MEDICAL ULTRASONICS

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP83-00423R001201280001-6
• Release Decision: RIPPUB
• Original Classification: C
• Document Page Count: 31
• Document Creation Date: November 9, 2016
• Document Release Date: January 27, 1999
• Sequence Number: 1
• Publication Date: December 18, 1953
• Content Type: REPORT

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ALS ONLY
25X1A2g
COUNTRY Western Europe CIA
SUBJECT Medical Ultrasonics
DATE I ? fie C 63
(BY SOURCE) 25X1A6a Supplemental to:
DATE ACQUIRED
DATE (OF INFO) Sep 53
25X1X6
Responsive to:
1. In the field of acoustics and especially ultrasonics the European scientists are
doing much more research and study than we are doing here in the US. doubt
who a re.. p:owing the application of ultrasonics in 25X1X(
there are 10 men in the US
?
Congress there were
medicie_. In Europe at the International Medical Ultrasonics
mo err than 200 foreign scientists, medical doctors, and engineers. Some of the out-
25X1X6 standing leaders in the field appear in the pamphlet "Impressions from Third Inter-
national Congress on Ultrasound, Austria, 1952" by R J Lindquist. ~--
2. condensed report of the Congress; however, printing of the compl
MrepoRr as panned was never realized because of financial limitations andaill there-
fore be presented piecemeal in the British Journal of Physical Medicine.
AV
The following documents are available on loan from the CIA Library:
(1) "Impressions from Third International Congress on Ultrasound, Austria, m
1952" by R J Lindquist. (2) Condensed Report on the International Medical Ultrasonics Congress,
Bad Ischl, Austria, September 7-10, 1952.
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 (IMPRESSIONS FROM THIRD INTERNATIONAL CONGRESS ON ULTRA SOUND, AUSTRIA, 1952
CPYRGHT by R. J. Lindquist
engineers, an physicists from
12 countries gathered in Bad Ischl, from the
7th to the 10th of September, 1952, to dis-
cuss the technical, medical, biological, and
diagnostic application of Ultrasonics. After
an impressive ceremonial opening of the Con-
gress on Sunday, September 7th, the following
three days were filled with presentation of
papers and discussions on Ultrasound:
This meeting was called under very
ifficult and trying conditions. Its suc-
ess was a tribute to Dr. Dussik, Dr. Eckel,
r. Lettowsky and many others. The logical
eeting place would have been Vienna
but
,
hat would have meant incurring unwarranted
isks for some of the men in crossing "red"
Ines. Vienna is under the joint control
f 4 countries, and is entirely surrounded
y Russian occupied territory.
The first International Congress on
ltrasour_d was held in Erlangen, Germany,
n 1949. The second Congress was in Rome
n 1950, no meeting was held in 1951.
I The first group of papers was on the
eneral subject of Dosage of Medical Ultra
ound. The principal speaker was Doctor R.
ohlman of Zurich, author of "Die Ultra-
cfi alltherapie". His theme was "Dosage
egulation for Medical Application of
ltrasound"
The Kurhaus". where the meeting was held.
was built originally by the father of Baron
Franz Von Woeltsky especially for a gala.
royal wedding. Later it was turned into a
casino, but since the passing of Emperor
Franz Joseph it has been used as a public
hall. At one time Bad Ischl was the summer
headquarters of royalty. Royal splendor has
departed, but the lasting beauty of the high
mountains, the lakes, the glaciers and the
forests will remain.
Dr. Dussik, who has been associated
with Dr. Eckel in Bad Ischl, will come to
the United States soon. He will be affil-
iated with a hospital in Boston, where he
plans to continue his investigations with
the therapeutic and diagnostic application
of ultrasound.
Pain is always an effective indieatior
of excessive therapeutic dosage. If we do
not exceed the pain threshold, there is no
danger of causing damage to tissue.
Dr. Lettowsky says a maximum of 7
watts is adequate for all therapeutic
applications.
NOTE: Dr. Van Went expects to
have her new book on Ultrasound Therapy
ready for publication in April, 1953. It
will be in English. (good news!)
 CPYRGHT
Prim. Dr. K. Th. DUSSIK Dr. K. ECKEL
Vorsitzender Schriflffihrer une. 2. Vorsitzender
)C. Florisson, bf'France discussed "An
Experimental Method of Dosage Measurement".
Other representative papers in the field
covered 'Ultrasound Dosimentry"; "Transmiss-
ion and Absorption of Ultrasound"; "The
Coupling Factors;" "The Biological Effects
of Ultrasound;" and "The Mechanism of Ab-
sorption." Several of the papers in this
group were by physicists and were quite
technical.
An interesting part of Dr. Poh7.man's
presentation was the; demonstration of a
multiple-crystal flexible applicator for
shoulders, knees, and other irregular areas.
With this type applicator longer treatments
(up to one hour) with small doses. (,leas
than 1 watt per crystal) are employed.
The main point of agreement in the
presentation of the first group of papers
was that high intensities of ultrasound
energy were not necessary-for therapeutic
dosages
A question discussed in a special
session was, "Should there be established a
central point, or agency, for the collection]
recording, and dissemination of information
relative to workers and coworkers, and
material in the field of ultrasonic;a?"
Also "Should the work of the physicist and
the medical elinitionbe assembled
together?"
Die EROFFNUNG der Tagung findet am Sontag, den 7. September 1952,
um 19 Uhr, in der Trinkhalle (Aublekplatz) statt. Die Begrtll ung findet in
Anwesenheit des Herrn Landesrates Franz PLASSER als Vertrster der oberr,
dsterreichischen Landesregierung, des Herrn Obermedizinalra;es Dr. Karl
NIEDERBERGER, Prdsident der o: o. Arztekammer, and Landtagsabecordneter
Bfirgermeister Fridolin SCHROPFEII als Verfreter der Stadtgemeinde Bed
Doz. IDr. F. LETTOWSKY
Beisitzer
"Further Progress in Medical Ultrasound
Tec ique" was the subject of a discussion
by )r. F. Lettovsky and Dr. K. Eckel of Bad
Iscil, It was stated by Dr. Eckel that
temperature distribution with ultrasound is
fa more uniform than that of heat sources.
Also biological effects of ultrasound seem
to be entirely independent of frequency
except insofar as frequency effects penetra-
ti n of ultrasound.
Dr. Grunzmacher and Dr. Oberst of the
Physical-Technical Institute. (the German
eq ivalent of the U. S. Bureau of Standards)
ha a established standards for testing of
European ultrasound instruments. Four firms
in Europe have submitted their equipment for
testing and calibration, others have expects
to follow. Both men Were very helpful with
suggestions and in answering many questions.
In London I contacted the editors of th
Br tish Journal of Physical Medicine. I was
to d that the response to the special Januar
is ue of 1952 was overwhelming and unexpeote
As a result, further papers on ultrasound
wi 1 be published from time to time. Watch
fo them. Send your subscription to Butter-
wo th & Co., k,5,6, Bell Yard, Temple Bar,
Lo don W.C. 2, England. This publication is
wo thy of the support of everyone interested
in physical medicine.
Vienna, but I was told by a doctor that they
do not have microtherlany.
G. Ungeheuer and C. Glenk of Germany
discussed the importance of ultrasound they
a y in sciatic neuritis.
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 CPYRGHT
Dr. Pohlmann Dr. Tschannen
Dr. Stuhlfauth
1 The second group of papers dealt with
the working mechanism of ultrasound; biolog-
ical and biophysical questions and experi-
ments; and pathological and physiological
influence of ultrasound.
The "keynoter" of this group was A.Do .non,
of Paris, with a discussion on the "Influence
of Ultrasonic Energy on Cells in Suspension".
The influence of various frequencies on
bacteria was presented (on typhus bacteria,
and on mold spores). Reflection studies with
pulsed energies were discussed
The study of irradiation of human
blood with ultrasound energy was especially
interesting. No toxic effects from reinjec-
tion of irradiated blood were observed. This
method was originated by Dr. Eckel and was
presented to the congress by Dr. Hilbert.
Dr. Tschannen read a paper on the Neuro-
logical Influence of Ultrasound as illustra-
ted by electromographic studies. Dr. Kolle
of Berlin illustrated the importance of
reflections from various media, and their
relations to therapeutic application. Dr.
Wh. Woeber gave the result of combined x-ray
and ultrasound therapy on experimental can-
cer in animals.
In general, all were in agreement that
ultrasound energy is not dangerous to human
tissue, when applied in therapeutic dosages.
This reaffirmed the findings of the 1950
Congress when everyone agreed that the
danger of injury could be completely avoided
by correct technique; that there was no
damage from "summation effects". The
possible danger of late injuries received
of the slightest support, either from prev-
ous experience or biological considerations.
K. Schikorski gave an explanation of
he neural mechanism of ultrasound.
Dr. Von Sanden Dr. Lehfeldt
SAFETY- The first question I asked
of many of the doctors present was, "Do you
consider ultrasound to be a safe therapy in
competent hands?" The answer was always an
unqualified, "Yes". I further interrog-
ated several leading physicians about any
evidence of malpractice damages resulting
from ultrasound treatments. None was able
to recall a single instance of such action,
either in Germany, or in the whole of Europe.
As one prominent doctor told me, "This is
not true of any other therapy."
Dr. K. Woeber, of Bonn, Germany,
edits a quarterly publication devoted entirely
to U. S., "Der Ultraschall in der Medizin".
He recently published an article by Dz.
Aides and Mr. Jadeson, of Cedars of Lebanon
Hospital, Los Angeles, California, on "Ultra-
sound in Geriatrics". This article was al
.P Lt Mh L dkf' '04 d12f0f48 O'0~116liaine?"
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 OPYRGHT
Dr. Grttzmacher Dr. Guttner
The third group of papers discussed
"Indications and Clinical Applications of
Ultrasound;" new questions, theore,,ical
considerations, and combined applications
with other therapies.
K. Stuhlfauth of Munich, led off with
the "ApRlic&tion of Ultrasound in Internal
Disease'. Dr. Dussik discussed "Problems of
Application of Ultrasound in the Therapy of
the Central Nervous System". V. Buctala,
of W-drzburg, compared the use of the fixed
soundhead technique and the moving massage
technique.
In Italy, ultrasonic energy has been
used very effectively in the treatment of
Buergers' disease.
Diagnostic possibilities in u:,e of
ultrasound are limited by the extremely
high absorption of high frequencies. The
maximum usable upper limit is 5 to 7 mega-
cycles.
Papers were presented on the treatment
of various specific: ailments, such as
periarthritis, muscular diseases, traumatic
conditions and many others.
A summation was made by G. Williams of
ConE
to t
Do sE
I rE
the
difi
Eve]
lan
sin
a c
Dr. & Mrs. Stuhlfauth Dr. & Mrs. Tschanne
In accepting the invitationatoh of answers
ress in Austria I was in
hree questions concerning the Safety,
ge, and Calibration of Ultrasound. These
ceived, and much more. I had not planned
many friendships made with persons from
'erent countries, all with a common interes .
-gone was courteous and helpful in spite of
3uage difficulties. Many :Letters have arri ed
;e my return, and I no longer feel that I a
)mplete stranger in Europe.
Thanks to air travel I was able to
acc mjlish the entire journey in a very short
time. Airlines used were P.A.A., B.E.A., K.L. .,
Air ranee, and T.W.A. Rail transportation was
use only twice, in Austria and in Germany.
Countries visited were England, France, Austri ,
an Germany, with short stops in Switzerland,
Ho land, Scotland, Iceland and Labrador. A
.total of thirteen landings were made.
Travel companions at various times
in luded the Commissioner of Labor of Nigeria
a 1 usician from Scotland, a young architect
fr m San Francisco, a Fulbright scholar from
Vi nna, a business man from CaDr. lcutta, an
en ineer from the U.S.F.A.,.
M. .T., and various vacationing members of
th Armed Forces in Europe.
Lenz, on the practical work of mat=rial from
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to take-advantage of many invitations
bl
e
a+1~ 2A i~1"a?~various
stories.
 Mr. Strunz-Vienna Dr. Barone-Rome Prof. Dr. A. UTACOMINI,
Ref erate:
R. POHLMANN, Zurich, Schweiz: Voraussetzungen and M igliehkeiten der
Dosisfestlegung fur medizinische Ultraschallanwcndung.
Batalla, Rotes and Zannu of Barcelona,
pain, had an interesting paper on"Ultrasound
n the treatment of Rheumatic Diseases "
Professor Amedeo Giacomini, of Rome,
was very helpful, and was most insistent that
I visit him in Rome before returning to Amer-
ica. He was a "powerhouse" at this meeting,
volunteered tc carry the burden of being the
"clearing house" on information on ultrasound,
and information about workers in the field
Dr. Hintzelman, of Wiesbaden, discuss-
ing the use of ultrasound in the treatment of
rheumatic diseases., V. Buctala contributed
a second paper on Ultrasound in Orthopedic
Conditions.
Dr. Van Went of Amsterdam, stressed the
necessity of an accurate diagnosis preceding
treatment of spinal conditions. "Know what
lesions you are treating!" She says that
long periods of bed rest are not necessary.
Most of the patients are off work only a few
days or return to work almost immediately.
Dr. Eckel read a very important paper
on the treatment of muscular disease with
ultrasound.
Following this comprehensive report
there was confirming discussion by Doctors
Stuhlfauth, Zach, Mayr and.Pavelka. In
answering the question as to whether ultra-
sound treatment of heart and stellate gang-
lion in cartiac region brings about compli-
cation, Dr. Zach said that no injury was
done to myocardium by ultrasound treatment.
Well conditioned hearts do not show any
disturbance even in case of excessive treat-
ment.
Fanuechi and M. Girelli of Milan, Italy W. Degner of Berlin, Germany, presen-
lso discussed the same subject with summa- t d
U a method for measurement of ultrasound
ion of results of ultrasound therapy one intensity by means of fluorescence and
0 four years after treatment. o c
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 CPYRGHT
lFaw
Dr.. Zach
Dr. F. Zach, of Vienna, gave a very
comprehensive paper on "The Influence of
Ultrasound on the Vegetative System."
An English translation of Dr. :mach's
paper will be published in a forthcoming
issue of the BritishJournal of Physical
Medicine.
Dr. Van Went, of Amsterdam, who has
had such outstanding; success in treatment of
diseases of the spine with ultrasound, demon-
strated that apart from the neurological
effects, ultrasound has a direct effect on
the connective tissue of the spine.
The influence of the French, and one
of their favorite diagnostic methods,
(chronaximetry), was:shown in a paper by
four collaborators in making a comparative
study of ultrasonic and diathermy as
influencing chronaxy determinations.
M. Carlos, of Conception, Chili, was
not present in person, but he was represent-
ed by a paper (in Spanish). Other.i too,
sent their papers to be read, although they
were not able to be present. Among; these
were J. Wild (on-Reflections) and J. Hurich
(on Therman Changes in Tissues), both
doctors from U.S.A..
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Dr. Schikorski
Schneider of Innsbruck discussed the
u 3e of ultrasound in tendopathy. He report-
el no success in only five out of sixtyfive
e ses of calcification of tendons. He rec-
o ended starting the treatment as early as
p)ssible. "Positive results after ultrasv d
ti
me
t eatment can be seen within a shorter
tian with x-ray while the performance of
trasound treatment is easier."
The meeting was partially financed by
e Education Consultant Office of the U.S.
Forces in Austria. The official report of
he meeting will be edited by Dr. Eckel and
ill be published in. "Der Ultraschall in
er Medizin."
T 'L. Barb of Bourdeaux? France, discuss
d the use of ultrasound in ear, nose and
hroat applications.]
Dr. K. Wollmann with a background of
en thousand ultrasound treatments discuss-
d the question of local versus segmental
reatment.
Absorption of ultrasonic energy in
living human bone according to Dr. Bolt of
I.T. is (per cm), 5 decibels at .5 me,
0 db at 1 me, 40 db at 2 me and 70 db at
mc.
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 CPYRGHT
Lab. Physiologie Acoustique -France Dr. Tschannen
"GRAY PASS"
The fourth group of papers discussed
f ultrasound
liti
es o
the diagnostic possibi
. This was my permit
Dr. Dussik sees a great future for the use for travel in the
of ultrasound in diagnosis through
hyper-. Gtttner of Erlangen, could Russian Zone
phonography.
not share Dussik's enthusiasm. Dr. R.H.Bolt,y~ T~Y1FI~i
a
f th
d
e ro
of M.I.T., U.S.A., took a middle o
course, summarized the work up.to-date as~~
effective point was made when ne compared.
the diagnostic possibilities of ultrasound
with Radar. "The little "pip" that means an JLRCE
"~ae:m~
enemy bomber is all the information we need.
May be some obscure finding of U.S. diagnosis
may be just as important." All were in agree-
ment, however, that there is nothing in a
diagnostic way about ultrasound that is of.
benefit to the average practitioner, at the
present state of knowledge.
Dr. Tschannen said he had over 40 cases
of facial paralysis where great improvement
was shown during the course of 10 to 15
treatments. (Chronaxie values approached
normal rapidly during course of series of
treatments.)
T. Hitter, formerly of Erlangen, Germany,
and one of the foremost acoustic physicists
in the world, is now permanently in the U.S.A.
as head of the acoustics laboratory of Massa-
chuetts Institute of Technology, Boston. w"
Hitter is the inventor of the Siemens Acoustic
Intensity meter.
 CPYRGI-IT
V. BUCIITALA, Wiirzburg, Deutschland: Vergicichende Un.ersuchungen
der Ultraschallwirkung mit bewegtem and stehendem Seha]]-opf auf den
Prothrombin-Index.
? 11. BRUNI, Udine, Italien: Ultrasonoterapia e malattie dell' apparato dige-
rente.
E. DIETZ, Freiburg i. Br., Deutschland: Die U]traschallresistenzkurve, der
Leukozyten and ihre diagnostischen Miiglichkeiten.
1'. 11UGARD, Paris, France: be Syndrome Traumato-Vibratoire.
F. b'ANUCCIII - M. GIRELLI, Milano, Italien: Effetti degli ultrasoni
su alcuni distretti neurovegetativi.
9Y J. VAN WENT, Amsterdam, Holland: Biological Investigations of theChan-
gement in the Connective Tissue in Relation to Diseasies of the Spine.
Ftir das EH1tENI'RASIDIUM der Tagung haben sich in dankenswerter-
se zur Verftigung gestellt:
Prof. Dr. L. BERGMANN, Wetzlar
Prof. Dr. R. II. BOLT, Cambridge, USA
Prof. Dr. A. DOGNON, Paris
Doz. Dr. V. IIINTZELMANN, Wiesbaden
Prof. Dr. A. GIACOMINI, Rom
Dr. R. POIILMANN, Zurich
Prof. Dr. F. SCHEMINZKY, ]Innsbruck
Prof. Dr. F. SEIDL, Wien
I'? F. ZACH, Wien, 0
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 Approved For Release 1999/09/10 CIA-RDP83-00423R001201 X1A2g
SCIENTIFIC ULTRASONICS S 0 C I E T Y
REPORT
on the
International Medical Ultrasonics Congress
Bad Ischl, Austria, September 7-10-1952
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 CPYRGHT
4 QQQ FAD F4
M S OE
PROF. DR. L. BERGMANN, Wetzlar DR.
PROF. DR. R. H. BOLT, Cambridge, USA PROF. DR.
PROF. DR. A. DOGNON, Paris PROF. DR.
PROF. DR. U. HINTZELMANN, Wiesbaden PROF. DR.
PROF. DR. A. GIACONIINI, Roma
EXPENS S
R. POHLMAN, Zurich
F. SCHEMINZKY, Innsbruck
F. SEIDL, Vienna
VOSS, Berchtes,gaden
meeting has been considerably financially subsidized by:
EDUCATION CONSUL ANT OFFICE
UNITED STATES FORC S IN AUSTRIA
PARTICIPANTS
203 participated fully through the entire session, and 32 more
partially, adding to 235 persons, rom 12 different countries.
OFFICIAL REPORT O~ THE MEETING
The official report: of the meeting, containing most of the
papers in full extension will be a ited by DR. K. ECKEL in the
review: DER ULTRASCHALL IN DER EDIZIN, S. Hirze.:L Verlag,
Stuttgart, Germany.
THE PRESENT CONDENSED REPORT WAS PREPARED BY:
K. ECKEL, F. LETTOWSKY: Excerpts 1 7, 12-20, 23-25, 18, 29, 31,
32, 34, 36, 40-47, 51. (Includin preparation and translation
of complete report.)
F. D-U;SS I K: Excerpts. 8, 9, 11, 37-139.
K. THI. DUSSIK: Excerpts 21, 22, 16, 27, 30, 33, 35, 48-50.
TS %A
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MONDAY, September 8, 1952 Morning Session.
Presiding: U. HINTZELMANN - K.TH. DUSSIK
1. R. POHLMAN, Zurich, Switzerland
Voraussetzungen and M8glichkeiten der
Dosisfestlegung fur medizinische Ultra-
schallanwendung (Assumptions and Possibil-
ities for Determination of Ultrasonics
Doses for Medical Treatment.)
At first, a summary was given of the diffi-
culties encountered in fixing the dosage
of ultrasound for medical treatment.
These difficulties are due to 1. Deter-
mining the energy of the transmitter it-
self. 2. Control of the energy trans-
ferred to the body. 3. Irregularities due
to interferences in the ultrasound field.
4. The different absorption of the parts
of the human body under treatment. 5. The
reflection and dispersion on bones and due
to the non-homogenous character of human
tissue. 6. The fact that the product of
intensity (watts per square centimeter)
and time does not give a figure which is
equivalent to the effect.
Further difficulties arise in the use of
different frequencies and in the use of
pulsed sound, since all six parameters will
then change again. A further question
arose on transferring results of experi-
ments with ultrasound on small animals to
human beings. Several investigations,
however, showed that the hon-homogeneity of
the field of ultrasound, the absorption,
the reflection, and the dispersion are of
minor importance, and that stress should be
laid on the determination of transmitters
energy and control of the energy transferr-
ed to the body. An interesting comparison
was given on the possibility of determin-
ing the intensity and effect of 19 differ-
ent therapies. In 15 therapies a change
of-intensity could not be substituted by a
change of time. It has been stated that
today it is possible to obtain a sufficient
physical control of the energy produced by
generator, and the amount of energy
transmitted to the body. The maximum
ossible instrument error in measurin the
bsorption of energy by the body is 2%.
ew experiments with prolonged ultrasonic
reatments with the new equipment called
'Schwingkissen" (moving sound pad) have
een reported. It transfers the energy of,
or instance, 6 transmitters (placed over
;he part to be treated), and, because of
is motion reduces the intensity (watt/sq
m) applied to the treated area to 1/10.
H. BORN: The possibility of concentra-
tion of energy In the tissue by reflec-
tion represents a hazard.
F. TSCHANNEN The moving sound pad
brings a lack of medical control.
F. ZACH: Because of the general-effects
onhe brain stem, prolonged ultrason-
ics treatment must be avoided.
2. C. FLORISSON, Paris, France.
Mesure absolue de la puissance acpistogie
d'un flux ultrasonore. (Absolute Measuring
of Acoustical Intensity of an Ultrasonic
Beam.)
The fact that the reflection coefficient of
acoustical energy in case of reflection on
an air-water surface is very near to unity
(0.9987), has been used to effect an absol-
ute device for measuring acoustical inten-
sity. An almost flat bell, containing air,
is suspended on a spring and submerged into
water, in equilibrium. The transmitter of
ultrasonics is fixed at an angle below, so
that the flux of ultrasonic energy "W"
travels from below at an angle to the flat
bell containing air. The angle of the ultra
sonic beam will be made practically about 60
The vertical component of the ultrasonic
pressure will be equalized by a weight "P".
A flux of ultrasonics yields W::; P 5~ J.
where "V" is the velocity of sound in water.
It is of importance that it became possible
in this way to design an ultrasonic radio-
meter for simple and quick determination of
the average total intensity of ultrasonic
apparatus for medical purposes. This method
is expected to be approved officially for
calibration of ultrasonic apparatus. (Very
important paper. (The reviewer)
3. W. G(JTTNER, Erlangen, Germany.
Uber Ultraschalldosierung. (About dosage of
ultrasonics.)
For medical purposes it is sufficient to
indicate the influx of energy necessary for
the particular part of the body. Because
of coupling difficulties,'there are always
considerable losses in intensity. If the
ultrasonic generator (transformer) is oper-
ated with constant current, (the system is
inherently underdamped; (The reviewer),
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ULTRASONICS SOCIETY
small coupling variations will have a big
influence on the acoustical output, and an
instrument for measuring the intensity
shows big oscillations. On the other hand,
an apparatus operated by a constant-voltage
transformer is emitting a constant sound
intensity. Construction and action of an
alarm has been described, which is con-
trolled by changes in radiation resistance,
which cause changes in transformer imped-
ance, so that the surgeon can notice big
changes in coupling.
4. G. KOLLE, Berlih.- Germany.
Der heutige Stand der'Ultraschalldosimi-
trie (Todayys Knowledge about Determining
Ultrasonics Doses.)
Assumptions in determining ultrasonics
doses depend on knowledge about:
a) primary effects of ultrasound in the med-
ium, b) secondary effects resulting from
transmission through the medium c) process
of absorption. The unity of measurement
should be easily reproducible. Biological
units of measurement can not be defined
with sufficient accuracy, because the prod-
uct intensity x time does not determine the
effect of the energy applied. By sound
velocity and resistance, the transmitted
medium.becomes characterised. Velocity
and acoustical resistance are characteris-
tic quantities of the transmitted medium.
Since the pressure of ultrasound ear.L be
easily measured, unit intensity or total
intensity of ultrasound can be considered
quantities easily determineable. Whether
the primary effects of ultrasound are thus
sufficiently determined is not yet known;
same is true for secondary effects of
ultrasound, like the formation of HH! 02
or luminescence. It was announced that
attempts are being made to connect ].umine-
sence with some other physical-chemical
process in order to enable finding of a
useful way for a direct determination of
doses.
WENK, BUSHEL, SCHUMACHER: They suppose
that luminiscenses can be found in
human tissue also.
5. H. BORN, Frankt'urt a.M. Germany
Der Kopplun gfaktor ljei der Ultraschall
Dosierung. (The coupling factor in determin-
ation of ultrasonics doses.)
Some technical descriptions which emphasize
preference for use of the coupling factor
for devises for measuring intensity. A
meth d was explained in which, by means of
relays, a signal flashes in the Schallkopf
(par of the apparatus for medical treat-
ment which is in direct contact with the
patient), when the coupling factor falls too
low. In practice it is very difficult to
perf rm treatment in such a way that the
coupling factor would only seldom fall
below 80%.
6. F. SEIDL, Vienna, Austria
Uber die Ultraschalldurchdringung am
mens hlichen Schiafenbein. (About the
penetration of ultrasound on the human
temple bone.)
The problem of propagation of sound in the
hums tissue, which is !an extremely non-homo-
genous medium, have not yet benn cleared.
Physically expressed, this seems clear since
the resistance of the ultrasound (given by
the product of density :x sound velocity) is
ver variable. Many fine pictures have been
sho , which demonstrate, with many examples
the propagation of ultrasound. It has been
poi ted out that plexiglass, which has an
eve increasing usage in plastic-surgery,
will show cracks even at low intensities
(below 0.5 W per sqcm). Sound transmission
thr ugh various bones showed that treat-
men from front side and back side of the
auditory passage did not lead to trans-
mis ion of sound through the human temple
bon detectable by the striae method, not
eve for 4 W per sqcm. Since 0.1 W per
sqc represents the lowest limit detect-
abl in the striae pictures, the effects
of ny possible lower amounts present in
the inner ear would be highly questionable.
NK, GfTTNER, WII,j,IAM: According to
experiences of the 1st Chirurg. Univ.
Clinic in Vienna ultrasound has had
very good effect against the violent
regular pains after, operations to
replace the head of the femur with
plexiglass.
ER: Even in cases wheremedium inten-
sities of ultrasound are being used
possible liquefaction of plexiglass
must be taken into consideration.
71 F. LETTOWSKY - K. ECKEL, Bad Ischl,
Austria
For entwicklungen der medizini_schen Ultra-
sch lltechnik. (Further progress in Medical
Ult asonie Techniques.)
Any further development; of medical ultra-
son c techniques depends first on elucidation
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artificial objects. Transmission and
reflection of an ultrasonic beam through a
human forearm are shown in very instructive
striae pictures.
11. H. HOMPESCH, Dortmund, Germany
Weitere Untersuchungen zum Mechanismus der
bakteriziden Wirkung des Ultraschalles.
(Further investigations concerning Mechan-
ism of the Bactericide Effect of Ultrasound)
The effect of ultrasound on bacteria can be
regarded as a colloidal chemical phenomena
leading to cell dissolution. Behavior of
bacterium pseudo anthracial, pseudo moms
pycyanea and colon bact. was investigated in
this paper. About 70% of bacteria nitrogen
was dissolved two hours after exposing them
to ultrasound, which fact can be regarded as
criterion of progressing cell dissolution.
The bacteria flotation was effectuated in a
physiological salt solution. Intensities of
3.5 - 4 W/sqcm at 800 kc were used. Autoly-
tic processes could be avoided. The results
of this investigation are quantitatively the
same for spore forming as for gramnegative
bacteria and appear to be independent of
temperature. The biggest decrease of the
amount of bacteria nitrogen was already
observed within 30 minutes, in the case of
bact. pseudo anthrac. Former measurements
of transparency loss of solutions proved to
be nonconclusive concerning ultrasonics
effects, because then grampositive espec-
ially spore forming bacteria showed less
clarification than gramnegative ones.
12. KH. WOPER, Bonn, Germany
Vergleichende Untersuchungen Uber die Prim9r-
wirkung des Ultraschalls, der Ultrakurzwelle
and der Hyperthermie and die Mitosen des
Walker. -Carzinoms als Beitrag zum wirkunga-
mechanismum dieser physikalischen Therapeu-
tics. (Comparative Experiments about Prim-
ary Effects of Ultrasounds, Ultrashort-
waves and Hyperthermy on Mitoses of the
Walker - Carcinoma as Contribution to the
Mechanism of Ultrasonic Effects of these
Physical Therapeutics.)
Criteria were sought for determining the
primary effects of different physical ther-
apies on living cells. The cellular -
mitoses of the Walker carcinoma from white
rats have been examined and the results com-
pared. Ultrasound waves, ultra-short waves
& hypertherming were included in the treat-
ment. Various frequencies were applied.
The carcinomatous tissue was examined
immediately after treatment in order to
avoid, as far as possible, biological con-
sequences. After the ultrasonic treatment
there were observed quantitative and qual-
itative irregularities of the mitoses with
conform histological details; furthermore
clinical pictures change in zones, which do
not show any alteration. Hyperthermy
produces alterations (clumps) depending on
duration and temperature but equally distri-
buted. Alterations in case of treatment
with ultrashort waves are similar to those
in case of hyperthermy. Thus a positive
criterion has been found for biological-
morphological differences between ultrason-
ics and pure heating effects.
13. KH. WOEBER - W. KLUG, Bonn, Germany
Ergebnisse kombinierter R8ntgen - Nah -
und Ultraschellbehandlung suf den experi-
mentellen Tierkrebs (Results of Combined
Adjacent X-Ray - and Ultrasonic Treatment
of Experimental Cancer of Animals.)
In course of studies on the primary effect
of ultrasonics treatment on carcinomatous
tissue and on the effect of combined X-ray
and ultrasonics treatment after Chaoul,
investigations were made by the authors on
Walkerscarcinoma, implanted subcutaneously
to a white rat with a specially constructed
apparatus, permitting adjacent X-ray and
ultrasonics treatment simultaneously and
from the same direction. With this oscilla-
tor acting almost purely thermically as far
as histological effects are detectable the
following results were accomplished: in 30
experimental series, containing 4 animals
each, 120 animals were observed. One
animal was used for control purposes, the
2nd was treated with X-rays only (350 r
Chaoul) the 3rd. with 1.0 w/sgcm ultra-
sound oI this oscillator, the 4th with
ultrasound and X-rays, conditions and doses
being identical with animal 2nd and 3rd
simultaneously. While all animals 1, 2
and 3 always died on cachexy as a result of
the permanently growing tumor, all 30
tumors exposed to combined treatment
decreased and remained for 90 days of
further observation time without relapse.
A possible explanation for those results was
given.
14. W. KNAPP, T{lbingen, Germany
Die immunogene wirkung beschallter Typhus-
bakterien (Immunization Generating Effect
of Typhoid Bacteria, Treated with Ultrasound)
The question whether typhoid bacteria treat-
ed with ultrasound, their filtrates, or
solutions, obtained by centrifuging cultures
treated by ultrasound could be used for man-
ufacturing inocula and if this method is
advantageous, was analyzed. It was known
by preliminary experiments that neither
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f the mechanism of ultrasonic effects in
lying organisms. The Pact that the thera-
eutic effects of ultrasound apparently
epend very little on f!requencies or inten-
ities, and the special; character of this
ependency permit the establishment of defin-
te criterions to determine, whether a
ertain physical factor(for instance
cceleration forces) is responsible fcr
hese effects. Only non-reversible, energy
xchange processes, yield an effect which
n case of mechanical effects could be
stablished as non-reversed deformaticn.
he significance of physical irregularities
n ultrasonic fields with regard to the
ffect of heat generation has been, in gen-
ral, overestimated, as can be concluded
rom mathematical analysis of extreme cases,
n which it has been shown that temperature
istribution is far more uniform than that
if heat sources. The establishment of high
temperatures in boundary interface planes
an be easily shown bylan explicit formula.
The ultrasonic effect of nervous exci'.ement,
probably caused by changes of ionic mobil-
ity, being entirely independent of frequen-
cy and intensity over a wide range (accord-
ing to chromaxy measurements by Busnel it
must be regarded as a specifceffect.(the
reviewer)), leads to most favorable results
in case of optimum temperatures, at which
action voltages have their highest values.
(careful experimental investigations made
by ZACH confirm this statement,(The reviewer)
Modern therapeutic apparatus already complies
with all requirements;; certain possibilities
for improvement are briefly discussed.
POHLMAN: Quotes diagrams of haemolysis
with regard to influence of frequency
and emphasizes thesignificanee of
eigenfrequency in case of cavitation.
K. ECKFL: It cannot, be overemphasized
that no important physical effect espec-
ially any which would depend on frequen-
cy seems to be of any significance as
far as biological effects of .ultrasound
are concerned. Infact the biological
effects of ultrasound seem to be entire-
ly independent of frequency except for
the fact that the degree of ultrasound
penetration (whichhas some biological
influence) depends of course on freq-
uency.
F. LETTOWSKY: (Conclusion) It is not
pro'6-abble that in case of therapeutical
doses even mild cavitation (as meant by
POHLMAN) will appear in living tissue.
It would not depend on frequency as in
the case of cavitation formed by vibrat-
ing gas bubbles, and it would be detect-
able by the random character of any
measured quantities, even a minor degree
than in the case of real cavitation.
8~ H. KELLER, Reinbek, Germany
Ube den Mechanismus der Ultraschallabsorp-
do its Gewebe. (About the Mechanism of
Ult asound Absorption 'Ln Tissue).
Absorption of ultrasound in tissue is simil-
ar to absorption in suspensions. This
hy othesis has been of value, as suspen-
si ns can be easily treated mathematically.
The investigations on a suspension model
lead to the result that absorption by
tissue was caused by motion of particles,
le dine to variation of density in areas
of 10- cm. Bigger unhomogen.eit.ies cause
pr longing the length of path, and addit-
io al absorption by scattering.
W. DEGNER, Berlin, Germany
Au messung des Schallfeldes dureh Fluor-
es enz and Phosphoreszenz von Leuchtkris-
ta len. (Measurement of Ultrasound Fields
Intensities by Fluorescence and Phosphores-
ce ce of Crystals.)
Ex eriments are described in which ultra-
sound fields are measured quantitatively
by a new method. For this purpose,
fluorescence phenomena are used directly
th ough the excitation of crystals by
ultrasound. Very good, photographic pict-
ur s have been shown. Converging rocker
ar s are used for calibration. The crystals
re uire very sharply pointed probes. The
su prising simplicity of this method is
ve y advantageous. Leaves of artificial
re in were used, either coated with ZnS
ac ivated by means of Cu, or also with
Zn uS.
Mo da September 8, 1,952 Afternoon Session
Presiding: R. H. BOLT - K. BEREK
0. W. DAUM, Braunau, Austria
Be trag zur Schalldarstellung mit der
Sc lierenmethode. (Contribution to Sound
Pi turing by Means of the Striae Method)
Sh wed some studies on propagation of ultra-
so nd on different specimens? all pictures
male by means of Toepler's striae method.
Pr cise coupling of the Schallkopf is
re uired and this requirement holds too
fo investigation of all problems of penetra-
ti n of ultrasound through biological objects
as this is incomparably more complicated
th n investigations on non-living or
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dissolved nor not-dissolved antigens could
be-activated by ultrasound ( 5 W/sqcm) with-
in one hour. The following results were
obtained: 1. Inocula containing bacteria
manufactured after treatment with ultra-
sound from Na Cl suspensions or broth-cul-
tures, did not show better immunizations
in experiments with animals than inocula
used in practice. 2. It was shown by
using filtrates of flotations of agar or
broth cultures exposed before to ultrasound
for manufacturing inocula, that by treat-
ment with ultrasound richer of immunizing
substances with clearly increased degree of
protection by vaccination would be achieved.
3. Optimum enrichment of solved immunizing
bacteria substances has been achieved by 30
minutes treatment with ultrasound.
15. G. VELTMAN, Bonn Germany
ttber ein neues, mittels Ultraschall hergez-
telltes Tbc. -Antigen zur Komplementbindun-
gsreaktion (About some new Tbc.-Antigen
Produced by means of Ultrasound for Reac-
tions with Complement - Fixation.)
Some The - antigen has been produced by
exposing a bacteria suspension to ultra-
sound, and in this way an alcoholic extract
has been obtained free of all morphological
remains or other admixtures. Investigation
of 70 series of tuberculous people to which
it had been administered showed through
correspondence between our antigen and the
"Antigen Essen", used for control purposes.
In twenty series with luctics, whoes
reaction otherwise was strongly positive,
the new antigen showed an advantage, be-
cause reaction was only weakly positive in
16 cases, so that the new antigen proved to
be more specific. Also by treatment of 10
healthy people and in case of other illness
better specifity of the new antigen was
shown. So this new antigen always proved
to be advantageous.
16. W. SCHUHMA.CNER, Berlin, Germany
Ultraschallvarsuche an Schimmelpilzen.
(Ultrasonic Experiments with Mould Oidia.)
Mould oidia spores are biologically very
suitable objects for ultrasonic experiments.
They were ultrasonically irradiated with 800
kc half cycle operation, 1-3 w/sqcm. The
spores were suspended in destilled water.
Electron-microscopic controls showed that
no celluler destruction occured with this
method. From the results it follows that
the germ velocity of the spores was consid-
erably decreased by exposing them to ultra-
sound. Constant product intensity x time
similar to other biological measurements
does not yield constant effects. This
became especially clear from investigations
with repeated short time exposing to ultra-
sound. It was striking that these effects
were more intensive at 50 temperature than
at 45?, in evident contrast to results of
haemolysis investigation. This is regarded
as further indication for existence of
mechanical ultrasonic effects.
17. A. BARONE - L. VIVALDI, Roma, Italy
Der Proteusbazillus unter Ultraschallbestrah-
lung. (Reaction of Ultrasonics Treatment in
Proteus.)
The autors exposed a suspension of proteus
to ultrasound. An ordinary cylindrical
vial as is used for biological experiments
contained the preparation. It was exposed
to ultrasound traveling along the same axis,
generated by an ultrasound transmitter with
conical reflector. Intensity of the cylin-
drical waves on. vial surface was approxima-
tely 16 W/sqcm, (considering all losses in
transmitter.) The bacilli were exposed to
ultrasound of this intensity at which cavita-
tion appears for different periods of time
(5,10,15,25 min). Then they were put on
nutrient broth, where only bacilli exposed
to ultrasound for more than 15 minutes
proved to have died out entirely. Electron-
microscopic photos showed that after 5 min-
utes exposure destruction of membran and
flagellum begins. Bacilli exposed to ultra-
sound for more time were deprived of their
membranes, they had considerably reduced
dimensions, and measurably larger proto-
plasm densities.
18. W. D. KEIDEL, Erlangen, Germany
Lassen rich bei inadequater Reizung des Ohres
mit Ultraschall ilber die Knochenleitung
Cochlea-str8me ableiten? (Is it possible to
shunt cochlea currents by bone conduction
from the ear inadequately excited by ultra-
sound?)
Objective hearing thresholds measured by
cochlea currents (currents in consequence
of nervous excitement) were plotted, whereby
ultrasound at frequencies from 2 to 57.5 kc
had been introduced by bone conduction.
Thresholds plotted against frequencies show-
ed between 16 and 60 kc a sharp increase
(20 db). The break at 18 kc known from sub-
jective threshold measurements on human
beings is however missed. Above 18 kc a
slightly painful high sound sensation
yields, showing no further pitch change.
At the experiments in question with animals
the frequency of the cochlea currents has
been established, that the sensorial cell-
ules had been exposed to pressure oscilla-
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tions precisely in agreement with sound
frequency. It has been concluded that hear-
ing sensation in the range of ultrasonics
comes from adequate excitement.
N. V. GIERKE: It does not seem to be
clear enough whether sound sensation
in the range of ultrasonic frequencies
was not influenced by subharmon.ic
vibrations, caused by nonlinear char-
acteristics of the ear.
19. K. SCNIKORSKI, Hamburg, Germany
Der neurale Wirkungsmechanismus des Ultra-
schalles. (Neural Mechanism of Ultrasonic
Effects.)
Some theoretical consideration based on
SCNEIDT's theory of 'nerve function
(synallaxy theory). It is supposed. that
Ultrasound interferes with the potential
gradient resulting electrically from unidir-
ectional arrangement of non-spherical
molecules.
ZACH: Neural effects are generated just
at smallest ultrasonics intens._ties.
According to EPPINGER tissue potentials,
which are to beunderstood literally in
the sense of electrophysiologioal ones,
are increasing the trophotrophi_c phase,
decreasing in the ergotropic phase.
TUESDAY, September 9 1-952 Mornin Session
Presiding:. L. BERGMA1NN - K. ECKEL
20. N. von GIERKE,1 Ohio, USA
Propagation of Mechanical Energy in Biologic-
al Tissues. Investigations about complex
acoustical Impedance of body surface in
the frequency range from 0 to 30 kc showed
that soft muscle tissue is a medium with
compressibility, elasticity and viscosity.
Elasticity was found to be 2.5.10 dynes/
sqcm, shear viscosity 150 dynes sec/sgcm.
These values approximately are in accord-
ance with calculated ones from measurements
of penetration depths in the range of a few
megacycles. Therefore viscosity of tissue
has a relatively large value (5 times
larger than that of glycerine) and it causes
shear waves, generating at the surface of
the transducer and at boundary plains in
case of inclined incidence of art accustic-
al beam, where far more energy than in case
of normal value of the absorption coeffic-
ient dependent on frequency becomes absorbed.
Viscosity shear waves, are strongly clamped,
therefore their penetration depth is very
sm.11. Most local generation of heat at
sk n and muscle boundaries is due to them.
Al o the fact that sound absorption is
different for penetration of ultrasound
along or normal to muscle tissue, can be
ex lained easily in considering that, besid-
es longitudinal waves,, there are also trans-
ve sal ones (the above-mentioned. viscosity
wa es).
TTTOWSKY: It seems necessary to assume
two different absorption coefficients
for explaining P019LMAN's measurements
of temperature rise in ultrasonically
radiated tissue.
OHLMAN: Absorption in the field near
the transducer is different of that in
the field far from it.
ERGMANN: It would be of interest to
calculate the difference in absorption
of longitudinal and transducer shear
waves characteristics.
. v. GIERKE: This problem is mathmetic-
ally too complicated because surface
waves with propagation speed dependent
on frequencies are present on transducer
surface and on boundary planes.
CCEL: Apart from the importance of the
above mentioned results, it can be con-
cluded from the shown diagrams that
these are nonvariable conditions at
frequencies above 100 kc. It can be
assumed that thus has been found some
physical reason for the clinical non
specifity of frequencies, which fact
should be emphasized.
1. W. GLOGGENGIESSER, Munich, Germany
Di Pathologic der Ultraschallwirkung.
(Pathology of Ultrasonics Effects.)
Morphological investigation, based specially
on experiments with animals. First of all,
ab ormal changes were discussed and also
ph nomena having some relation with physiol-
o h'o Intensities used considering size of
ex erimental animals, are above therapeutic
does. Today, different groups of changes
an reactions can already be distinguished,
an they can be classified from the follow-
in points of view. 1. Degenerative changes
2. Reactive inflamato:ry and reactive hyper-
plastic changes 3. Functional circulatory
disturbances acting probably on arterial
nervous system.
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ad 1. With the exception of bone lesions
caused by ultrasound, which might be attribu-
ted to mechanical ultrasonics effects, most
degenerative changes are non specific ones.
Experiments about ultrasonics effects on
muscular tissue yield both non-characteris-
tic changes and muscle lacerations. (mechan-
ical factor). Characteristic degenerative
changes are furthermore infarct looking
necroses. The author could produce them in
lungs, heart, hepar, and stomach. They are
caused by functional circulatory disturban-
ces. It has not been decided yet whether
completely developed or not yet fully devel-
oped materials are injured by ultrasound.
Some experiments by the author give eviden-
ce of an ultrasonics effect in stimulating
growth of juvenile cells.
ad 2. Reactive granulous and fibrous over-
growths, originating after ultrasonics treat-
ment, are generated from excess material.
Mesenchymal overgrowths, remaining on a low
differentiation stage, give evidence of
elective ultrasonics effects of growth stim-
ulus to mesenchyme.
ad 3. New experiments by the author give
evidence of functional circulatory disturb-
ances, acting probably on arterial nervous
system (experiments on kidneys and supraren-
als of rabbits and rats.) The experimental
results probably might be best classified
as "initial reactions" of the living organ-
ism to ultrasonics. (effect on terminal
vascular system). The circulatory disturb-
ances proved to be big enlargements and
hyperaemiae of capillaries and veins. They
lead to isolation and detachment of ephithe-
lial tissue shreds, in more intense stages
to haemorrhages, and finally they cause
infarctial desintegration of tissue. These
experiments confirm RICKENS' theories about
effects of physical or chemical stimuli to
terminal vascular system.
BORN: These experiments should be repeat-
ed on bigger animals with regard to
insufficient heat convection.
BUCHTALA: More recent investigations of
my own give evidence for higher sensitive-
ness of juvenile tissue.
LETTOWSKY: It should be emphasized that
more intensively cooled nervous tissue
did not show any morphological changes
at ultrasonics intensities, by far
exceeding the above mentioned. (up to
145 w/sqcm; mechanical effects are seem-
ingly 'hniinri to navitatint, Anr7 -1n nn aa
of less efficient cooling, the cavita-
tion threshold is reached at lower
ultrasonics intensities).
GLOGGEiE,SSER: (Conclusion) It seems
that temperature does not influence the
above mentioned ultrasonics effects.
Higher sensitiveness of juvenile cells
can be probably confirmed.
22. G. BAUER, Munich, Germany
Experimentelle morphologische and biolog-
ische Untersuchungen {fiber die wirkung des
Ultraschalles auf die Ovarien des
Kaninchens. (Experimental Morphological and
Biological Investigations about Ultrasonics
Effects on Ovaries of Rabbits.)
The author reports about results of ultra-
sound treatment of full grown rabbits.
(24 animals, 18 of them were exposed to
ultrasound, 6 of them served as controls).
Total ultrasonics intensities were 15 - 35
Watts. Hyperplasia of theca, inhibition of
follicular ripening, acceleration of corpus
luteum involution, and in case of larger
doses atrophy of ovarian stroma were shown.
FRIEDMANN's pregnancy test was negative for
almost 5096 of animals having been exposed
to ultrasound, while ovaries not treated
with ultrasound showed the well known
aspect of positive FRIEDMANN's test.
HINTZELMANN: Doses used are relatively
very large ones.
HOWANITZ: In contrary to the above mention-
ed effects some chronic adnexae tumor
could be influenced favorably, whereby
pregnancy could be achieved only after
treatment with ultrasound for the first
time.
WOEBER: Warns of too extensive conclus-
ions from morphological findings.
These are mostly irreversible changes,
while the sought primary effects are
reversible ones, and therefore only
could be found with difficulty.
BAUER: (Conclusion) It should not be
forgotten that irregular prolonged blood
discharges were frequently observed at
routine treatment with ultrasound.
23. M. CARLOS, Conception, Chile
Einfluss des Ultraschalls auf das Ovar mit
Berucksichtigung des Scheidenabstriches
nan h Pppa.nianlA.cu_ (TnfluPnc of Ultra-
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sound on the Ovary with Consideration of
the Vaginal Smear after Papanicolacu.)
he ultrasonics therapy is still little known
in Chile. Investigations are being made to
find out whether in Amenorrhea cases
results can be obtained by ultrasound
therapy of the ovaries. Of ten case's of
secondary amenorrhea menstruation was
ffected in three cases. No ill after-
effects.
24. S. KOEPPEN, Wolfsburg, Germany
Zusammenfassende Darstellung der bekannten
Reaktionen des Ultraschalles in vegetativen
Nervensystem, an den Eingeveiden and den
Blutgefffssen. (Summary of known reactions
of ultrasound in the vegetative nervous
system, on the intestines and blood vessels.)
The chief point of the paper is about RICKER
's gradual action law. Weak and medium
strength intensities irritate the va,3ocon-
strictors, stronger intensities can ?Daralyze
them. The result is a collapse of t',ae cir-
culatory system and finally necroses of the
tissue. Biological effects of ultr&3ound
are attributed as caused and set off by
the thixotropic effect of ultrasound. Brain
changes from mechanical vibrations (commotio)
are shown in comparison with them. This
stage of ultrasonics effects is irre'7ersi-
ble.
25. V. TOMBERG, Bruxelles, Belgium
Zum Einfluss der Kavitationsschwelle ouf
den biologischen Vorgang. (On the influ-
ence of the Cavitation Threshold on 3iologi-
cal Processes.)
The biochemical effects of ultrasound depend
on cavitation. The cavitation threshold
depends on the ultrasound intensity and
frequency and furthermore on the nature of
dissolved gases and the kind of wave set up
in the ultrasonically radiated medium, The
addition of substances can raise the biolo-
gical ultrasound effect especially the bac-
tericide efficiency, as far as these sub-
stances lower the cavitation threshold.
This fact has been proved by the author in
certain experiments on ciliate and para-
sites.
26. F. TSCHANNEN, Bern, Switzerland
Neurale Wirkung des Ultraschalles nach
elektromyographischen Forschunge:n. (Ner-
vous effects of ultrasound in electrDmyo-
graphic research.)
Indications are that the tonus relaxation
'ffect of ultrasound is transmitted over the
spi al centers. This explains the good
res lts in case of non infective rheumatism,
at dicular treatment with ultrasound be-
cause reflexes and muscle spasticity im-
pro e. Pulsed sound seems to be better
the eontinous. A series of interesting
obs rvations on electromyograms are describ-
ed, thereby relaxation of reflexogenic
exc tement seems to be well proved in case
of scle spasticity.
IDEL: In the shown myograms changes are
striking, referring to influence of re-
lex center. Continuations of electro-
yographical research for explaining
ultrasonics effects was suggested.
VAN WENT: In case of light neuralgies and
I'-muscle spasms short wave therapy seems
to be better.
CH: Confirms the good therapeutic
effects of pulsed sound in general and
when arthroses were ultrasonically rad-
iated at radicles.
21. R. G. BUSNEL, H. MAZOUE, P. CHAUCEARD,
J. GRIGORJEWITCR, Jouy-en-Josas,
France
Corn raison entre l'action specifique des
ult axons et l'effet thermique sur le system
ner eux. (Comparison of specific influence
on nervous system in case of specific 'ultra-
son es and thermal effects.)
The authors have analyzed the effects of ul-
tra ound on rats.and frogs measured by chron-
axy. Ultrasound causes decrease of chronaxy
being always larger than that in case of
equ valent thermal effects. The return to
normal values is also much slower.
The response on excitement of reflex phen-
omena is different for reflexes generated
by temperature. The last ones are suppres-
sed by anesthesia, the other, caused by
ultrasound, survive and disappear only if
the nerves are dissected or if the medular-
ry heaths are destroyed. The effect of
ultrasound appears also at intensities,
which practically have no thermal effects
at all, and are below cavitation thresh-
hold.
28. N. VYSLONZIL, Vienna, Austria
Uoe die Beeinflussung des Vestibularappar-
ates durch Ultraschall (About the influence
of ultrasound on the vestibular apparatus.)
Film.
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S C I E N T I F I C U L T R A S O N I C S
Some impressive experiments demonstrating
the vestibular reaction by rabbits and
guinea pigs including all irritation phen-
omena of the equilibrium organ up to
exhaustion and total paral zing of labyrin-
thine system, were shown. film) The animals
indicated from head motions mystagm to cir-
cular motion, and complete inability to go
in Any direction. These investigations are
part of general endeavor to reduce the sen-
sibility of the vestibularis nerve without
damaging the cochlearis nerve, primarily
with respect to the Meniere's syndrome.
29. K. ECKEL - T. HILBERT, Bas Ischl, Aus-
tria """
Uber den therapeutischen Wert des mit Ultra-
schall vorbehandelten Blutes.
(About the Therapeutic Value of Blood
Treated with Ultrasound.)
This work is based on the biological and
colloid chemical effects of the ultrasound
on cell suspensions and blood albumin, and
deals with these effects. The changes of
the native blood-albumin by ultrasound in
vitro and the reinjection are introduced by
ECKEL as an essential enlargement of the
well known blood-reinfusion therapy. A
very favorable change of stage in the auto-
nomic nervous system is brought about as was
shown in a series of chemical analyses of
examined cases. Demonstrable changes of
stage as well as therapeutical observations
apparently go beyond the effect of the sim-
ple blood-reinjection or the effect of blood-
reinjection combined with ultraviolet treat-
ment.
BUSHEL: Inquiry on blood-reinjection
treatment techniques. It seems incred-
ible that no toxic effects can be
noticed.
ECKEL: The change of autonomic tonus is
-very interesting, although we cannot say
anything on the importance of this effect.
It certainly cannot be described only
with ergotropic and trophotropic react-
ion stages. (In German: ergotrope and
trophotrope Reaktionslage, in English
the word trophotropic is used in other
sense than in German (the reviewer).
Attention might be paid to the fact that
also little quantities (i.e. 0.5 cucm)
cause very distinct reactions.
TUESDAY. September 9, 1952 Afternoon Session
Presiding: A. GIACOMINI - ON. KUBASTA
30. K. STUHLFAUTH, Munich Germany
Die Anwendung des Ultrasehalle bei internen
Krankheiten and ihre Grundlagen. (The use
of Ultrasound in internal diseases and its
basis)
For internal medical applications ultrasound
is of importance in cases of spastic and
degenerative diseases, and chronical inflam-
ations. Such therapy successes are obtained
for asthma bronchiale, tuberculosis and
exsudative pleurisy. All these are exam-
ples of diseases where effects can only be
achieved by affecting the autonomous ner-
vous system. Heart diseases, especially
Ztngina pectoris are hardly treated with
ultrasound because of unfavorable effects.
Two cases of esophsgospasm were treated
with success. In case of gastritis and
ulcers as well as at spastic obstipations
etc. are sometimes achieved very good
results, but the therapy causes too great
expenditure of time and physical effort by
the physician. To another group of indicat-
ions, partly topical and partly centrally
regulated, belong vasodilatations affecting
the level of blood sugar, arteriosclerosis
and autonomic blood circulation disorders
at essential hypertonic stage, and potency
disorders. In the experiment is proved
that ultrasound on isolated animal organs
sets free acetylcholine, adrenalin and
histamin. The former assumption by the
author that some damping of nervous conduct-
ivity, caused by heat, occurs, and that it
is responsible for reducing of different
effects of the disease in internal organs,
in the vascular system, and in muscles,
could not be accepted. The mechanism of
the effects is more complicated and concerns
the autonomic reflexive system. Because
stabilization of external membrane poten-
tials caused by ultrasound appears too in
case of isolated muscles (otherwise the sen-
sible production of pertaining reflexes in
situ would not change) it can be attributed
also from this point of view to an effect
caused chiefly by autonomic receptors.
KEIDEL: The assumption that actual sensa-
tion of heat is caused by ultrasound,
leads to important theoretical consider-
ations. The thermal receptors immediate-
ly below the skin only are struck by
unidirectionally moving molecules excit-
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ed by ultrasound.: Had the receptors
themselves been excited, thermically,
then it would follow that multidirec-
tional motion (heat) and unidirectional
motion (ultrasound) should not mike any
difference. Thisis of great importan-
ce in understanding the physical-phsio-
logical transforming mechanism of therM-
al receptors. The free pain perceptive
endsof nervesare located in deeper lay-
ers and they will'be in the field of
multidirectional molecular motion be-
cause of scattering. It is possible to
distinguish the two kinds. of receptors
by measuring action potentials because
pain perceptive fibres do not show
adaptation.
31. K. Th. DUSSIK, Boston, USA
Probleme der Ultraschallanwendung in der
Therapic der krankuxigen des Zentralner-
vensystems. (Problems in Application of
Ultrasounds to Therapy of Diseases of the
Central Nervous System.)
Ultrasonic treatment in case of neurosis,
solves a series of important problems that
otherwise therapeutically cause great diffi-
culties. It is the only means of producing
heat and influence on different systems in
a limited area of the central nervous
system. (ZNS). The experiments, causing
destructive effects on ZNS in case or high
intensities, are no counterproofs, since
there are extreme intensities. A series of
results have been obtained, in order to
establish the threshold effects for function-
1 and histological alterations. The cran-
ial bone causes a high attenuation. Usually
only a small fraction of 1 W/sgcm enters
the brain. For valuating the therapeutic
ffect there must be: 1) Exactly neurolog-
c experiments 2) A sufficient number of
ases in order to differentiate from spontan-
eous remissions,3)over'sufficiently long per-
ods after treatment has been finished and
Controlling test observations on other
ases. Until now, there have been no statis-
ical experiments. These can only be per-
ormed in especially equipped mental hospit-
ls with properly experienced staff. Other
esults about pathophysiologic effects of
iltrasonic treatment on ZNS may be expected
rom the last works of FRY, FALL and cowork-
rs, who apply very high intensities (up to
00 Wsqcm)
32. B. BRUNI, Udine, Italy
ltrasonoterapia e malattie dell'apparate
igerente. (Ultrasound Therapy and Digestive
ystem Disease).
RASgNICS SOCIETY
12 patients suffereing from chilecystitis
wi h gallstones, pericholecystitis,spastic
co itis, duodenal ulcer, pericolitis with
po toperative adhaesions at abdominal tuber
cu osis were treated exclusively with ultra
so nd. Before all of them had taken othar
tr atments with non satisfactory results.
Al diagnoses were confirmed exactly. All
of them showed excellent results, whereby
also clinical changes were controlled.
Ul rasound of 1 me and. 0.75 -?1.5 W/sgcm
wa used. Before each of 10-30 treatments
so e liquid was given to every one for
dr nk.
3. P. BUGARD, P. VALADE, E. COSTE,
J. SALLE, Paris, France
Le syndrome traumato-v.ibratoire experiment-
al (Ex erimental Traumatic Vibratory
Sy drome.
Th paper deals with disturbances appearing
on test animals (dogs, rabbits, guinea pigs)
if they are exposed to large ultrasonics
intensities. Noise from pulso- and. turbor-
ea tors were used, also Pimon.ow's sirene
an ultrasound. Red and white blood corpu-
sc es, leucocyte forms (blood sedimenta-
ti n rate) quantity of urine and properties
of 17- ketosteroids, electroencephalogram
an histological aspect of tissue were
observed. The progress of the traumatic
vibratory syndrome is characterized by two
phases. In a first nervous and neurovege-
ta ive phase some reaction of medulla of
the suprarenal gland appears, especially
distinctly if influenced by reactor noise,
less distinctly in case of ultrasound. In
a second phase the participation of endo-
cri e systems becomes more important:
pit itary gland, thyroid, and adrenal
cor ex become more active in 'blood and
tis ue.
34. F. PANUCCHI, R. PARISCENTI, M. GIRELL
Milano, Italy
Ef etti. degli ultrasuo.ni su alenni distretti
neu ovegetativi. (Ultrasonic Effects on some
Neu ovegetative Zones.)
Exp riments were made to investigate the
ult asonic effects on the nervous mechanism;
hea t and vessel reactions were especially
tes;ed (dogs and rabbits). Stellate gang-
lio , carotid sinus, vagal nerve on the
regLon of the neuro-vascular :fascicle and
spl nchhie nerves were treated with ultra-
sou d.. The experiments demonstrated: 1) At
the stellate ganglion there was no remark-
abl change of the arterial pressure and no
ace leration of pulse rate and no change of
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SCIENTIFIC
the electrocardiogram. 2) The carotid sinus
treated with ultrasound showed an arterial
rising of the blood-pressure and an acceler-
ation of pulse. rate. 3) The vagal nerve
shows a reaction only in case of more inten-
sive ultrasonic energies. These cause an
acceleration in pulse rate and a slight,
but immediate rising of arterial blood
pressure. The splanchnic nerve does not
show any ultrasonic response.
35. J. VAN WENT, Amsterdam, Holland
Biological investigations of the Changes in
the Connective Tissue in Relation to disea-
ses of the Spine.
A report was given about investigations of
the changes in the connective tissue in
relation to diseases of the spine when treat-
ed with ultrasound. In case of bony fusion
of vertebrae and its stiffness, herniation
of the nucleus pulposus in the course of
ultrasonics treatment, changes of deformity
were recorded on graph paper by means of a
simple instrument. Tissues were examined
for changes. (The vertebrae and interverte-
brae disks were examined on the spine of a
pig. When the preparation was treated with
ultrasound and some drops of Ringers solu-
tion added, after 5 minutes one could see
that the preparation dissolves 9-10 drops
and the control preparation only 1-2. The
volume of small pieces of the ligamentum
anterius and posterius was determined and
it was noted, that the volume of small
pieces treated with ultrasound had grown by
2-6 tenths cm. Heat did not produce the
same results. Micro-photography with inci-
dent light and in the phase contrast micro-
scope were then taken. It was noted that
the changes do not affect the fibres but
the interstitium. Better effects were obser-
ved in case of smaller doses (I W/sgcm)
than in case of longer and stronger dosage.
In case of bony fusion of vertebrae and its
stiffness and spondylosis deformans, the
neutrophil leucocytosis, being 6o-70%aater
beginning has been reduced to 45-5
ultrasonics treatment. Conclusions by
lecturer: 1) Beneficial effects of ultra-
sonics treatment on various diseases of
spine. 2) Deformations of spine formerly
considered as fixed, can be mobilized by
means of ultrasonics treatment. 3) Oper-
ation for degeneration of intermediate
spine should be made only when ultrasonics
treatment is not successful. 4+) In case of
diseases of spine ultrasound treatment
probably is successful because of effect on
the connective tissue. Liquid is absorbed
by the surrounding tissue and not by the
fibres, but by'the environ tissue. 5) Be-
sides a neural, effect, a local effect is
assumed. The influence of ultrasound on
the tissue is specific, besides the heating
effect. If there are no counter-indications,
low doses (low intensity and short time)
give the possibility of a long ultrasonics
treatment without any damage. 6) The per
cent of neutrophil leukocytes, which rises
greatly in case of bony fusion of vertebrae
and its stiffness and spondylosis deformans,
is often normalized with ultrasonics treat-
ment.
Discussion:
HINTZELMANN: The effect of ultrasound on
the water absorption of connective tissue
presented by Mrs. VAN WENT by means of
simple experiments is very impressive.
The oldest opinions concerning ultrason-
ics effect were: the tissue treated by
ultrasound absorbs liquid and thus the
elasticity of the connective tissue
grows. The lecturer's own opinions in
this case were advocated 11 years ago.
The neurovegetative effect being in the
foreground today, has been justly empha-
sized, however, it is not the only
effective component.
VAN WENT: (Conclusion): Since the verte-
brae never shows observable changes but
muscular causes of diseases of the spine
react very well to ultra short waves,
however, these do not show any effect in
case of morb. Bechterew; there remains
only the assumption, that ultrasound
affects the elasticity of the interverte-
brae discs, which are also traumatically
or degeneratively changed.
36. F. ZACH, Vienna, Austria
Beitrag zur Ultraschallwirkung am vegetativen
System. (Contribution to Research on Ultra-
sonic Effects on Autonomic Nervous System.)
In many considerations on responses to stim-
uli in the organism studies about the auto-
nomic nervous system are first undertaken.
Knowledge of centrally regulated phase varia-
tions after W. R. HESS and W. BIRKMAYER
gives us the base for all pathophysiological
considerations. An ergotropic and tropho-
tropic phase is known by measuring variations
of the secondary electromotor phenomena of
skin, by polarization voltage. Electroder-
matometry has been developed according to
own scientific work (Constant-current-device,
1.5 V and about 1 A). whereby at 10 minutes
intervals measurments were undertaken on
24 spots, on each side of the body. Large
variations in polarization voltage indicate
trophotropic neurohumeral phase brought
about, low polarization voltages ergotrophic
phase. Twenty convalescents were treated
with ultrasonics (1.2 me, pulsed sound 1:15
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SCIENTIFH: ULTRASONICS SOCIETY
- 1:13, intensity 0.75 - 3 W/sqcm) partly on
extremities, partly paravertebrally. The
autonomic phase variations in the electro-
dermatogram and gas exchange were observed.
Results show that ultrasound effects in any
case local and general reactions. Even the
smallest intensities of pulses sound can be
demonstrated by tangible signs. The reaction
time depends also on Intensity and localiza-
tion of ultrasonics treatment. Clinical
improvement is accompanied by decrease of
measured values (increase of polarization
potentials in trophotrophic phase) in seg-
ments and also almost anywhere in the body.
Small doses are especially effective in case
of ergotropic stage at beginning, in the
sense of physiological progress of the re-
action and, by using them, it is possible,
to establish the "vegetativer Dreitalct"
(vegetative reaction in three phases after
SIEDEK) while larger doses rather become
effective at trophotropic stage at the
beginning, and frequently are followed by
dystonic regulation.
PAVELKA: Ultrasonic treatment of the
cerebrum in dementinfants shows, regard-
ing the psychical expressions a Xronounc-
ed effect of three! phases : for. the first
days the infant becomes more quiet and
calm and sleeps better. From the 5th
to the 14th day, apronounced activity
starts with restlessness and erethism;
following this condition, it changes
to a permanent state of quickness and
it can be affected:more easily.
Z,ACH: In 6 control cases no changes after
fictional treatment. (without ultrasound)
VAN WENT, SCHIKORSKY: Doubts whether the
subtle reactions like metabolism of gases
and the electrodermatogram are precise
enough to determine the vegetative reacti-
ons. In many cases of vegetative irrita-
tions, already minor external causes are
answered violently., That is proved by
the well known psychogalvanic reflex.
The patients for the control test have
to be of the same group of patients.
VAN WENT: Because of the marked sensibil-
ity asthmatic patients should not be
exposed to extreme ultrasonics. treat-
ment.
ECKEL: The reproach that the experimental
neurovegetative research uses too
intricate methods, should be rejected
as well as the reproach that the patho-
logical i.e. the morphological examina-
tions are performed too late. Between
these two fields of research, up to now,
there is an unknown space? where we will
find the answer for the mechanism
causing the effect,,
CH: Conclusion: The changes of the
vegetative tonus by pharmaLcodynamic,
physical and physical causes can be
distinguished exactly and sufficiently..
The reported cases shall explain mainly
how sharp the reactions to ultrasonics
treatment fit all other experiences we
have learned about the vegetative ner-
vous system. Especially the reported cases
with bronchial asthma can explain this. In
one case, too intensive irritation by
ultrasonics effects a sudden change in the
reactive stage and produces a fit. In the
other case the stimulus meets the organ in
such a way that the fit can be stopped.
he positive action of ultrasound, as said
efore, in cases of sypathicotropic stage
is to act in a damping way, and the clinical
observations show any effective stopping of
an asthmatic fit, as the practical value of
his precisely aimed use.
DNESDhY, September 10, 1952, Morning
Session
residing: R. Pohlman - F. Dussik
37. U. HINTZELMA)[N: Wiesbaden, Germany
er Ultraschall im Rahmen der Rheumatherapie
Ultrasound in Rheumatism Therapy)
Between the medical praxis and the scienti-
ioal research in the field, of ultrasonics
here exist still great differences. Em-
iricism is far more advanced than theoreti-
cal knowledge. In the field of the rheuma-
ic disease, much progress has been made
since the last explanations by the author in
he book about the ultrasound-therapy
(R. POHLMAN (1950),-which can be found in
the following report. The experimental
e aminations of HORN:IKIEWITSCH with the use
o therapeutic doses showed, from which
dsage on the shift of the reaction of the
t slue goes to the basic side and the rela-
t ons of the pH in the artificially inflamed
t ssue. The conclusion has been reached,
that the local or topical treatment in
r eumatic cases will furtheron be of ther-
a eutic value. HOLZand coworker from the
p armacological standpoint found the forma-
t on of pharmacodynamic substances of the
tissue in isolated organs if therapeutic dos-
e are used. Whether these substances will
a so be produced if spinal roots are treated,
I not sure. Anyway, all other clinical meas
u es based upon rheumatic etiology may still
b observed. Also the perception about the
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ULTRASONICS SOCIETY
disbalanced mechanism of immunity and the
accumulation of muco-polysaccharides and
protein substances in the tissue, which
produce auto-antigene in the rheumatic
body, is not touched. According to the
opinion of the author, the Bechterew's
disease and the deforming spondylopathy
still rank under the first indications for
ultrasonics treatment. Emphasis is laid
upon simultaneous treatment of peripheral
and central segmental parts of a zone in
the nervous system, with different intensi-
ties (relation of intensity 7:1)
VAN WENT: She confirms that and points to
the fact that successful treatment
requires early beginning.
LEHMANN: In cases of Bechterew's disease
these good results have never been seen
as HINTZELMANN and VAN WENT reported.
But only such cases have been treated
where the blood sedimentation rate was
normal. He expresses the thanks of the
French delegation and affirms that by
this session the practical importance
of the u.s. has been affirmed.
ZACH: In an acute arthritic state of a
joint the combination of a central
analgesic drug (Irgapyrin) and ultra-
sound is of great importance. The seg-
mental- ultrasonics treatment plays the
role of the so-called . segmentale Ent-
warnung . (all clear signal in segements
(FENZ.) In cases of spondylopathy pains
after ultrasonics treatment indicate
herniation of nucleus pulposus in the
vertebral disc. The osteoarthritis of
the hip joint (Malum coxae senillis)
shows good results after treatment.
38. E. BATALLA, J. ROTES, A. ZAUNER,
Barcelona, Spain
Die Ultraschallbehandlung bei rheumatischen
Affektionen. (The Ultrasonic Treatment in
Rheumatic Affections.)
Reports of 200 cases particularly good
.results in cases of arthrosis; muscular
rheumatism, neuralgia, sciatic neuritis
and neuritis cervicobraehialis. As an addit-
ional treatment in cases of Bechterew's dis-
ease. A selective influence upon nerve
roots, muscles and tendons is assumed, as
such as its analgestie action; further a
lissive action on muscular contractures,
myogelosis, fibrositis. The superior value
is accented in relation to other means of
physical therapy 'in the cases indicated
above.
39. E. UNGENEUR, C. GLENK, Frankfurt/Mai
Germany
Bedeutung der Ultraschallbehandlung bei
rezidivierender'Ischialgie. (The importance
of Ultrasonics.-Therapy in Recidivation of
Sciatic Neuritis.)
Both, the acute as well as the chronic
sciatic neuralgia are in the domain of
ultrasonics treatment. ROSENBERG found by
animal experiments good results of ultrason-
ics treatment in neuritis (sciatic), becaus
of a pronounced selective influence upon the
medulla oblongata. Within 4 years, 473
cases have been reported, including many
herniations of nucleus pulposus. The most
cases with recidivations showed pathologic
changes in the X-ray reading.
40. F. FANUCCHI, M. GIRRELLI, S. INGEGN-
IEROS, Milano, Italy
Risultati raggiunti con Is terapia ultrason-
ics dopo 1 - It anni. (Results of Ultrasonic
Therapy 1 to It years after treatment.)
In 318 cases the frequency of reoidivation
has been studied. 150 cases have been
excluded from test series because of the
short time of possible observation. Anyway
this group had 60% to 80% good effects upon
treatment. The percentage of cure and
improvement (relief) Is about the same in
the different groups of diseases. Recidiv-
ation appeared in 60% of the cases and has
been more frequent in cases where only a
slight improvement was present. Dosage
used: 1 MHz 1 to 1.5 Watt per square centi-
meter 3 to 20 minutes. It is said, that
the elementary mechanical and the thermical
factors because of the simultan and synch-
ron action, cannot be separated as to its
effect.
