Tousey-Sinclair · Source catalogue

Title page: Sinclair Tousey, A.M., M.D., Consulting Surgeon to St. Bartholomew's Clinic, New York; W. B. Saunders, Philadelphia and London, third edition 'thoroughly revised and greatly enlarged', 861 illustrations (16 in colours), 1921. Imprint: copyright 1910; revised and recopyrighted 1915; reprinted 1916; revised and recopyrighted April 1921. Dedicated to his father, John Euart Tousey. The scan is a library copy (bookplate 'GIFT Dr. Frank M. Whiting'; Lane Medical Library stamp). Preface to the third edition (April 1921): claims 'most important advances' in dental and gastro-intestinal radiography and in the standardisation of apparatus and technique, with tables of correct exposure 'for every portion of both sexes and of every weight and measurement' from 'many hundred hours' work' on thousands of radiographs; adds war-injury rehabilitation. It states that the book describes inventions 'patented and unpatented' and that absence of a patent mention does not mean rights are unprotected; it names no patent or patentee. Original preface (1910): credit policy (a named observer marks either a claim not yet verified or credit for an established fact); radiographs are the author's own unless stated; thanks Dr. Smith Ely Jelliffe and Dr. Harry F. Waite; special mention of Houston, J. J. Thomson, Curie, Albert-Weil and Bordier; the author's 'greatest obligation' is to the professional friends who referred patients. The contents (printed pp. 13-16) show the whole scope: static electricity (p.25), dynamic electricity (78), animal electricity (268), physiologic effects (292), electropathology (354), electrodiagnosis (386), ionic medication (399), galvanic/faradic/sinusoidal therapy (422), nervous-system electrotherapy including electric sleep and death (455-537), high-frequency currents and diathermy (538-641), electricity through gases (642), phototherapy (655), the x-Ray (692-1150, over a third of the book), Rontgenotherapy (1150-1238), radium (1239-1280), index (1281). Items the contents mark as the author's own: 'The Author's Contact Diaphragm' (p.801) and 'The Author's Technic for Gastro-intestinal Radiography' (p.1035). The OCR renders 'x-ray' as 'z-ray' in many places; the printed letter is x.

Key claims

• The book is a general practitioner's textbook of medical electricity (static, galvanic/faradic/sinusoidal, high-frequency, light, x-ray, radium) written by an x-ray practitioner and inventor in the 1910s.
• The 1921 edition claims standardised exposure tables for every part of the body, and advances in dental and gastro-intestinal radiography, from thousands of the author's own radiographs.
• The book reserves unspecified patent rights on 'inventions, patented and unpatented' described in it.

Relevance: Establishes who the 'inventor' is (Sinclair Tousey), the edition (third, April 1921), the scope of the book and which devices he names as his own; sets the edition and date for every later citation.

Mainstream conflict: none (front matter). Stake: Tousey sells his own practice and designs apparatus; his descriptions of his devices are his characterisation.

Textbook account of frictional and influence (Holtz, Toepler, Wimshurst) machines, the Leyden jar, charge by conduction and induction, sparks and brush (effluve), the units (ohm, ampere, volt, farad), and water-pipe analogies of voltage versus quantity. Machine care (moisture is the enemy; calcium chloride, aluminium parts, drying with lamps or lime); the author reports a Holtz machine running 'winter or summer' with dishes of calcium chloride. Output table (Joubert) of voltage against sphere-gap separation (0.1 cm 4,830 V to 15 cm 61,800 V). The author estimates that a six-plate machine puts about one-fiftieth of the motor power into separating charge and concludes the static machine is 'the least economic of all sources of electricity' with 'no industrial application'. Therapeutic modes: static bath/insulation, head breeze, sparks, Morton wave current, indirect sparks, the author's own spray electrode with distance regulator (Fig. 61), static-driven d'Arsonval/Piffard 'hyperstatic' transformer and De Kraft's inducto-resonator. Benoist's 'Franklin' charge-density unit and electro-densimeter. Reported effects and indications (neurasthenia, insomnia with head breeze, constipation, sciatica, diabetes by W. A. White's wave current, pelvic disorders, arteriosclerosis cautions) are largely compiled from named practitioners (Snow, Pitcher, Titus, Humphris, Peckham, De Kraft); the author reports a few of his own observations (hair fall after static head breeze; nail charred by crown breeze; 'remarkable cures' of impotence with a possible psychic element).

Key claims

• A static machine converts only about 30 per cent of its input power into charge separation, making it the least economical source of electricity.
• A static head-breeze with insulation is the best treatment for insomnia, and static sparks and breeze have a sedative or stimulating effect depending on technique.
• Static wave current to the liver and pancreas is of value in diabetes (W. A. White, cited).
• Static electricity acts through voltage (tension), not quantity, so its effects are unlike those of galvanic current.

Relevance: Background to the author's later argument that static charge from the x-ray tube (an electrostatic or 'condenser' effect) may matter in x-ray burns and healing, and to his use of static machines as x-ray generators.

Mainstream conflict: Mostly historical electrostatics (consistent with textbook physics). Therapeutic claims for static baths, breeze and wave current in systemic disease are not accepted modern medicine; the dating is 1910s practice.

Textbook account of the voltaic cell (Arrhenius ionic view, polarisation, local action, internal resistance, series versus parallel), thermo-electricity, storage batteries, dynamos, alternating, polyphase and rectified current, transformers and choke coils, induction coils (primary self-induction, interrupters, condensers, secondary sections), galvanometers and meters, Wheatstone bridge, rheostats, and wiring rules. Author-specific items: 'The Author's Use of Triple Phase Currents in an x-Ray Generator' (digest PDF p.130): 220 V DC drives a motor-generator giving three-phase current to a transformer with a commutator; his experiments with his 12-inch and 8-inch x-ray coils (4 A with both primary layers, 5.5 A with one layer; the 8-inch portable coil regulated by tapped primaries and the Wehnelt platinum exposure so that no rheostat or ammeter is needed); a hot-wire milliammeter experiment on the inverse discharge; a remark that the human body's resistance 'under certain circumstances is 2000 volts' (as printed; ohms meant). The author states the faradic coil's high-tension discharge is 'not as good even as an excitomotor as a rapidly interrupted voltaic current'. Spottiswood's 1876 coil (240 miles of secondary wire) is described. QE deep read (PDF pp.144-162, 213-217; printed pages are PDF minus 2 in the coil chapter, equal to PDF from p.213 on): (1) The book's power bookkeeping [read: p.155]: 'no more power can come out of an induction coil than was put into it'; worked case 20 A x 100 V = 2000 W in, 60,000 V out, so 1/30 A = 33 mA at most. (2) Meters [read: p.155-156]: a D'Arsonval (moving-coil) milliammeter 'indicates in a general way the average strength and direction of the secondary current ... Such a meter may indicate 0 when the x-ray tube is giving a radiance by which a moderately good picture may be made' (inverse discharge equal to direct); a hot-wire meter 'is not influenced by the amount of inverse discharge, because that has the same heating effect as if it were in the right direction'. (3) TOUSEY'S OWN APPARENT-POWER EXPERIMENT [read: p.156, printed 154]: hot-wire milliammeter rated to 650 mA at one pole of a 12-inch coil, a Wehnelt interrupter on 110 V DC giving 6 A in the primary, a regular flame across 4 inches; 'The length of the spark showed a voltage of 40,000 and the milliamperemeter indicated an intensity of 150 milliamperes. Here there was an apparent power of 6000 watts produced by the application of about 600 watts, a considerable part of which was certainly expended in overcoming the resistance in the liquid interrupter. The apparent discrepancy is due to the fact that the voltage is greatly reduced during the passage of the continuous flame, just as 100 volts will maintain an electric arc 1 inch long which it would take 10,000 volts to originate.' Recomputed: 110 x 6 = 660 W in; 40,000 x 0.150 = 6000 W 'apparent' (about 9-10 to 1); the 40 kV is inferred from the 4-inch spark at the book's 10,000 V per inch (p.217), not measured. By the book's own p.155 rule 600 W at 40 kV would allow at most 15 mA, so Tousey presents the 6000 W as an appearance explained by the arc, not as a gain. (4) Printed p.214 [read]: hot-wire ammeter and voltmeter readings multiplied 'will often be found to exceed the amount of power expended in running the dynamo ... The hot wire milliamperemeter evidently does not register the average strength ... but indicates somewhat more than the true figure'; no measurements or instruments are given. The book therefore offers two different reasons for volt-ampere products exceeding input: arc-voltage collapse (p.156) and hot-wire weighting of current maxima (p.214); it does not say which applies to the coil (the deep reader flags them as separate). (5) Other details [read]: secondary of a 12-inch coil 'contains 40 miles of wire' (p.155); a wheel-interrupter apparatus reported giving '100 to 500 milliamperes' on a primary of about 1 A (p.146, voltage not stated); Lewis Jones oscillograph traces (make current weaker and longer, break current abrupt; p.157-160); alternations above about 5000 a second no longer excite muscle (p.161-162); the book's Spottiswoode battery spark lengths differ between text (28/36/40 in) and table (28/35/42 in).

Key claims

• Induction-coil interrupters, primary self-induction and condenser size control the x-ray tube current, and the inverse (reverse) discharge must be suppressed for sound x-ray work.
• A rapidly interrupted voltaic current is a better muscle stimulant than the faradic coil's discharge.
• A coil's apparent power can exceed its input: in the author's own experiment (12-inch coil, 110 V x 6 A = about 600 W in; 4-inch spark read as 40 kV; hot-wire meter 150 mA = 'apparent' 6000 W) the discrepancy is attributed to the voltage collapsing once a continuous flame is running ('100 volts will maintain an electric arc 1 inch long which it would take 10,000 volts to originate') [read: p.156].
• A D'Arsonval milliammeter on an x-ray coil reads the signed average of direct and inverse discharges (it may read 0 while a usable picture is made), whereas a hot-wire meter ignores the sign [read: p.155-156].
• Volts times amperes read from hot-wire alternating-current meters 'will often be found to exceed the amount of power expended in running the dynamo' because heat surges at maximum current outweigh cooling at zero current [read: printed p.214].

Relevance: Supplies the circuit and induction-coil background for the x-ray generators and the high-frequency apparatus the author uses; contains his triple-phase x-ray generator note.

Mainstream conflict: none; standard 1910s electrotechnics, with some pre-modern conceptual language.

Condenser formulas in electrostatic CGS (dielectric constant omitted from the plate-condenser formulas), dielectric table, the action of a condenser across an induction-coil interrupter (the author says his condenser circuit diagrams were 'devised by the author'), Faraday's laws with an electrochemical-equivalent table (several slips: oxygen equivalent printed 1.000, ferric iron valence 4, electron charge 1.34e-19 C against 9e23 electrons per faraday, 'faster than light' 288,000 mi/s), Grotthuss and Clausius, Arrhenius dissociation, osmotic pressure and Raoult cryoscopy with a worked CuSO4 example, ionic speeds (about 3e-4 cm/s per V/cm), and Leduc's two-rabbit experiment. The animal-electricity account: demarcation current, current of rest versus 'alteration' theory, Bernstein/Mostinsky's membrane (concentration-cell) view quoted from Boruttau, electrotonus as a cored conductor, electric-organ voltages (about 100 V), the 'body as a 0.5% sodium chloride electrolyte' and the statement that 'almost all the physiologic effects of electricity upon the animal tissues should be considered as due to electrolysis and to electric osmosis'. SOURCE GAP: the scan lacks printed pp.282-283, 286-287 and 290-295 (and repeats printed pp.284-285 three times), so the main electrotonus text and the opening of the concentration-cell section cannot be read; the book's index points to printed p.286 for the concentration-cell example. No concentration-cell equation (Nernst) appears on the surviving pages. QE note on the 39 m/s passage (checked against the extracted text): on PDF p.289 Tousey himself writes [read] 'The rate of progress of the wave of low potential, not over 30 meters a second ... does not indicate the rate of transmission of the same electric current through the tissues ... The velocity at which the current flows, possibly 180,000 miles a second, will not be materially altered' (a correct signal-speed versus wave-of-action-potential distinction). On PDF p.296 the body is described as a sodium-chloride solution that 'according to many observers conducts only by electrolysis and not at all by ... passage of simple electrons'; then 'This would mean that electricity can travel through the body at a rate not exceeding 39 meters a second, instead of at the rate of 180,000 miles a second' [read]. The premise is the observers'; the inference ('would mean') is stated in Tousey's text without his own p.289 distinction being cited, and the two passages are seven pages apart.

Key claims

• The potential differences of living tissue arise from unequal migration of positive and negative ions through a semipermeable limiting membrane (a concentration cell), as Boruttau, Bernstein, Mostinsky and MacDonald hold.
• Almost all physiologic effects of electricity on animal tissue are due to electrolysis and electric osmosis, because the body behaves as a sodium-chloride electrolyte.
• Electricity can cross the body at a rate not exceeding 39 metres a second, instead of 180,000 miles a second, if the body conducts only by electrolysis.
• An electron carries a charge of about 1.34e-19 coulombs and 9e23 electrons carry one faraday (as printed; the two numbers do not agree with each other), and electrons are about 1/1000 the size of a hydrogen atom.
• Electric organs of the torpedo and eel generate about 100 volts, each fibre acting as a small condenser charged at will.

Relevance: Shows the book's physical-chemistry basis for ionic medication and for its view that the body is an electrolyte; the 39 m/s claim and the electrolysis-only claim are the author's statements of a conduction model (the book itself notes a conflict with the 180,000 mi/s signal speed).

Mainstream conflict: The 39 m/s statement confuses ion drift with signal propagation, and the electrolysis-only view of all tissue effects is not modern physiology (heating, membrane excitation and field effects matter); the membrane (concentration-cell) view of the demarcation current is the one modern physiology kept. Electric organs are batteries in series-parallel, not condensers (modern view [memory, high]).

Compiled physiology: current paths and nerve polarity, special-sense stimulation (flashes, taste, sound), the author's own test of a moistened finger on a 110 V socket and of metal in each hand on 110 V DC (severe shock), the difference between static and condenser/high-frequency action, condenser discharges as stimuli (Q = CV; the threshold voltage varies about as 1/sqrt(C), i.e. equal energy), Carvallo and Weiss's frog-nerve tetanus table, DuBois-Reymond's laws, polar effects, myograph and electrocardiograph technique (leads I-III; waves P, Q, R, S, T), time marks, latent period, tripolar/virtual-electrode stimulation, spinal-cord and cortical stimulation, nerve speed (50 m/s) and the statement that alternations above 5000 a second do not excite muscle. The author reports that watches near his x-ray and high-frequency apparatus are not magnetised. QE deep read (mechanism of stimulation): the sweeping statement is hedged and located [read: PDF p.297 = printed 301]: 'It is probable that in the last analysis almost all the physiologic effects of electricity upon the animal tissues should be considered as due to electrolysis and to electric osmosis', immediately after deferring high-frequency and x-ray effects to their own chapters. On PDF p.330 the book says the stimulus is 'doubtless due to a change ... of the character covered by the term electrolytic used in its broadest sense. There is a migration of ions and a difference in the osmotic pressure inside the muscular cells and the nerve-fibers'; Nernst's theory is given in one sentence only ('tissues may be considered a series of cells separated by semipermeable membrane', no formula); osmotic pressure in contracting muscle raised 'as much as 2.6 kilograms per square centimeter' is presented as a result of contraction and a cause of fatigue, not the trigger. Condenser discharges [read: PDF p.306, page image]: Q = CV, energy 1/2 CV^2; equal contractions need equal energy, so the required voltage 'varies approximately inversely as the square root of the capacity' (20 V at C, about 10 V at 4C, about 40 V at C/4; arithmetic checks) within 'quite wide limits' and not for extremes; yet the book itself cites negative tests (the Lapicques), Lewis Jones's duration measure, Weiss's law as true only of short discharges, and 'No one simple formula suffices'. Discharges 'produce hardly any electrolytic or polarizing effect' (p.306) and the d'Arsonval induction method is designed to avoid electrolysis (p.340), so the book's own pages contain stimulation without measurable electrolysis. Three different explanations are given for the failure of high frequencies to excite: ions cannot keep the rhythm through the semipermeable body (PDF p.302); alternations above 5000 a second give the effect no time to develop before reversal (p.326, no source or derivation); and a nerve's refractory interval of 0.002-0.012 s (Gotch and Burch, 1899) against reversals at intervals 'of less than 1/1,000,000 second' (p.339). Other items [read]: Hoorweg's formula has ambiguous printed symbols; the Carvallo-Weiss frog table has an out-of-trend entry at 30/s; Millener's 22 power-house workers (single observer, no controls) and Tousey's own seven-year note on unmagnetised watches (p.302-303); his own 110 V shock experiment (p.299-300). The deep reader's reading: the p.297 claim is best taken as a statement about DC and slow alternating currents, with static, condenser and high-frequency action assigned elsewhere to vibration or capacity (p.301-302).

Key claims

• The effect of a condenser discharge on a nerve depends on the energy released (about 1/2 CV^2), not on the charge CV alone; required voltage varies about as 1/sqrt(C) within wide limits, but the book cites negative tests and says no single formula suffices [read: PDF p.306-307, 330].
• Alternating currents with more than about 5000 alternations a second do not excite muscular contraction (latency account, PDF p.326; no derivation); the book also gives an ion-transport account (p.302) and a refractory-period account (p.339).
• Stimulation is 'doubtless' an electrolytic change in the broadest sense (ion migration and a difference in osmotic pressure inside the cells and fibres), with Nernst's semipermeable-membrane theory cited in one sentence [read: PDF p.330]; 'almost all' physiologic effects of electricity are 'probably' electrolysis and electric osmosis 'in the last analysis' [read: PDF p.297].

Relevance: Background for the author's electrodiagnosis, condenser and strength-duration material and for the electric-death material.

Mainstream conflict: The 'equal energy' reading of condenser stimulation conflicts with later strength-duration/charge analysis (Weiss, Lapicque) [memory, medium]; the book itself reports Lapicque's negative tests. 1/2 CV^2 is energy stored in the condenser, not energy delivered to the tissue [memory, high]. The modern account is depolarisation of the membrane to a voltage threshold with high frequencies filtered by the membrane time constant, not chemical electrolysis or osmotic pressure [memory, medium; not checked on the web].

Reports the Prevost-Battelli (Geneva, 1899) condenser and alternating-current experiments: a dog put into fibrillation by 50 V AC for 3 s was returned to normal heart action by 4800 V AC for 2 s; condenser capacity 0.16 uF per glass plate, 15 plates; sphere-gap voltage table (e.g. 0.1 cm 4,800 V, 1 cm 29,100 V); the finding that injury goes with energy 1/2 CV^2 (joules), not charge: a rabbit given 15,510 uC at 255 J died while another given 27,132 uC at 154 J survived (one pair); dose by animal size (rabbit about 2 kg 900-1000 J; dogs of 6.5-8.5 kg survived 947-1029 J); AC about 50 Hz most dangerous; DC at 50-70 V can fibrillate dogs. Safe-current statement (unsourced): 25 mA absolute safety, 30 mA often dangerous, 100 mA almost always fatal. The author's own items: the Farrow case (June 17, 1919, Dover NJ; a 22-year-old died using a vibrator on his chest in a zinc-lined bath on 110 V AC; one second-hand report), his shoe-contact experiment of May 12, 1919 (110 V DC through a 25 W lamp: a dry shoe on dry floors passed no current; wet shoe on wet cement 20 mA), two burn cases, and body resistance tables. Electrodiagnosis: galvanic thresholds, reaction of degeneration, Weiss (Q = a + bt) and Hoorweg (V = alpha + beta/C) formulas, condenser excitability (normal alpha 2-5; 0.0006 in complete degeneration), Lewis Jones's condenser table, blood resistance 93.5 ohms (Dawson Turner; gap printed '75 mm', likely 0.75 mm) and a hemorenal index. Source errors noted by the deep reader: '3300' for 33,000 V, 255 vs 225 J, the wrong parenthetical definition of joules, 1 J = '0.814 ft-lb' (should be about 0.738). Lapicque's strength-duration work is not in this range.

Key claims

• The lethal and injurious effect of a condenser discharge on an animal is proportional to the energy in joules (1/2 CV^2), not to the quantity of electricity.
• A 50 V alternating shock that fibrillates a dog heart can be reversed by a 4800 V shock a few seconds later (Prevost and Battelli, as reported by Tousey).
• Alternating current of 25 mA through the body is the limit of absolute safety, 30 mA is often dangerous and 100 mA almost always fatal.
• A dry shoe on a dry floor passes no detectable current from a 110 V DC wire, whereas a wet shoe on wet cement passes about 20 mA (author's single-shoe test, May 12, 1919).
• Hoorweg's condenser excitability alpha is 2-5 for normal muscle and falls to 0.0006 in complete nerve degeneration.

Relevance: Contains the clearest numerical electrical-safety material in the book and the defibrillation precedent; also the author's own 1919 experiments, used by the project to see how he reasons from small tests.

Mainstream conflict: The energy-not-charge result and the defibrillation observation are consistent with later work [memory, medium]; the 25/30/100 mA figures are of the same order as modern thresholds [memory, medium]. Tousey's reading of high condenser voltage as exceeding ordinary spark length is his interpretation of sphere-gap data.

Ionic medication (cataphoresis): the author states that ions may pass through the body but 'it is not at all certain' they act on deeper tissues, and that the effect seems due to nascent elements liberated at the contact. Reported experiments: Salaghi (silver in dog sciatic, 12 mA, 24 h), Leduc's two rabbits (cyanide, strychnine), Massey's mercury-on-meat (oral report), Gautrelet's rabbit-ear 30 mA series, Iscovesco and Matza (gelatin: 1 cm in several hours), Tuffier and Maute, Latteux and Zimmern, Zimmern and Bresard (surface action only; effect due to the current). The author's dosage table lists about 25 treatments with doses and reporters (e.g. zinc iodide tonsils 15-20 mA; lithium for gout 150-200 mA 20-30 min, Guilloz, 70 cases; Bouchet 30 chronic gonorrhoea cures by zinc sulphate). Mercuric cataphoresis (Massey): amalgamated-zinc points, 100-200 mA, general anaesthetic, coagulation necrosis about 1/4 inch around each point; the author judges it 'an imperfect form of surgery' with no selective action and thinks the current, not mercury, is the chief factor; Massey's breast dose of 1800-2000 mA for 30 min is flagged by the deep reader as possibly a unit slip. Electrolysis for hair (2-5 mA, 5-20 s; 20 per cent regrowth), nevi, strictures, rodent ulcer. Galvanic joint currents of 60-120 mA (Billinkin, Delherm), obesity by Bergonie, herpes zoster 60-70 mA (Petit), triple-phase and sinusoidal baths (Strubel: blood-pressure effects, 'hundreds of cardiac cases'), the author's finding that slow sinusoidal current is preferable for muscle and nerve and rapid sinusoidal 'an exceedingly valuable therapeutic agent in heart disease'. Ozone: concentrated (8 mg per litre kills rabbits in 10 min), therapeutic 1-3 mg per litre; a General Electric outfit recommended for offices. War-injury electrotherapy (Turrell, Granger). Electromagnets (printed p.453): 'so many excellent and entirely unbiased observers have tested the matter with magnets of every possible strength and without any discoverable effect' that magnets 'cannot at the present time be considered as being of practical value'; the author adds that prolonged exposure to such a field is 'perhaps usually' deleterious, and that improvements in neuralgia/insomnia were 'possibly due to suggestion'. He names no observer, field or control.

Key claims

• Medicinal ions introduced by an electric current act on the surface and near the electrode, not on deep tissue, and any deeper effect is due to the current itself (Zimmern, Gautrelet, and the author).
• Mercuric (amalgamated-zinc) cataphoresis destroys malignant tissue only by non-selective necrosis around each point, so it is an 'imperfect form of surgery'.
• Lithium cataphoresis at 150-200 mA relieves gout and removes gouty deposits (Guilloz, 70 cases).
• Rapid sinusoidal current baths are valuable in heart disease, improving dyspnoea, pressure and electrocardiographic tracings (Strubel; author concurs).
• Electromagnets of every strength have no discoverable therapeutic effect in the hands of unbiased observers; reported benefits are transitory or suggestion.
• Ozone at 1-3 mg per litre increases oxyhaemoglobin and red cells after a single 10-minute inhalation.

Relevance: Gives the author's own, mixed-scepticism handling of ionic medication, which matters to any later claim that medicines can be driven deep by current; the electromagnet passage is the only direct statement in the book on magnetic therapy.

Mainstream conflict: Surface-only action of cataphoresis agrees with modern understanding; strong claims for deep ion delivery, gout cures by lithium cataphoresis and sinusoidal-bath cardiac benefit are not established in modern medicine. The magnet statement is a no-effect literature summary without cited trials.

Leduc interrupted current (100 interruptions per second; best pulses about 1 ms): the author calls the apparatus 'a most valuable improvement over the faradic coil for diagnostic purposes' but advantages for treatment 'not so well established'; his own rhythmic rheostat and pole-changer. Leduc's threshold-voltage table (7 V minimum near 1 ms). Bordier and Bonnenfant's rabbit growth experiments (treated rabbits lighter by 100 g after two months; the author warns against long courses in growing children). Electric sleep (Leduc, 1902-03): 90-110 interruptions per second, 30-35 V, 4 mA, cathode on the head; one human self-experiment, two sessions of 20 minutes, with loss of speech and motor inhibition, 'instantaneous awakening'; animals kept asleep for hours; the book says its use in man has not been tried in enough cases to generalise. Electric death: Corrado's dogs (720-2175 V, 'amperage 20 to 30' as printed, death in every instance, cell changes by Nissl and Golgi methods) which the author says are 'not considered final' and unverified in man; Cunningham's cardiac-fibrillation account; Kemmler autopsy notes; Prevost and Battelli. Clinical sections report others' claims (trigeminal neuralgia, sciatica, poliomyelitis, syringomyelia, neurasthenia) and some of the author's own: x-ray and high-frequency in exophthalmic goitre ('a certain percentage of permanent cures'), impotence cured by Oudin resonator with a glass vacuum electrode ('erections become extremely vigorous', no count), 'disheartening' results in writer's cramp, tabes improved but with mercury, sciatica from adhesions 'magic' with high-frequency and ultraviolet. He writes that for organic brain disease 'extravagant claims would border on charlatanism'.

Key claims

• A Leduc interrupted current of about 4 mA at 30-35 V, applied with the cathode on the head, produces an electric sleep with loss of speech and motor inhibition in man and prolonged anaesthesia in animals.
• Strong direct current (720-2175 V) kills dogs instantly, with cellular changes in the brain and spinal ganglia (Corrado), though these are unverified in man.
• Industrial-strength currents kill by cardiac fibrillation, not by destroying the nervous system (Cunningham).
• Electric treatment of poliomyelitic muscle is worth continuing for six months to a year or more, and reaction of degeneration for years does not preclude recovery.
• High-frequency currents from an Oudin resonator restore potency in impotence (author's own cases, no counts).

Relevance: Shows how the author weighs claims in a neighbouring field (he hedges Leduc and Corrado) and records his own uncounted case claims in nervous disease.

Mainstream conflict: Electric-sleep anaesthesia and Leduc current claims were not established as a general anaesthetic [memory, medium]; the fibrillation account of electrocution is the modern one [memory, high]; the poliomyelitis electrotherapy claims conflict with later controlled evidence [memory, low].

Apparatus: induction coil or transformer with Leyden-jar condensers and spark gap feeding a solenoid (d'Arsonval), the Oudin resonator, the Tesla current, Piffard's 'hyperstatic' transformer, autoconduction cage and autocondensation couch, the author's glass vacuum electrodes with insulated stems (Fig. 362-363) and 'Tousey's electrode for high-frequency sparks' (Fig. 366, shown to the American Electrotherapeutic Association, 1905). Claimed physiology: increased metabolism, lowered blood pressure in arterial hypertension (Moutier 3-9 cm Hg fall at first treatment, Guilleminot 21 to 17 cm in 15 cases, Gidon of Caen 240 to 160 mm Hg in five cases; German authors found a transient rise), more urea and less uric acid, heat production 79 to 127 calories per hour, rectal and skin warming of 1-4 F, ozone from the vacuum electrode as the active 'tonic'. [Corrected after QE deep read; the first fact-finder pass wrote 'ozone and ultraviolet from the glass electrode', which the book does not say: see the ultraviolet paragraph below.] The author states that 'violet-ray treatment' is a term used 'very carelessly, as there is really no such treatment'. His own reported results (no counts): diabetes cases with sugar falling from 2700 grains (180 g) a day to a trace, infantile paralysis (a crippled limb 'grew beyond normal size'), chorea 'with uniform success', locomotor ataxia improved, sciatica and neuritis with prompt results, gout/rheumatism, pyorrhea (x-ray plus high-frequency; 'in three weeks the dentist almost always reports the teeth are better'), pruritus ani cured by x-ray, hemorrhoids, warts, epithelioma, alopecia, lupus erythematosus (cited: over 50 per cent complete cure), the combination of x-ray and high-frequency in tuberculosis of bone with a sinus (case with sinus healed). Diathermy (Nagelschmidt, Bergonie, Doyen electrocoagulation, DeForest cutting needle) is described from named authors; Hertzian waves and the Marconi coherer are summarised. The author writes that high-frequency application appears 'apparently innocuous' and used it successfully in acute gout. ULTRAVIOLET FROM THE VACUUM ELECTRODE, what the book says [read, QE deep read]: p.557-558: 'As the ultraviolet ray will not penetrate the thinnest piece of mica or celluloid, the results which have been obtained when using the vacuum electrode are due to the form of current applied, and not so much to the ultraviolet rays, which are given of[f] from the sparks outside of the electrode.' p.578: the visible light 'has no demonstrable physiologic or therapeutic effect'; ultraviolet arises from the current through the partial vacuum 'and especially through the air between different parts of the tube and the patient (for minute sparks may be seen passing along the outside of the tube)', enough to excite Willemite fluorescence; 'It is hardly to be supposed that the ultraviolet rays absorbed by the body during a treatment by means of vacuum electrodes takes any more direct part in the physiologic or therapeutic effect.' p.579 instead claims an indirect role through ozone and nitrous acid ('very important'; oxidation, 'urea instead of uric acid', 'vacuoles ... filled with ozone'), with no experiment cited. Against this the book also credits ultraviolet 'in part': p.611 (gout) tune the electrode for 'the greatest amount of ultraviolet radiation, as detected by the fluorescence caused in a piece of Willemite'; p.631 (acne) 'a germicidal effect from the ozone generated in the tissues by electrolysis and from the ultraviolet ray produced around the vacuum tube'; p.635 (skin disease) glass electrodes most effective 'in part' because of the ultraviolet. p.658 says a violet-glow tube's own light contains 'an appreciable amount of the ultraviolet rays'. The book does not reconcile these. CLINICAL RESULTS TABULATED (QE deep read of pp.544-647; Tousey reports others' work second-hand with a journal citation, and none of the series has a control group): blood pressure (BP) - Guilleminot 15 cases, 21 to 17 cm Hg, '15 or 20 treatments' for a 'permanent effect' (p.559); Moutier 'many' cases, first-treatment fall 3-9 cm, reduced to about 15 cm for 'several weeks' (p.582-583); Moutier and Challamel cage versus couch (fall of 30-50 mm versus 15-30 mm); Gay 12 neurasthenia cases with high tension, only 2 given (case 1: 10 treatments, BP 160 to 120 mm, urea 12 to 16 g/L, uric acid 3 to about 1.5; case 2: 15 treatments, BP 180 to 135, uric acid 5 to 2; urea unchanged), 40-inch Ruhmkorff coil, 350-400 mA secondary, 25 min every other day, 'in several ... some months after treatment the improvement had been permanent', no co-treatment stated (p.595); Gidon of Caen 5 cases 'permanent reduction of arterial tension from 240 down to 160 mm' with diet unmodified in some and mechanotherapy, sinusoidal and effluve co-treatments in case 5 (p.593-594); Doumer 4 cases (27-29.75 falling to 13.5-17.75, printed 'mm' but the magnitudes read like cm Hg, unit unresolved; 'remained normal') (p.584). CONTRARY reports kept beside them: Delherm and Laquerriere (Arch. d'Electricite Med., 1907) after 'considerable experience', Moutier's technique followed 'as closely as possible', found the immediate fall 'not as constant or as marked', the permanent reduction 'decidedly less marked and less constant', and high-frequency does not 'surely prevent the bad effects of arteriosclerosis' (p.584); Boedeker and German authors found a rise averaging about 5 cm that disappeared after about twelve minutes, which Tousey suggests may be due to apparatus (p.582-583); Carvallo and Boedeker found no effect from the cage in animals (p.579); Wertheim Salomonson attributed the effect to Joule heating (p.582); Tousey's own cases showed 'a more gradual improvement' rather than Moutier's abrupt fall (p.584). DIABETES: d'Arsonval, Charrin, Boinet and Poncy, Apostoli and Berlioz, Reale and Renzi, Vinas, 'numerous' cases: 'uniformly beneficial effects upon the patient's general condition, whether the sugar disappears from the urine or not' (p.585); APOSTOLI, reporting to the Twelfth International Medical Congress, 'success in over 500 cases', average 25 treatments in cage or couch, no sugar or urine figures given, followed by named successes among his pupils, Williams, Allen and 'the present author' (p.603, page image); CONTRARY: Boedeker, Cohn, Loewy, Doumer and, more recently, Halfon 'have reported that high-frequency currents produced no reduction in the amount of urine' (p.603), Cohn and Boedeker no change in sugar (p.585), Vinas's four cage cases without sugar clearing, DeRenzi sugar returning in high-nitrogen cases. Tousey's own: sugar 2700 grains (180 g; 2778 by arithmetic) a day 'to a mere trace' with x-ray over pancreas and liver (p.585); a lady of 40, 56 oz urine at 10 per cent sugar, after three weeks of 'combined treatment by medicines and the x-ray and high-frequency currents' 55 oz and under 1 per cent; a man of 55, 61 oz at 10 per cent ('2751 grains per diem'), arsenic continued, no final sugar value (p.604). His own caveat [read: p.604]: 'It has not been the author's habit to ask for a discontinuance of medicinal treatment, and so his own cases can hardly be cited as absolute proof that the electric treatment alone would have been effective.' OTHER OWN CLAIMS with their own caveats: epilepsy 'cures must be substantiated by prolonged freedom from recurrence' (p.597); tuberculosis 'who can say just what role the treatment has played' (p.613) and a lung and larynx case that improved and relapsed and died in May 1905 (p.613-614); pruritus ani 'There is nothing magic about the high-frequency currents' (p.619); Keating Hart fulguration 'he cannot recommend' (p.567); his gonorrhoea case where gonococci did not disappear (p.591); a rheumatism series with improvement before the drug was given and a four-year follow-up (p.605-608). Measurement notes [read]: patient currents of 100-1000 mA by hot-wire meter, Tousey's inference of 600 mA through the body by subtraction (p.583-584); the text gives both 'No important rise of temperature' and 'the therapeutic effect ... is due to the heating of the body' for autoconduction (p.646). Diathermy: Nagelschmidt 1913, about 1,000,000 oscillations a second, hundreds of mA; animals killed by 2300 mA for an hour; 'should not be entrusted to a nurse' (p.643-647).

Key claims

• High-frequency (d'Arsonval or Oudin) currents lower arterial blood pressure in hypertension and raise metabolism, urea output and oxygen intake.
• High-frequency applied with a glass vacuum electrode owes its tonic effect largely to ozone and the form of current; the book denies that ultraviolet passes glass, mica or celluloid, places the ultraviolet in sparks outside the electrode, calls a direct therapeutic role for it 'hardly to be supposed' (p.578), yet credits it 'in part' in acne and skin disease (p.631, 635) [read].
• Combined x-ray and high-frequency treatment cures or relieves tuberculous sinuses, pyorrhea, locomotor ataxia and exophthalmic goitre more than either alone.
• High-frequency treatment reduced a diabetic patient's urinary sugar from 2700 grains a day to a trace (author's cases, no count).
• Alternations above about 5000 a second lose the power to excite muscle, so very high-frequency current passes through the body (lighting a lamp) without sensation.
• Apostoli reported success in over 500 diabetic cases (average 25 treatments; no sugar figures given), while Boedeker, Cohn, Loewy, Doumer and Halfon reported no reduction in urine amount; Tousey's own diabetic cases were also given medicines (arsenic) and x-ray, and he says they cannot be cited as proof that the electric treatment alone works [read: p.603-604].
• Gay reported hypertension cases with measured pulse, pressure, urea and uric acid (case 1: 160 to 120 mm Hg in 10 treatments; case 2: 180 to 135 in 15), the improvement 'permanent' in several seen months later [read: p.595]; Delherm and Laquerriere, repeating Moutier's technique, found the fall less constant and less marked [read: p.584].

Relevance: This is the core of the book's electro-physical therapy and the area where the author argues from his own cases; the x-ray plus high-frequency combination recurs in almost all his cures, so the x-ray's own effect is not separable.

Mainstream conflict: Blood-pressure fall after d'Arsonvalisation is reported with disagreement within the book itself (Moutier versus German authors) and has not been established as a lasting treatment; claims for diabetes, ataxia and tuberculosis are not accepted modern therapy. Diathermy as deep heating and electrosurgery are mainstream. Ozone absorbed through skin and 'vacuoles filled with ozone' in tissue (p.579) are claims without data in the text. The book's own statement that ultraviolet does not pass mica or glass agrees with mainstream optics; the unreconciled part is its later credit to ultraviolet 'in part' for acne and skin disease.

Gas conduction, ions, Crookes tubes, cathode rays, Lenard and channel rays, the Coolidge tube, vacuum electrodes and lamps (Cooper Hewitt, Moore, Tesla, Nernst). Cathode rays are said to be a stream of material particles about 'one thousandth the size of an atom', travelling about 20,000 miles a second (up to 50,000); no e/m, charge or mass is given in these pages; J. J. Thomson's atom with 'eight times the atomic weight' electrons; the chart 'after Satterley' with an '(ELECTRICITY ?)' bracket. Photometry units including the author's own 'Tousey' (the light or radiation that produces on Kodak film the effect of 1 candle-power of carbon-filament light; 1 Tousey meter-second = that effect at 1 m for 1 s). Phototherapy: Finsen carbon arc (80 A; Finsen-Reyn 20-25 A; improvement 'not in less than three months'), iron-electrode (Bang) and condenser-spark lamps, Kromayer quartz mercury lamp (maker Hanovia states 3-5 times Finsen's penetration), Alpine-sun lamp doses, bactericidal data (Bang: tubercle bacilli killed in 6 min at 30 A, 30 cm; Finsen: B. prodigiosus in 2-3 s; Henri: 1 s at 140 V, 4.7 A versus 300 s at 23 V, 2.3 A; Klingmuller and Halberstadter: lupus tissue exposed 70 min still infective in rabbits), erythrosin/eosin sensitisation (Forchhammer's 350 injections in 23 lupus cases: 'therapeutic effect seemed to be bad'), eye injuries (Birch-Hirschfeld, Grimsdale; the author's own file short-circuit with no perceptible effect at 15 inches, though he cannot recall if he wore glasses), light baths (Hasselbach: arterial tension lowered about 8 per cent; Jacobaeus angina series of 15 and Hasselbach-Jacobaeus 44 angina cases with 'rapid and strikingly favorable results which were quite lasting'), red light for smallpox, blue-light anaesthesia (Redard of Geneva: two-thirds of cases), the author's Cooper Hewitt tuberculosis case (combined with x-ray and high-frequency; patient later died of pulmonary tuberculosis) and a blue-light dental case in which the dentist and patient could not attribute relief to light. Internal tensions recorded by the deep reader: UV ionisation only by reflection (p.649) versus sunlight ionising air (p.675); peroxide mechanism (p.682) versus 'infinitesimal trace' (p.686); X-ray frequency 'five or ten times' visible (p.656) versus the chart's wavelength ratio; blue glass protective (p.671) versus 'not by blue glasses' (p.689). QE addition [read]: Tousey's ultraviolet tests. Willemite (a mineral) fluoresces green under ultraviolet and is his detector (p.658, 677). The glass test (p.678): put glass between source and Willemite; 'if the fluorescence is due to ultraviolet rays, the glass will cause the fluorescence to disappear entirely'; solio (printing-out) paper under glass hardly darkens while paper under quartz blackens nearly as much as uncovered paper. The Cooper Hewitt mercury lamp is 'rich in violet rays ... not especially rich in ultraviolet rays, as tested by Willemite' (p.659); the uviol lamp uses special glass that transmits more ultraviolet. An unreferenced, unexperimented claim at p.681: 'A burn 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' (the cited work, Bierry, Henri and Ranc, C. R. Soc. Biol. lxx, 523, 1911, is about ultraviolet from a quartz-pocket tube acting on carbohydrates; the text does not say that paper reported burns). This is a third burn mechanism proposed in the book, besides the x-ray itself and the electrostatic ('condenser') theory.

Key claims

• Cathode rays are streams of material particles about one-thousandth the size of an atom travelling about 20,000 miles a second.
• Ultraviolet light kills bacteria directly, independent of heat and oxygen, and spores are 3-5 times as resistant as the germ (Finsen school).
• Injection of erythrosin lets the Finsen effect be reached in one-quarter to one-third the time, a claim the author reports as seriously questioned (Forchhammer's series was bad).
• Carbon-arc and mercury-vapour light baths lower arterial pressure about 8 per cent and give lasting relief in angina pectoris (Hasselbach and Jacobaeus, 44 angina cases).
• Light from a Cooper Hewitt lamp does not kill or apparently influence bacteria in 75 minutes (Nogier and Thevenot, as cited), though the author used it in tuberculosis.
• One Tousey unit is the effect of 1 candle-power of carbon-filament light on Kodak film, usable also to measure x-ray and radium output.
• A burn appearing within twenty-four hours after an x-ray exposure is 'doubtless due to ultraviolet rays generated by the x-ray tube' and can be suppressed by any screen opaque to ordinary light [read: p.681; no experiment of the author's cited].
• Ordinary glass stops the ultraviolet that excites Willemite; quartz passes it (author's Willemite and solio-paper tests) [read: p.678].

