticu litis In fec tio n o f th e eye N o w th a t such a larger p e rce n ta g e o f o u r p o p u la tio n is eld erly a n d th is is increasing reg u larly th e use o f d ia th e rm y fo r o ld e r p e o p le is o f in creasing im p o rta n ce . T h e A u g u st, 1948 issue o f T h e M edical R e c o rd c arried an article entitled “ V alue o f P hysical T h e ra p y as a n ‘A d ju n c t fo r the A g e d ’ ” by L o u is F e ld m a n , M .D . o f B righton, M a ssac h u se tts. D r. F e ld m a n re p o rts d ia th e rm y o f v alu e in these elderly folk in th e tre a tm e n t o f varicose veins, c h ro n ic cholecystitis, g astric neurosis, a to n ic dyspepsia, benign p ro sta tic e n la rg em e n t a nd ch ro n ic p ro sta titis , spasm o f th e u re te r w ith u re th ra l sto n e o r g o u t, o ste o a nd rh e u m a to id a rth ritis , fibrositis, m yositis, b u rsitis, stiff jo in ts a n d fo r lessening m u sc u la r rigidity and im p ro v e m en t o f m o tio n in p a raly sis a gitans. T h e N o v e m b er, 1949 issue o f M e dical E co n o m ics carried th e a rticle “ D ia th e rm y E q u ip m e n t fo r th e G .P .” by E dw in M a tlin , M .D ., D r. M a tlin re p o rte d th a t his p ra ctic e is lo ca ted in a village o f a p p ro x im a te ly 1,800 in h a b ita n ts in P en n sy lv a n ia . H e re p o rte d th a t in d ia th e rm y he was giving a tan g ib le service to his p a tie n ts . T h o u g h by n o m eans d oes he specialize in physical m edicine he re p o rte d th a t d u rin g th e six m o n th s ’ p e rio d im m ediately pre ce d in g he had seen a n a verage o f 15 p a tie n ts p e r day. D u rin g th e six m o n th s th e cases tre a te d by d ia th e rm y w ere as follow s: S prains, stra in s, co n tu sio n s Sinusitis ................................... N e u ritis, S ciatica .................. F ra c tu re s (a fte r cast rem o v al) . Pelvic in fla m m a to ry disease F u ru n cles ................................... B ursitis ................................... T o rtic o llis (follow ing URL) Pleurisy ................................... P n e u m o n ia .................................... 59 18 18 10 8 6 5 4 2 2 Yes, d ia th e rm y c o n servatively e v alu ate d has a n extrem ely b ro a d usage. P e rh a p s in m a n y cases a d ru g will d o as well. \A b it o f c o d in e o r five o r six ou n ces o f w hiskey will p ro b a b ly 'relieve a d y sm e n o rrh ea , b u t is it de sirab le to in tro d u c e a very toxic d ru g in to this p a tie n t w hich m a y becom e h a b it fo rm in g ? T o go b ack to m y first p a ra g ra p h a n d the goo d d o c to r w h o carelessly sa id , “ D ia th e rm y never c u red a n y th in g ” , I shall agree w ith him b u t I o b jec t to his fa ilu re to m ake the re m a rk w ith o u t fu rth e r co m m e n t. N o , D o c to r , d iath e rm y never c ured an y th in g , b u t p e rh a p s y ou h a ir has n o t grow n grey w ith m in e in usage o f d ia th e rm y fo r o ver 30 years. P e rh a p s y o u have never given six one h o u r d ia th e rm y tre a tm e n ts in a 24 h o u r p e rio d to an a p p a re n tly hopeless lo b a r p n e u m o n ia as I have a n d on m a n y occasions seen the te m p e ra tu re declined by lysis. P e rh a p s y ou h ave never tre a te d an agonized a c u te lu m b a g o fo u r o n e h o u r tre a tm e n ts in a single d a y fo r tw o d ays th en observed th a t p a tie n t on a ten n is c o u rt th e f o u rth day. I have. N ow , d ia th e rm y never c u red a n y th in g b u t I am m ighty glad this w onderful to o l o f m edicine is a v ailable to m y h a n d s in m y d a ily practice. L et u s ta k e th e fam ilia r, th e c o m m o n p lac e, the re liab le m e th o d o f 50 y e ars a n d guide it w ith intelligence a nd w ith th e sincerity, e n th u sia sm a n d e nergy o f a m issionary, n ot to fo reg o in te rest a n d th e stim u la tio n o f th e new b u t to revitalize a n d renew the old. This hygienic P h y s i o t h e r a p i s t Uniform has so many good points! S a n fo ris e d , M e rc e rise d w h it e tw il) A d ju s ta b le n e c k lin e -------------- t o th e sp e c ific a tio n o f th e U n iv e r s it y P h y s io th e ra p y S e c tio n B re a s t p o c k e t - - " ' " L o n g s le e v e s ................................... D e ta c h a b le b e lt T w o h ip p o c k e ts , on e w it h co n ce ale d in sid e p o c k e t . . . B u t to n fr o n t DELILAH G ARM ENT O F Q U A LIT Y A N D STYLE by T H E H O U S E O F E N S I G N M a n u f a c t u r e d b y The AFRICAN C LO TH IN G FAC TO R Y P.O. BOX 1098 CAPE TOWN a n d o b t a in a b l e f r o m g o o d c lo t h i n g s to r e s e v e r y w h e r e R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )