It is certainly a great improvement over the old method, which required the patient to hold the handle almost at arm’s length.
   The electrode is placed in the ear and the machine started with a minimum of current.  The strength is then increased in accordance with the tolerance of the patient to the point where the buzzing sound becomes annoying, or the fine sparks become to sharp.  With the insulated tube, the sparks coming from loose contact with the external opening are avoided.  A marked sensation of heat is noticed in the ear, and the best method of regulating the length of treatment is to allow the tube to remain until this heat effect becomes a little uncomfortable, although I would never under any ordinary circumstances continue the treatment longer than seven minutes.
   I designed a holder a few years ago which permitted treating both ears at the same time, but for all ordinary conditions this is scarcely necessary, as the additional time required in treating the other ear where both require treatment is not sufficient to interfere seriously.  The conditions of the ear in which high frequency currents give the best results are catarrhal deafness; earache; tinnitus aurium, and chronic suppurative diseases (middle ear diseases).
 

   Special Technique in Treating the Eyes.  For applying high frequency currents to the eye, a double electrode is used, as shown in Fig. 46, which is inserted in the handle and the socket bent so that the patient may hold the handle against the body and thus steady it, and at the same time keep the electrode in contact with the eyes, without taking any chances of touching the cord connecting the electrode to the high frequency apparatus.  This is shown in Fig. 47.  The eyes are closed and the tube kept in light but firm contact with the lids.  The current is turned on after the tube is adjusted and is turned off before the electrode is removed, thus saving the patient from any spark.  The duration of the application varies from three to ten minutes.  If only one eye is affected, only one lobe of the tube may be brought in contact with the eye and the other may extend out to one side of the head, or a special single eye tube may be used.  One of the other vacuum tubes may be employed in treating the eye and kept in motion back and forth over the closed lid, or held in contact with it as preferred.  This method with a fine spark has proved very effective in blepharitis.
   These currents are useful in atrophy of the optic nerve; catarrhal conditions of the eye; absorption of hemorrhages; inflammation of the retina, and in connection with auto-condensation for the reduction of the blood pressure, they have given remarkable results in glaucoma.  Blepharitis, trachoma, iritis, paralysis of the ocular muscle, and cataract, are other conditions in which they have been employed.
 

   Nasal Technique.  The diseases of the nose that are specially suitable for treatment are all catarrhal conditions, including ozena (atrophic rhinitis), coryza, etc.  Even in hay-fever it has proved useful.  The small nasal tube (Fig. 48 or Fig.21, No. 13) is introduced and the current turned on very slowly.  A mild current is all that is required and the length of treatment varies from two or three to seven minutes.  It makes very little difference whether the tube is inserted in the straight or the movable socket handle.  If the upper or back part of the nasal cavity is to be treated, a tube having an insulated chamber to within possibly three-quarters of an inch or an inch of the end is preferable to the non-insulated tube.  In acute inflammatory conditions the application of a vacuum electrode to the sides of the nose, externally, is advised.
   Technique in Treatment of Rectum and Prostate.  In treating the rectum for fissure, hemorrhoids, catarrhal conditions, etc., the insulated tube shown in Fig. 21, No. 8, should be used.  The non-insulated tube is of much less value for diseases above the sphincter.  The rectal tube may be employed in treating the prostate, although the tube specially designed for the latter purpose is the one shown in Fig. 21, No. 1, where the depression in the tube is supposed to be turned toward the anterior wall of the rectum, and receive into it a portion of the gland.  My new spatulate tube used with one of the flat surfaces toward the prostate gives a larger contact surface, it being doubtful whether with the other tube the gland really ever fits into the depression.  In prostatic diseases of all kinds, the high frequency current has proved most efficacious, whether used alone or in connection with some other modality.
 

   In treating both the rectum and the prostate, my special technique consists in placing the patient on one side in the Sims’ position with the knees well drawn up.  The electrode is lubricated, inserted in the movable socket handle and introduced into the rectum.  The handle is then bent upwards in contact with the body and the patient takes hold of the handle, thus keeping the tube in place during the treatment.  The duration of each treatment is seven minutes, and the tube is inserted always before turning on the current and the latter turned off before the tube is removed.  Treatment through the rectum is very effective in posterior urethritis, also in diseases of the bladder.  Occasionally in virgins it will be found desirable to treat uterine or vaginal conditions with the high frequency electrode in the rectum.  The current penetrates surrounding structures to a much greater extent than one would suppose.
   The special technique for itching is given in Chapter VIII under pruritus
   Scalp Treatment.  In treating the scalp, the body electrode, Fig.49, is used.  The electrode is moved rapidly back and forth over the scalp using a spark of from one-quarter to three-quarters of an inch or keeping the tube in light contact with the scalp.  If too sharp a spark is used, the scalp will be sore after the treatment and tiny sores will be found.  High frequency currents are indicated in all diseases of the scalp, in falling hair, and some years ago I made the discovery that if employed for a sufficient length of time they are capable of restoring the color to gray hair.  This will be specially considered in Chapter VIII.  The tube shown in Fig. 21, No. 11, is used conveniently in treating the scalp, being equally as good as the body tube, and a new tube resembling a glass rake is now in general use. Fig. 49a.
 