Relevance: The author's own 'Tousey' photographic unit first appears here; the chapter also shows the book setting both sides (positive and negative reports) next to each other, and his light-bath and tuberculosis claims.

Mainstream conflict: UV bactericidal action and Finsen's lupus treatment are historically real; direct deep light action, 8 per cent blood-pressure change and blue-light anaesthesia claims lack controlled support in the text. The corpuscle statements pre-date the Rutherford-Bohr atom (1911-13) and give no e/m.

Tousey's account of the nature of the x-ray (as he dates it, 'discovered by Rontgen, in Wurzburg, April 30, 1895' - a date that does not match the usual 8 November 1895 [memory, high]): Stokes' pulse theory (isolated transverse ether pulses; 'Sir Joseph Thomson (Lord Kelvin)' is his conflation of two men); Bragg and Porter's corpuscular theory (also citing a star-light deviation of 0.8 second of arc); Barkla and Haga on polarisation (Haga: secondary rays 5 times stronger in one plane); characteristic rays tied to specific gravity (Moseley later tied them to atomic number [memory, high]); Whiddington's threshold voltages and velocities (Al 2,600 V 2.8e9 cm/s; Fe 9,200 V; Cu 10,000 V, which the deep reader checks to within 7 per cent); Eve and Day's air absorption; Roentgen's equal-opacity metal series; M. Wien's 2.5/1000 energy ratio; E. Marx's measurement that the x-ray velocity equals that of electricity in copper wire (185,000 miles a second); Battelli's report (corrected by the deep reader: the plate in the tube was NOT affected). Tube practice and the author's own tubes: the 'Sinclair Tousey Tube' (lead-glass contact treatment tube), the Tousey single-focus and bifocal radiographic tubes, an endodiascope for the mouth, the 'Beaker Interrupter' (Medical Record, Oct. 24, 1903; 'He makes no claim to originality'), his Ripperger/Friedlander shields. Generators: static machine, induction coil with Wehnelt/Caldwell/mechanical interrupters (his tables of primary amperes), transformers, the Villard 'ventril' valve, oscilloscopes, and the Coolidge tube with the author's regulation tables (e.g. 70 kV, 3 mA; filament about 3.8 A), the radiator tube destroyed after a 45 s, 30 mA exposure, and the Cabot heterodyne / Cabot-Shaw constant-potential generator. The 'Power Apparently Generated in the Secondary Current' passage (printed p.735 = PDF 741): 100,000 V x 2 mA 'would be 500 watts' and at 15 mA 1500 watts against a primary of 'only about 500 watts and 1500 watts', so 'there is apparently a greater output than intake of power. Of course this would be an impossibility, and the explanation is found in the fact that the meters indicate the maximum of the successive currents rather than their average strength.' The deep reader finds 100 kV x 2 mA is 200 W, not 500 W, and 56 kV x 10 mA is 560 W, not his '1 horse-power or 746 watts'. The same argument is made for the Oudin resonator (10,000 V x 0.25 A = 2500 W against a 500 W primary). Tousey also states output x-ray intensity varies with milliamperage and the square of the voltage, and that without constant voltage the milliammeter 'is useless'. From his first edition (1910) he proposes a constant-potential x-ray generator ('the ideal current ... will maintain a constant difference of potential') and says that Messrs. Sewall Cabot and Joseph T. Shaw, after reading it and consulting him, produced such a generator (described on p.750); this is his own account of his influence. QE addition (Cabot generator and calibrations, PDF pp.755-764; printed = PDF minus 6) [read]: first-edition reference 'In the first edition of this work (page 663) the author expressed the opinion that neither the induction-coil or the static machine or the transformer with a high-tension rectifier ... was the ideal generator for x-ray purposes' and that a constant unidirectional regulable high-potential current would be preferable; 'The discovery of this apparatus came about from the perusal of these paragraphs by Messrs. Cabot and Shaw' (electric engineers making high-tension apparatus for wireless telegraphy; maker on the figures is the Electric Conversion Co., Brookline, Mass.), an interested-party account of his own influence with no second source in the book. Stage 1 'heterodyne' (220 V stepped up, condensers and chokes; oscilloscope showed a continuous band instead of flashes; Tousey thought 'too much power was wasted'); stage 2 the Cabot constant-voltage generator (220 V DC to a rotary transformer, three transformers forming 'a Gramme ring', brushes on the outside; 10,000-140,000 V continuous, 'about 1 or 2 per cent.' loss; Tousey's own report of 'thousands of exposures'). General Electric (Hull) found the spectrum from a constant-potential source 'the same as that of the ordinary transformer with a high-tension rectifier. This does not confirm my hope in regard to securing homogeneous x-rays' (p.764). Erythema calibrations: (a) PDF p.759: 'each 10,000 volts, corresponds to 1 degree Benoist, so that 90,000 volts indicate x-ray of about No. 9 Benoist ... Cabot's experiments show that with this voltage an exposure of 3400 milliampere seconds at 10 inches from the skin equal 1 Sabouraud-Noire dose' (5 1/2 H; OCR '54' is 5 1/2 on the page image); (b) PDF p.763: 'Cabot and Dodd, experimenting at the Massachusetts General Hospital, found that with a penetration of 4 Benoist this standard erythema dose was applied by an exposure of 3400 milliampere seconds at a distance of 10 inches' (3.4 mA for 1000 s, 1.7 mA for 2000 s, 6.8 mA for 500 s; arithmetic checks) - the two passages give 3400 mA-s at about 90 kV/No. 9 and at No. 4/about 40 kV, and the book does not reconcile them (Dodd and the hospital appear only on p.763); (c) PDF p.762: '57,000 volts and 4 ma. correspond to about 6 Benoist and produce an erythema dose of 5 H. in twenty to forty minutes at a distance of 13 1/2 inches', i.e. 4800-9600 mA-s at 13.5 in, about 2640-5270 mA-s scaled to 10 in by inverse square [calculation], bracketing 3400. His caution on mA-s [read: p.763]: 'milliampere seconds do not form a reliable measurement of x-ray dosage, but ... it is necessary to standardize the conditions as to voltage and milliamperage'; true dose to be found from patient records, Sabouraud pastilles or his own film comparison - yet p.762 also says that 'with any particular voltage ... the same number of milliampere seconds will produce the same radiographic result'. His settings tables for the Coolidge tube and the Cabot generator are on pp.759-762.

Key claims

• Output power of an x-ray coil that appears to exceed input power is an artefact of meters that read the peak, not the average, of the pulses; true output cannot exceed input.
• The intensity of the x-ray output varies directly with the milliamperage and with the square of the voltage.
• A constant-potential direct-current high-voltage generator is the ideal x-ray source, and the Cabot-Shaw generator was built after consultation with the author following his 1910 proposal.
• The x-ray is most probably a succession of isolated transverse electromagnetic pulses in the ether (Stokes, Thomson), although Bragg and Porter hold it consists of material particles.
• A characteristic (homogeneous) x-ray wavelength depends on the specific gravity of the anticathode, heavier metals giving the more penetrating characteristic rays.
• The author's lead-glass contact treatment tube holds its vacuum and can run on a Caldwell interrupter on which the Cornell tube overheats and loses its vacuum.
• The velocity of the x-ray in air is the same as that of electricity in a copper wire, about 185,000 miles a second (E. Marx).
• Cabot and Dodd (Massachusetts General Hospital) found 3400 milliampere-seconds at 10 inches (4 Benoist per p.763; about 90 kV per p.759) to equal one Sabouraud-Noire (erythema) dose of about 5 1/2 H; a second figure (57 kV, 4 mA, 20-40 min at 13 1/2 inches = 5 H) is numerically consistent with it by inverse-square scaling, but Tousey warns that milliampere-seconds are not a reliable dose measure [read: PDF p.759, 762, 763].

Relevance: Central to the project. This part contains the 'apparent over-unity' passage and Tousey's reasoning on peak versus average power, his constant-potential generator idea and priority claim, his tubes, the 'Tousey' unit use, and his own handling of the ether-pulse versus corpuscle debate.

Mainstream conflict: The peak-versus-average explanation is the mainstream one (real power is the time average of v(t) i(t)). The ether-pulse picture is superseded: x-rays are short-wavelength electromagnetic radiation, with wave and particle aspects (Bragg crystal diffraction 1912-13, Moseley 1913 [memory, high]). The constant-potential idea is sound as a source of a fixed maximum photon energy but still gives a continuous bremsstrahlung spectrum (Duane-Hunt law [memory, high]), so Tousey's hope of single-wavelength x-rays goes further than that.

Plate and film sensitiveness; the author's comparison that a heavy-target tube with 24 inches of resistance gave about 1/75 the photographic effect of a small gas jet at five times the distance (one experiment; the 76:1 figure needs the rounded 'five times'); the claim that doubling the primary amperage cuts the exposure tenfold (p.821 and 861) versus doubling the tube milliamperes halving it (p.824); exposure schedules for coil and transformer; the statement that the x-ray action on a plate falls 'rather more rapidly than the square of the distance', though the one worked number equals inverse square; the penny in the shadow of a silver dollar showing x-rays from the glass walls of the tube; secondary rays from the tissues and his theory 'given as the author's theory, not as an established fact' that tissue fluorescence supplies a large part of the plate effect (frontal-sinus plates); his radiating cellular diaphragm (first edition, abandoned as it needed dangerous fluoroscope placement; improved forms with a lead-glass cone), the Bucky grid (the author's experiments 'show that fully one-half the photographic effect upon the plate is ordinarily due to' tissue secondary rays; exposure with the stationary grid must be twice as long) and moving Bucky, filters of roofer's tin, vacuum rules and regulators, fluoroscope states, and penetration instruments including his own lead-foil fluorometer and Benoist, Walter, Villard, Heinz-Bauer and Christen devices. Safety remarks: the hand test leading to loss of fingers, a non-physician experimenter's fatal cancer (no name or source). Pages 865-904 (localization by stereoscopy, parallax methods, safe lights, development) were read in digest only.

Key claims

• Doubling the primary current of an induction coil reduces the exposure time needed for a radiograph about tenfold.
• About one-half of the photographic effect on a plate in a trunk radiograph is due to secondary rays from the tissues, which a Bucky grid removes at the cost of doubling the exposure.
• The photographic effect of a brilliant x-ray tube is about 1/75 that of a moderate gaslight at equal distance.
• The action of the x-ray on a photographic plate diminishes slightly faster than the square of the distance.
• Tissues emit secondary rays by fluorescence, which partly account for the ability to radiograph the frontal sinus at all (author's theory).
• A long exposure through three layers of roofer's tin gives much better contrast than a very short exposure with no filter.

Relevance: Contains the author's own measurements and caveated theory statements on secondary rays and distance law, and his exposure rules which the book later turns into standardised tables.

Mainstream conflict: Inverse-square law and secondary (scattered) radiation are mainstream; the steeper-than-inverse-square statement is not supported by the one number given (the deep reader's check shows his 9-inch example is off). The tenfold-per-doubling claim is not a mainstream relation (output rises with current roughly linearly, with voltage squared [memory, high]).

Localization of foreign bodies by parallax (worked example: a 7-mesh shift for a 3-inch tube shift at 21 inches gives 5.3 inches depth), the fluoroscopic localizer, the author's aluminium step-ladder device, safe lamps, developers (pyro, eikonogen-hydroquinone, coxin), tank development, defects, plate storage and filing. The author's exposure tables (teeth: 5-inch spark, 65 kV, 10 mA, about 4 s; limbs 23 inches; 390 mA-s for chest and gallbladder); skull technique; stereoscopic cranial and orbital (Sweet, Dixon, Bowen) triangulation; the fluoroscopy dangers (knee fluoroscopy 45 minutes leading to amputation; Guilleminot). The author's hands: 'incurable keratoses of the fingers' from holding dental films, which led to his film carriers (horizontal carrier, 45 degrees; vertical aluminium carrier). Focal infection: a doctrine (Rosenow, Billings, W. D. Tracy 1919) that blind dental abscesses poison the system; the author 'makes a set of dental radiographs in every case of cancer, wherever located, and has always found dental infection usually more severe', and believes timely cure of abscesses 'would make a wonderful difference in the number of cases of cancer' (no counts, no controls; 12 per cent of Minnesota State General Hospital patients said to be there from dental infection, unsourced). The Tousey method for the permanent dental arch (read before the N.Y. Institute of Stomatology, 9 Nov 1906): arch radius R = 2 x (x-ray width of one permanent upper central incisor) + 0.24 inch; first molar 1.5 R from the midline; about 100 children radiographed; unerupted widths matched actual widths to 0.01 inch in 9 teeth of 7 children (printed ratios in his table contain slips; 'varied 30 per cent' where the table spans 1.28-2.09); one untreated case showed the permanent arch reproducing the narrow temporary arch five years later. He links malformed arch to deviated septum and brain (single case, Bogue and Berens, septum 'straightened in a few weeks'). Sinus, ethmoid, neck, chest (orthodiagraph), pulmonary tuberculosis signs (Walsham, Orton), spine, gallstone and gastro-intestinal radiography (the 'Tousey position': prone with thorax lowered 45 degrees) were read in digest only.

Key claims

• For the permanent upper teeth the radius of the dental arch is twice the x-ray width of one upper central incisor plus 0.24 inch, and the first molar lies at 1.5 times that radius from the midline.
• X-ray width of an unerupted permanent central incisor at ages 5-6 matches its actual width after eruption within 0.01 inch.
• Blind dental abscesses cause systemic disease including endocarditis, gastric ulcer and cancer, and the author finds severe dental infection in every cancer patient he examines.
• Regulating the temporary teeth to the arch curve predicted from x-ray measurements guides the permanent teeth into position and can straighten a deviated nasal septum in a few weeks.
• A film held horizontally in the mouth with the tube at 45 degrees gives a good picture of the anterior upper jaw and antrum, and holding films by hand injures the operator's fingers.
• The author's positions (prone, thorax 45 degrees lower than the pelvis) show the stomach and intestine without gravitation toward the chest.

Relevance: Gives the author's dental innovations and his strongest and least supported statement (dental infection and cancer), and the only closed-form formula in the book that the reader can compute (arch radius).

Mainstream conflict: Focal infection as a cause of systemic disease and of cancer was influential then and later largely abandoned (Rosenow's work was criticised and not reproduced [memory, medium]); the dental-infection-cancer statement has no controls. The arch formula is an empirical geometric rule with no outcome data; modern orthodontics does not use it. Dental x-ray as a diagnostic aid is mainstream.

Chest and heart (orthodiagraph, the author's nine-cell tin screen), signs of early pulmonary tuberculosis (Walsham and Orton, Albers-Schonberg and Adam's 70 cases), aneurysm, spine, gall-stones (390 mA-s; two cases of Dr. Beaman Douglas), stomach and intestine (barium and bismuth meals, Cannon's cat experiments, Hulst's gastroptosis technique, duodenal tube), the author's gastro-intestinal technique (48-hour preparation, postures, 'Tousey's position' with 14 x 17 plates), kidney, ureteral and bladder calculi (compressor, catheter; Baetjer 351 cases; the author reports most positive diagnoses confirmed at operation), hip, thigh, knee, ankle (a Pott's fracture case; the foot-in-shoe case), shoulder, elbow, Colles' fracture positions, hand, congenital and bony disease (acromegaly, osteomyelitis, syphilis of bone, rickets, gout, arthritis, tuberculosis), injected-vessel radiographs, radiography for pearls in oysters, colour-blind perception of x-rays, and anatomic age by bone appearance. The author states fluoroscopy of the ankle before lateral radiography is 'an extremely dangerous practice'.

Key claims

• Most positive radiographic diagnoses of renal and ureteral calculi in the author's cases were operated on and the calculi removed.
• Placing the patient prone with the thorax about 45 degrees below the pelvis (Tousey's position) shows the stomach and duodenum without drag toward the chest.
• The signs of early pulmonary tuberculosis on fluoroscopy are reduced diaphragm movement on the affected side, failure of the apices to light up on coughing and deep inspiration, and a shadow in the apex.

Relevance: Documents the practical breadth of his radiographic work and the 'Author's Technic for Gastro-intestinal Radiography' that the preface names as an advance.

Mainstream conflict: none of central importance; period diagnostic radiology consistent with later practice.

Effects on colour-blind perception (Dorn, Uhthoff), the author's cat experiment (cat x-rayed during pregnancy), sterility and necrospermia in operators (first reported by Tilden Brown and A. T. Osgood), embryo damage (repeated pelvic examination of pregnant women undesirable), eye (10-20 H gives eye changes after 15-41 days), blood (leukocyte fall then rise), marrow and spleen (Heinecke, Krause and Ziegler: mice exposed 4 hours or more died), skin (four grades of dermatitis; x-ray warts; chronic hand dermatitis of operators; the author's own left-hand keratoses, Plate 14; Holzknecht cured about 50 cases with hard filtered x-rays and equal numbers with radium), and long lists of precautions (do not test with the hand; measure quality and intensity; use soft-ray screens; keep distance since dose falls as inverse square). Dosimetry: Holzknecht (H) and Kienbock (X) units, Sabouraud-Noire tablet, Haret carrier, selenium cell, Bordier unit, Contremoulin, Curchod voltameter, Villard radiosclerometer; the author's own 'Tousey' unit (he writes, PDF p.1173: 'With modern apparatus the author's unit of the intensity of the x-ray is no longer required'), erythema dose table in Tousey units (e.g. 500 Tousey meter-seconds as an erythema dose; 16 min at 6.5 inches for 6 Benoist, 9 Tousey power), and the effect of interruption rate on pastille reading (Bordier: 19 min at 1938 per minute, 10.5 min at 3544). The author also states that doubling voltage at constant amperage doubles the Holzknecht pastille reaction but quadruples photographic effect. In 'The X-Ray in the Treatment of Malignant Disease' (printed p.1165 ff.) he states that x-ray acts selectively on atypical rapidly dividing cells; soft rays are most beneficial for surface disease. QE deep read additions [read]. DOSE CONVERSIONS: the deep reader lists 35 statements converting settings or units into H, Sabouraud tints or erythema doses. Equivalences (p.1169-1173): Kienbock 1 X = 1/2 H; Sabouraud-Noire tint B = 5 1/2 H (Hampson: 'about 5 H'); Bordier tint 1 = 2 I and 3.5 I = about 5 H (the book also equates tint 1 with '3 or 4 units I'); 100 Tousey meter-seconds = 1 H and 500 Tousey meter-seconds = 5 1/2 H = tint B = 'an ordinary erythema dose', 750 = 'an extreme erythema dose without ulceration'; 1 Tousey = 6-inch spark at 100 mA = 9-inch spark at 50 mA = 4-inch spark at 200 mA; erythema time = 500 d^2/P seconds (d in metres, P in Tousey), tabulated on p.1175. Statements bearing on the author's own dose (6-inch spark, 3 mA, 10 in, 5 min unfiltered = 15 mA-min = 900 mA-s, or 10 min through 3 mm Al = 1800 mA-s): exposure-table erythema dose at 6-inch/10 in/unfiltered is 14 mA-min = 5 H (so the unfiltered 5 minutes is about 1.07 erythema doses, about 5.4 H); p.1167 'one-sixth erythema doses ... 6-inch spark, 3 milliamperes; 10-inch distance, 3 mm. aluminum filter for two minutes' (so the filtered 10 minutes is about 5/6 erythema dose); p.1173 a filtered 10-minute, 3 mA, 5 3/4-inch-spark 'erythema dose of hard x-rays' followed by 'scarcely any change in the appearance of the skin', with single applications made about 50 per cent longer; p.1179 the massive dose of '4 H., 5 H., or even more' is 'about 600 ma. seconds at 10 inches with a 6-inch spark and no filter. Or 1200 ma. seconds with 3 mm. of aluminum' (so the author's 900/1800 mA-s is 1.5 times that, about 6-7.5 H or 1.2-1.5 erythema doses); p.1180 'About 3 ma. ... 6 inches ... 10 inches ... a normal dose of 1/2 H in one minute' (so 5 min = 2 1/2 H, about half an erythema dose); the Tousey-unit scale gives 3 mA at 6-inch spark as 0.03 Tousey, an erythema dose of about 18 min, and the 5 minutes about 140 Tousey meter-seconds = 1.4 H = 0.28 of an erythema dose. The book's own conversions of the author's settings therefore range from about 0.28 (Tousey scale) through 0.5 (p.1180) and 0.83 (p.1167, filtered) to 1.07 (exposure table) and about 1.5 (p.1179), a spread of about a factor of 5-6; the filtered form is consistently presented as just under an erythema dose; the book itself warns that H depends on pastille distance (McKee: 1 H at skin distance is 4 H at half distance, p.1168) and that H is read after the filter (p.1180). The author says (p.1173, 1162, 1177) the Tousey unit 'is no longer required' and the method of choice is 'so many milliampere seconds with such a spark equivalent ... at such a distance through such a filter'. Other dose statements: 3 H is the least visible reaction on the face and may be repeated every three weeks (p.1148, 1161); epilation 4-7 H (p.1149); eye changes after 10-20 H (p.1150-1151); a 12-inch coil at 10 A and No. 6 Benoist gave 4 H at 5 in in 10 min (p.1162); inverse-square example 9 min at 12 in = 2 1/4 min at 6 in (p.1163). Two of the tables (p.1175, p.1176) were read from page images; the rotated p.1176 radiography table gives skin doses of 2 1/2 Tousey meter-seconds (hands) to 30 (adult abdomen), i.e. 1/200 to about 1/16 of an erythema dose, with some printed fractions blurred and the columns not fully self-consistent. THE CAUSE OF X-RAY DERMATITIS, in Tousey's own words: 'The experiments of Strater, Kienbock, Oudin, and Scholtz seem to leave no room for doubt that radiodermatitis is due to the x-rays and not to electric discharges and other physical phenomena which take place around the tube' (p.1158; no experimental details given); Bordier and Salvador's electrolytic action in erythema is accepted but 'the present author believes that the x-ray is the exciting cause of the electrolytic action'; and (PDF p.1162) 'Geyser has suggested that the cause of dermatitis is not the x-ray, but an electrostatic condition which may be avoided by placing the tube directly in contact with the part to be treated. The author does not regard this as probably correct, and recommends avoidance of overdosage when the Rontgen ray is applied in this way.' (Elsewhere, p.1231, he writes the condenser theory 'has not been proved' but 'probably contains a certain element of truth': see Part 16.) OPERATOR INJURIES [read]: a worst case, an apparatus maker who watched the bones of his own hand in the first year, with gangrene of the hand, tendons and cartilage bare (p.1154); named American x-ray workers who died of x-ray cancer, Kassabian, Caldwell, Leonard, Greene, Bauer and Baker (p.1155); the author's own keratoses of the left hand, persisting twelve years, being cured by radium, with fissures still in January 1920 (Plate 14, p.1156), which he attributes to his former practice of holding the film in the patient's mouth ('The individual exposures were of benefit to the patients, but their cumulative effect has permanently disfigured the operator's hands', p.1159); necrospermia and sterility in operators and leukopenia (p.1145-1146, 1160); the rule list (abandon the fluoroscope, never use one's body as a test object). THE PREGNANT-CAT EXPERIMENT (PDF p.1142-1143, Figs. 805-806): in 1904 Tousey radiographed a cat that had borne several healthy litters, holding her on the plate with his own hands, seven exposures from 6 Oct to 17 Dec 1904 on a 12-inch coil with Caldwell interrupter (spark 2-8 in, 8-11 A primary, 15-19 in, 10-65 s, total 276 s; tube current not given); 'No effect was produced upon the cat herself and none upon the operator's hands (this was a dangerous experiment), but at the natural time three mature and perfectly formed kittens were born dead' (30 Dec 1904); exposures stopped and four healthy kittens followed on 22 March 1905. One animal, one litter, no control litter; the author concludes repeated pelvic examinations of pregnant women are undesirable while noting that 'the x-ray will not always kill the fetus' (p.1144). The author also gives Laquerriere and Labelle's pregnancy completed during x-ray treatment of uterine cancer (1904).