   Throat Technique.  The throat electrode is shown in Fig. 50.  Any of the other electrodes may be used externally.  In acute inflammatory conditions of the throat the low vacuum tube is preferable.  The tube may be placed directly in contact with the mucous membrane of the throat or a spark allowed to pass, according to the nature of the case.  Sparks from the regular tube or from the fulguration point have been employed to destroy follicles in pharyngitis or in place of nitrate of silver cauterization, and the fulguration point has even been used in the removal of the tonsils.
 

   Urethral Technique.  When employing glass sounds (Fig. 20, No. 5, or Fig. 21, No. 12) within the male urethra, the patient is placed upon his back on the operating table.  Whether the knees are flexed and the legs drawn up depends somewhat upon the individual case; ordinarily the legs are straight, but slightly separated.
   The sterilized sound is lubricated and introduced in the same manner that a steel sound would be used, taking care, however, not to use much force, on account of the possibility of breaking the tube.  This has happened occasionally, through a prying or sidewise motion, or through a sudden jerk.
   If the canal is too small to admit of the easy passage of the tube, steel sounds are used first to dilate the urethra to sufficient size.
   In case stricture is present and the whole canal cannot be dilated sufficiently to allow the glass tube to pass the stricture, then it is introduced as far as the stricture and the treatment given.  On subsequent days it will be found that the stricture gradually disappears until finally the glass tube will pass by it.
   When the urethral tube has been properly inserted, the socket of the holder is slipped over it, and the handle bent back over the patient’s abdomen.
   The patient takes hold of it and thus steadies the tube.  In stricture he is instructed to make steady downward pressure to keep the point of the tube firmly in contact with the stricture.  The handle is connected to the machine and the current turned on.  In this way the patient experiences no shock.  The current is turned off before the sound is removed.  Duration of treatment, seven minutes.
   Do not forget that the posterior urethra may be treated almost as thoroughly and with much less pain, by introducing a tube into the rectum.
   Uterine and Vaginal Technique.  High frequency currents are suitable in all catarrhal conditions of uterus and vagina, including leucorrhea, cervicitis endometritis, etc.  They are extremely valuable in specific vaginal diseases in conjunction with the usual method.  Treatment through the vagina is also indicated in diseases of the fallopian tubes and of the ovaries and in pelvic abscess and in adhesions.  Low or medium vacuum tubes should be used in the latter diseases.
   The technique which I use in applying the current in the vagina, is as follows: The patient is placed on her back with her feet in the stirrups and the lubricated tube in the author’s movable socket holder is inserted, and then the handle is bent down to touch the table and the patient’s skirts folded over it, thus anchoring the tube and preventing it from slipping out.  A towel is then wrapped around the metal connection between the tube and handle to prevent the latter from tipping sideways and thus giving the patient an uncomfortable spark.  The cord connecting with the generating apparatus passes out under one leg of the patient and care should be exercised to see that it does not come in contact with it, nor should it rest upon any metal which touches the patient, for if there be a defect in insulation a sharp current will be communicated along the metal.  After the tube is properly adjusted the current is turned on and allowed to pass for seven minutes, when it is turned off before removing the tube.  In very acute cases, I have not hesitated to give two ro three treatments in a day until improvement took place.  Ordinarily from one treatment a day down to two or three treatments a week will prove satisfactory in sub-acute or chronic cases.  The insulated vaginal tube should be used.  It is shown in Fig. 21, No. 10.  The prostatic tube also makes an excellent one for vaginal use, and Fig. 27 shows my new spatulate tubes, which admit of contact with a larger surface.  Occasionally in treating diseases of the cervix, a small electrode may be inserted within the canal, taking care to insulate against contact with the metal speculum, if the latter is used.  (An old-fashioned glass one is better.)  In cancer, the fulguration tube may be used through the vagina to destroy the cancerous tissue.  This may or may not require an anaesthetic.
 

   One authority packs the vagina with moistened gauze with a metal electrode in the center and thus carries the current to all contiguous parts.  The D’Arsonval current may be used in the vagina by this method.  Direct D’Arsonvalization is now known as diathermy.  See Chapter XI