Key claims

• Repeated small x-ray exposures are cumulative and cause dermatitis and keratoses in operators, including the author's own incurable finger keratoses.
• X-ray exposure of the testes causes necrospermia and sterility in operators, which can reverse after protection.
• X-rays act selectively on atypical, rapidly dividing cells, with soft rays most beneficial in surface cancer.
• Doubling voltage at constant amperage doubles the Holzknecht pastille reaction but quadruples the photographic effect.
• The Tousey unit measures x-ray power by film effect relative to 1 candle-power of carbon-filament light, and 500 Tousey meter-seconds is an erythema dose.
• The book's own conversions put the author's dose (6-inch spark, 3 mA, 10 in, 5 min unfiltered or 10 min filtered) anywhere from about 0.28 to about 1.5 erythema doses; the filtered form is consistently presented as just under an erythema dose [read: pp.1167, 1173, 1179-1181; reader's arithmetic].
• Tousey rejects the electrostatic (condenser) theory of x-ray dermatitis, citing the experiments of Strater, Kienbock, Oudin and Scholtz, and says of Geyser's version 'The author does not regard this as probably correct' [read: PDF p.1158, 1162].
• Mild repeated x-ray exposures of a pregnant cat (seven, 10-65 s, 6 Oct-17 Dec 1904) were followed by three mature kittens born dead, while the cat and the operator's hands showed no effect; a later litter was normal [read: PDF p.1142-1143].

Relevance: The dosimetry part explains why the author's doses cannot be read as modern dose units, and records his injuries and the early evidence of x-ray harm. The 'Tousey' unit is a film-density comparison, not a standard dose.

Mainstream conflict: Cumulative radiation harm to operators, sterility and embryo damage are established. Dose in H/X units is not comparable to modern units, and the author warns that H depends on pastille distance (the same dose reads four times larger at half the distance).

The dose table (printed pp.1168-1171): about 36 rows of spark length, Benoist number, mA, minutes, mA-minutes, distance, filter and dose in H and X units. By the author's own note, 'most of the above x-ray dosage is quoted from other writers' without saying which; only his own dose is marked: 6-inch spark, 3 mA, 5 minutes unfiltered or 10 minutes through 3 mm aluminium at 10 inches, 'never causes dermatitis'. Dose figures such as 22-30 H (8.5-inch spark, 60-80 minutes) are stated to kill carcinoma cells in vitro or in vivo (no source). The reader's checks: the first row (25 mA x 20 min) prints 250 rather than 500 mA-min; the same 5 H is given for 7.5 and for 20 mA-min under the same conditions; and Tousey's H is measured with the pastille at half skin distance, so his H differs from other writers' H. Own and cited clinical results (case counts rarely given): acne cured by x-ray plus high-frequency plus oral mixture and ointment; hypertrichosis with a deliberate x-ray burn; hyperidrosis palmaris cured permanently by a 10 H, 28 minute dose but with keratosis and fissures ('the patient would have preferred the disease'); lupus vulgaris of the cheek, woman of 67 (Dr. Jarman), 14 H in 35 two-minute treatments, 'complete cure ... no recurrence in three years', but 'not absolutely certain that the disease was lupus and not epithelioma' (no microscopy); tinea capitis (Sabouraud-Noire, 5.5 H); tuberculosis (negative earlier reports: Bergonie, Muhsam, Rodet, Rieder; his own 'excellent results' in suppurating glands, no count; kidney tuberculosis improved locally, patient died; pulmonary tuberculosis 'little if any permanently curative effect'; a spinal sinus healed with x-ray plus high-frequency); exophthalmic goitre (Dr. Love's patient, pulse 130 to 90, 'perfectly well' at three years, x-ray plus Oudin; Verning's two deaths after 5 H repeated in 1-2 days); Hodgkin's and lymphatic disease (Pancoast's series of 44 cases: of 29 with known outcome 25 per cent alive and apparently well 1-4 years, 60 per cent dead); leukaemia ('permanent in only 1 case in about 15'; 'the author has had no case of permanent cure, but several of wonderful temporary benefit'; 'a sudden fall of perhaps 200,000 leukocytes is not an unheard of thing in leukemia without special treatment'; fatal toxaemia from single 4-5 H exposures in America); epithelioma ('almost certain to be cured' for the non-adherent skin form; own cases: flat ulcer over trapezius cured in seven months; nose epithelioma woman 67 with no recurrence at three years; gum/palate epithelioma held in check six months then fatal; lower eyelid epithelioma enlarged under 1.5 years of x-ray; inner canthus ulcer held in check not cured; an indurated ulcer (14 years after a childhood scratch) healed under x-ray, recurred over two years and was finally excised, without microscopy; 'several hundred similar cases have been treated in different parts of the world'); breast carcinoma (male breast recurrence, 'five years since cessation of treatment ... no return'; Dr. Clement's patient held in check two years then died; Dr. Bissell's patient tumour halved then death); his toxin/antitoxin theory that 'substances analogous to toxins or antitoxins are produced by exposure of a cancer to the x-ray' with a suggested 'anticancerous serum'. The lupus (woman 67, Dr. Jarman, father lost the ala of the nose) and the nose epithelioma (woman 67, father lost ala) share age and history and may be one patient described twice (deep reader's flag; text does not say). The tube dispute (printed pp.1204-1205, 1217-1220): the 'condenser theory' that the x-ray itself does not cause dermatitis, which is due to a condenser (electrostatic) effect and avoided by placing the tube in contact, argued by Dr. Geyser (about 5000 contact applications without a burn by his records, as Tousey reports them). Tousey: 'The author feels that the condenser theory of the origin of x-ray dermatitis has not been proved, but that it probably contains a certain element of truth', and 'exceedingly dangerous to say that a burn cannot be produced with the tube in contact'. He asserts that the Cornell tube (made for Geyser by the manufacturer of the Tousey tube) 'copies all the essential features of the Tousey tube', is lighter and cannot stand the current, and claims that at St. Bartholomew's Clinic 'not a single burn has been produced from the discovery of the x-ray to the publication of this book'. This is an interested party's account (Tousey designs the competing tube). In contact the anticathode is only about 2.5 inches from skin, so a Tint B pastille reading means four times the usual dose. He also says static electricity from the tube may stimulate ulcer healing and that a 'cloud of atmospheric dust repelled from the x-ray tube' can implant bacteria. In digest only (pp. 1238-1253): sarcoma technique (massive 7 H every 2-3 weeks or 1-2 H every 2-3 days), melanosarcoma, multiple pigmented sarcoma, uterine carcinoma case, fluorescent medicines with x-ray (fluorescin, eosin; esculin), specific immunity (A. W. Crane's toxaemia-antitoxin idea), larynx case with gastrostomy, and captions of cases 'held in check' 2.5 and 5 years. QE correction and addition: the condenser theory is Geyser's, not Tousey's. Tousey reports it, cites Strater, Kienbock, Oudin and Scholtz against it (PDF p.1158) and calls it 'not ... probably correct' (PDF p.1162), while elsewhere (p.1231) conceding 'a certain element of truth'; the claim that is actually his is the superiority and priority of his own contact tube. The book also proposes a third burn mechanism, early burns from ultraviolet made by the tube (Part 10, p.681). Dose note: the deep read of pp.1130-1180 (Part 15) finds the book's own conversions of 'the author's dose' spread from about 0.28 to about 1.5 erythema doses, so 'about 5 H' and 'never causes dermatitis' should be read with that spread.

Key claims

• The author's own x-ray dose for any therapy, a 6-inch spark at 3 mA for 5 minutes unfiltered or 10 minutes through 3 mm aluminium at 10 inches, never causes dermatitis.
• The non-adherent skin form of epithelioma ('cancroid') is almost certain to be cured by x-ray treatment, whereas lip and mucocutaneous forms are seldom completely cured.
• Lupus vulgaris of the cheek in a 67-year-old woman was completely cured by 14 H in 35 treatments with no recurrence after three years and no scar, although the diagnosis was not microscopic.
• In leukemia the x-ray gives marvelous temporary benefit but, in the author's cases, no permanent cure, and permanent results occur in about 1 case in 15 in the literature.
• Substances analogous to toxins and antitoxins are produced by exposure of a cancer to the x-ray, and in proper proportion cure it, even in deep parts that could not have received enough direct radiation.
• The condenser (electrostatic) theory of x-ray dermatitis is Dr. Geyser's; Tousey, who designs the competing contact tube, writes that it 'has not been proved, but ... probably contains a certain element of truth' (p.1231) and that contact treatment can still burn, while in the x-ray-effects chapter he cites experiments against it and says he 'does not regard this as probably correct' (PDF p.1158, 1162) [read].
• Pulmonary tuberculosis is little if at all permanently cured by the x-ray, whereas tubercular glands, sinuses and bone are benefited, particularly when combined with high-frequency currents.
• A male-breast carcinoma recurrence disappeared under x-ray treatment with no return five years after cessation (author's patient, Dr. R. W. Hall).

Relevance: Central to the project. This is the book's principal body of claimed clinical results, with detailed technique, named referring physicians, relapses and failures reported by the author himself, and the dosimetric 'Tousey' and pastille-distance caveats; it also holds the contact-tube dispute with Geyser, whose condenser theory of burns Tousey reports, partly rejects (p.1158, 1162) and partly allows (p.1231).

Mainstream conflict: Early x-ray therapy of skin cancer, lupus, tinea, Hodgkin's disease and leukaemia is historically real and later partly replaced by chemotherapy; the claimed near-certain cure of basal-cell epithelioma by x-ray is broadly in line with later radiotherapy of basal-cell carcinoma [memory, medium]. Modern radiotherapy does not use H or Tousey units and gives different dose limits; toxin/antitoxin production by irradiated tumour is a theory, unsupported in the text; the 'no burn at St. Bartholomew's' claim sits beside the author's own reports of x-ray dermatitis, keratoses and fissures; the condenser theory of burns (Geyser's, which Tousey himself doubts) is not accepted (x-ray burns are due to the absorbed radiation dose [memory, high]).

Radio-activity as of 1910s: radium as an alkaline earth (atomic weight about 226), self-heating, alpha rays as heavy fast particles of range about 3.5 cm in air, beta velocities 90,000-180,000 miles a second, gamma absorption by lead, the emanation (niton), induced activity, helium production, price in 1909-14 ($80,000 a gram), and measurement. The author's unit of 'Tousey meter second' is re-used for radium; his 1904 experiment with 0.1 g radium in 6 oz saline for 14 days in an iron safe (tested 'not radio-active'; physiologic tests by Dr. R. C. Kemp); his own forearm test with a 20 mg tube of activity 2,000,000 (1 min no effect, 2-5 min redness, itching, desquamation; Plate 15); his own radiodermatitis cured by radium. Therapy as reported: lupus, warts, keloid, hypertrichosis, nevi, epithelioma, breast carcinoma (a Plate 16 case of disseminated breast carcinoma 'showing improvement from radium treatment'), radium puncture, exposed saline for pyaemia (case with Dr. R. W. Hall), eye diseases (vernal catarrh; trachoma), uterine fibroids (Krönig and Gauss, mesothorium), nerve diseases, internal doses (radium water, ointments, intravenous 50-100 micrograms, 1 mg intravenous lethal), with doses given as activity x time. The author cites Abbe's child with jaw sarcoma as 'the only supposed cure of truly malignant disease'. Statements of effects on micro-organisms and plants are compiled from named workers. QE deep read additions [read]. Radium 'activity' in the book is a multiple of uranium's activity (pure bromide 1,800,000-2,000,000; 10 per cent 180,000; 1 per cent 20,000), not a curie figure; radiation shares are given as alpha 64, beta about 24, gamma 10 per cent (p.1255-1256) and, for the author's own bare 20 mg tube, alpha 90, beta 9, gamma 1 per cent (p.1260), unreconciled. TOUSEY UNIT ON RADIUM (p.1259-1261): a patch of Kodak film is first given 1 Tousey meter-second of carbon-filament light; the author's applicator No. 4 (about 20 mg radium, activity about 2,000,000, in a glass tube) laid on film under two thicknesses of black paper makes 'as dense black' a patch in 5 seconds (developed 10 min in M.Q. developer); contact with the bare tube 'will produce a pronounced dermatitis after about five minutes'; in a 1/2 mm aluminium tube it 'could be applied for three times as long'; with 3/8 mm lead the permissible time is 18 times that for the glass tube alone, 6 times that for glass plus aluminium; a table of alpha/beta/gamma shares by filter (bare 90/9/1; glass 0/82/18; plus aluminium 0/70/30; plus lead 0/12/88) whose '55 per cent.' total does not reconcile with the 90/9/1 split; skin dose is to be inferred by comparison with this tube, so the Tousey meter-second is a photographic transfer standard (source: Tousey, a seller and user of radium applicators). RADIUM TO H (p.1281-1282): activity 7000 through a thin metal screen gives 5 H in 12 h and 10 H in 24 h; activity 300,000 gives 5 H in 15 min and 10 H in 30 min; pure bromide (1,800,000) gives 5 H in 5 min and 10 H in 10 min (about 0.42, 20 and 60 H/h; activity up 6 times but rate only 3 times between the last two); limits 'not more than 6 H. for lupus or 10 H. for cancer'; Oudin's 1,500,000 specimen 'takes an hour to produce 3 H., but ... will produce an erythema lasting a month from a fifteen-minute application' (about 20 times slower per hour than the 1,800,000 figure, unexplained). The book's own caveat: 'The Holzknecht measurements are useful as a general guide, but are to be cautiously verified. Darier and others do this by self-experimentation.' FOREARM SELF-EXPERIMENT (p.1270, Plate 15 on PDF p.1272): applicator No. 4 on the author's forearm: 'One minute produced no visible effect; two, three, four, and five minutes produced a more and more pronounced redness and itching with some desquamation, but no blistering or ulceration. This reaction was preceded by a period of incubation lasting about two weeks.' In the aluminium tube: 'a dry redness in fifteen minutes and blistering in twenty-five or thirty minutes'. One subject, no repeat, no dose in any unit, date not given; the plate shows one red patch on the forearm and the graded sites cannot be told apart. 1904 RADIATED-SALINE EXPERIMENT (p.1282-1283, from 24 February 1904): a sealed glass tube of 0.1 g radium (activity 20,000) in 6 oz normal saline for 14 days in a 75-pound iron safe: the solution 'seemed not to be radio-active' (not luminous or fluorescent, Willemite glowed in it as in water, fluorescein-saline on film under silver coins for 18 hours made no impression); physiologic tests by Dr. R. C. Kemp (cat, rabbit, and a dog with 30 cc intravenous: effects 'directly attributable to the saline solution, such as an elevation of blood-pressure ... none apparently referable to any radio-active property'); the dog died a few days later 'evidently in consequence of the operation, but just why it was difficult to say'. The deep reader notes a sealed tube transfers no radium or emanation to the liquid and glass stops alpha rays, so the null result is what the arrangement would give; the book does not say so. Dose tables in bare activity units (p.1280) and the mache unit (about 2500 mache = 1 microcurie) are also given; Tousey's tube 'can be applied five minutes only once in three weeks to any particular spot' (p.1284).

Key claims

• Radium applied to epithelioma, lupus and nevi destroys tissue in proportion to activity and time, with a reaction after an incubation of one to two weeks or more.
• Radium dissolved in or radiated into saline can be given therapeutically (the author's exposed-saline experiment).
• A 20 mg radium tube of activity 2,000,000 produces erythema in 2-5 minutes of skin contact (author's forearm test).
• Contact of the author's 20 mg, activity 2,000,000 glass tube for about five minutes gives pronounced dermatitis; 5 seconds of the bare tube equals 1 Tousey meter-second on Kodak film; lead of 3/8 mm lengthens the permissible time 18-fold over the bare tube [read: p.1259-1261].
• Radium exposure converts to Holzknecht units at 5 H in 12 h (activity 7000), 15 min (300,000) or 5 min (1,800,000), with Oudin's 1,500,000 specimen giving only 3 H an hour; the book says H values 'are to be cautiously verified' [read: p.1281-1282].

Relevance: Completes the book's clinical picture and shows the author's dosimetric unit (the Tousey meter second) and his radiation-injury observations.

Mainstream conflict: Radium therapy and its injuries are historically accurate for the period; internal radium (radium water, injections) was later recognised as hazardous [memory, high]; claims of cure with 'activity x time' doses cannot be compared to modern Gy.

Back-of-book subject index (A-Z), badly garbled by OCR, followed by blank pages, a Lane Medical Library date stamp and the spine label 'Tousey, S. Medical electricity, 1921 roentgen rays and radium'. Useful pointers in the index: 'Bifocal tubes for radiography (p.770)', 'Cabot heterodyne and Cabot high-potential constant-voltage generator (750-751)', 'Cornell X-ray tube (1217-1219)', 'Tousey's cellular and contact diaphragms (798-801)', 'Hoorweg's formula (388)', 'Demarcation current (288)', 'Concentration cell, Boruttau's observations (286)'.

Key claims

• The index lists the author's own devices: bifocal tubes, cellular and contact diaphragms, the Cabot constant-voltage generator, and Tousey's film clips.

Relevance: Used by later steps to locate the author's own inventions and to confirm which pages of the scan are missing (printed 282-283, 286-287, 290-295).

Mainstream conflict: none