41. W. A. DALICHO, Gera. Germany
Die Behandlung der Periarthritis humerosca-
pula.ris. (The treatment of Periarthritis
Rumeroscapularis)
Comparison of 100 patients each treated with
ultrasound and X-rays. Among causes are
included mechanotraumatic, infective-toxi-
cal, endocritic-hormonal and vasculary dis-
turbances. From the pathologic standpoint
it is a deposit of phosphorated and carbo-
nated calcium into the inflamed tissue of
the tendons. Besides the elimination of a
present focus, the treatment of the periar-
ticular region has to be performed. X-ray
therapy achieved complete cure in 54% and
relief in 37% that means successful treat-
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 SCIENTIFIC ULTRASONICS SOCIETY
tent in 91%
ultrasonico treatment
(800 KHz)
ith topical
application over the
shoulder
oint and the related segmental paraverte-
ral region. Cure in 50%, significant
elief in 38%, total
8p%.
That
shows
the
ame therapeutical value as
the
X-ray
treat-
ent,
approx.
the sam
e numb
er of
times
.
lso
calcifica
tion di
sappea
rs wi
th bct
h
ethods of treatment. Relapse seems to be
tore seldom after X-rar treatment. The
egmental application brings also mar..y
dvanta.ges for X-ray treatment. No benefi-
ial results have been observed if osteochon-
rosis was present. Failures with or.e
ethod can mostly be compensated by the
ther method.
MM : Report of a case that during; a
treatment of the shoulder joint s. eon-
cealed disease of the heart became
manifest.
42. H. SCHNEIDER, Innsbruck, Austria
Die Ultraschallbehandlung der Tendope.thie.
(Ultrasonics Treatment of Tendopathy,)
eport of studies, according to which a
group of degenerative'diseases are caused
by affection of the tendon, i.e. Epichon-
dylitis, Coracoiditis,; Deltoidalgy, and
styloiditis. Report of experiences after
treatment in 239 cases, 65 of which were
diseases of the heel tendon. 2/3 of the
cases had no complains after 2 weeks of
treatment. Relief in almost all of the
other cases. No success in only 5 out of 65
persons with calcifications of the tendons.
The earlier the treatments starts, the
better the results, especially before the
onset of calcification. In acute cases of
disease of the tendons subfebrile tempera-
tures are present andsome times a hLgher
blood sedimentation rate. Positive results
after ultrasonics-treatment can be seen
within a shorter time than with X-ray,
while the performancelof the ultrasonics
treatment is easier. Demonstration of good
X-ray films.
LEHMANN: (concerning the lectures of
DALICHO and SCHNEIDER) The vegetative
influence is of marked importance in the
formation of the periarthrit:is humero-
scapularis. These manifestations
following a neuritis are successfully
treated with the sound application dir-
ected to the stellate ganglion. If the
cause is myositis, topical application
and the surrounding muscles have to be
in the field of treatment.
NTZELMANN: (concerning the lectures of
DALICHO and SCHNE:{DER): Reports, that
barbital drugs help the onset of periar-
thritis humeroscapularis. That means no
barbiturate may be used In this treat-
ment.
3. L. BARBE, Bordeaux, France
Le ultrasons en oto-rhinola:ryngologie.
(Ultrasonics in ENT.
St dies about the action of ultrasound on
th auditory organ in the field of physics,
hi to-physiology and therapy. (used frequ.
1 egacycle). Description of a special
ap ratus. If ultrasound penetrates
aq eous solutions or :Living tissue, lumin-
es ence occurs with wavelength from ultra-
vi let to 3500 A. In the physiologic test
by erfunction of the auditory organ can be
fo d at 0.5 watt per sqcm. At 1.5 Watt
pe sgcm a primary functiona:L loss of hear-
in is present which then becomes second-
ar and can be noticed at higher frequencies
At 0.3 W/sqcm, a hyperaemic .state is present
wh eh becomes pronounced at :L.5 W/sqcm;
ne rotiaing effect at 4.0 W/sqcm for the
cell. In the therapy of otosclerosis 35%
ha 25 decibel gain, 26% had 10 decibel
ga n of hearing capacity, in 49% no effect
wa present. Moderate deafness in case of
le ions of the inner ear: 42% had 20 deci-
be gain, 36% had 10 decibel, no reaction
in 22%. Tinnitus in the diseases reported
wi 1 be influenced in 80% of all cases.
4. K. ECKEL, Bad lschl, Austria
Di Behandlung muskulll.rer Er:krankungen mit
U1 raschall. (Treatment of Muscular Disease
wi h Ultrasound.)
I considering muscular diseases, this group
of sickness has been divided into 3 sub-
groups. Therapy possibilities were enhanc-
e by the excellent trophic effects of
ul rasound treatment of neural and spinal
muscle atrophies, that is, in case of toxic-
infective neuritis and of polyiomyelitis.
During treatment of these muscular atroph-
ies most of the effect are achieved over
vascular-vegetative i:nnvervation, because
ultrasonics treatment of regional blood ves-
se s,'conveying blood toward the region,
le ds to full effect. There was shown in
ca a of spastic paralysis that best effect
wa achieved by ultrasonics treatment of
t affected muscles themselves. By no
me ns in case of spastic paralyses by
ul rasonics treatment of the vertebral col-
um a special tonus loosing effect comes
ab ut. In some case of transverse lesion of
th spinal cord only the impression has
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been that improvement of conductivity it-
self comes about for the nervous tracts in
the spinal cord,-for instance in case of
myelitis arachnoiditis, and hematomyelitis.
Rather frequently, visceral functions of
bladder and intestines only improve, with-
out improvement of mobility. In sum, the
tonus loosing effect of ultrasound, however,
must be regarded in case of transverse les-
ions as practically little effective.
Results are better for more proximal spinal
localization than for lumbar. But because
also contractions show improvement in case
of local ultrasonics treatment, nevertheless
ultrasound shall be used as peripheral muscu-
lar treatment for transversal paralyzed pat-
ients. Best results and practically most
important ones were achieved by ultrasonics
treatment of Little's disease. Motility and
spasticity improve by it and permanent suc-
cess is achieved by loosing of contractures.
Considerable improvement can be shown for a
third group of diseases of nervous system;
in case of progressive mystonia atrophica,
dystrophic muscles sometimes show some gain
in strength but mostly it does not persist.
Amyotrophic lateral sclerosis and spastic
paralysis of spine were treated with little
success.
STUHLFAUTH: Confirms the great importance
of ultrasonics treatment in vegetative
vascular regions. It is important for
knowledge about spastic processes that
tonus loosing effects come out at direct
ultrasonics treatment of muscles. Vege-
tative reaction is shown also by dec-
rease of eosymophil blood cells which we
have found to be especially large at
ultrasonics treatment of vascular
system.
ZACH: The effects on the autonomic vascu-
lar system have been very often observed,
when no other therapeutic effects are
obtained; in 4 of 6 cases improvement of
bladder or visceral function were achiev-
ed, whereby motility remained unchanged.
MAYR: Indications and questions whether
ultrasonics treatment of heart and
stellate ganglion in cardiac region
brings about complication.
ZACH: No injury was done to myocardium by
ultrasonics treatment. Well conditioned
hearts do not show any disturbance even
in case of excessive treatment with
ultrasound.
STUFILFAUTH: In case of injuries to myo-
cardium and coronary sclerosis a series
of damages might lead to anginous attacks
of heart. This is by no means a conseq-
uence restricted to ultrasonics treat-
ment only; it can also be brought
about by a hot hand bath. If the heart
is in proper condition, effective dis-
turbances never occur: Experiments of
some authors on themselves showed that
only in case of extremal doses, cardiac
sensations could be excited. (Static
ultrasonics treatment with 2.5 W/sqcm.
PAVELKA: Does not find any danger from
circulatory system at many ultrasonics
treatments of stellate ganglion, if the
patient is treated with caution and by
slowly increasing doses. Regulative
effects to heart come out, but there
was never shown any serious complica-
tion.
ECKEL: (Conclusion): Agrees to last dis-
cussions, in which there was established
that generally little reaction comes
from ultrasonics treatment of vegetative
nerves along vascular system, if the
vascular system of the patients is
sound and if doses applied are small
ones. The danger of ultrasonics treat-
ment of cervical sympathetic system at
endangeitic processes and apoplectic
states cannot be overemphasized. There
was reported additionally that cardiac
phenomena are without doubt appearing
too, if for instance largely extended
parts of muscles are treated ultrason-
ically with large intensities. Perhaps
humoral substances acting on vascular
system must be considered, formed during
ultrasonics treatment of big areas.
45. K. HENKEL, Garmisch-Partenkirchen,
Germany
Mikrodosen (Mikrodoses).
Practical work with small intensities of
sound proves, that sensitivity and reac-
tive stage of the patient influences to a
very large degree the effect. Small doses,
thoroughly confirmed the opinion about
neural mechanism of the effect. Own exper-
iences confirmed that improvement by the
therapeutic effect is the same if there is
used a maximum of 0.6 W/sqcm instead of 3-4
W/sgem, it is rather better at small inten-
sities. Ultrasonics treatment is regarded
as stimulating treatment.
7C
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`.SCIENTIFIC ULTRA
ZACH: The smallgst doses in a ease of
bronchial asthma with clinical effect
proved by electrodermatograph;r was 0.1
W/sqcm, at a pulse to pause rE;tion of
1:13 at 1.2 me,: so that the average
total intensity, was 0.08 watts..
ECM: We have long ago found ty neuro-
logic application that, with regard to
the neural mechanism of the effect,
small doses arelsufficient to achieve
optimal effects; The calculation of an
average value cgncerning time in the
remark above should be rejected because
otherwise physical data taken for deter-
mining the applied energy, being compli-
cated enough in themselves, would be-
come yet more confusing. This averag-
ing includes already the assumption of
pure thermal effects, even if it has not
been explicitely said. In case of puls-
ed sound, amplitudes remain unchanged
for different pulse to pause ratio, in
ZACH's example, they always correspond
to 0.1 W/sqcm. In pauses at pulsed
sound peaks of temperature become equal-
ized but there is no mechanical action
then.
46. K. WOLLMANN, Berlin, Germany
Lokale Oder segmenta.e Beschallung? (Shall
ultrasonics treatment be local or segment-
al?)
The author, who has a ade experiences with
more than 10.000 ultrasonics treatments
proves at 39 cases that treatment of ulcera
cruris, scapulchumeral periarthritis,
arthrosis deformans of knee and hip joint,
ischialgia, epicondyl4tis leads to far better
and earlier improvement if besides local
ultrasonics treatmentialso segments were
treated. If only segments were treated'or
only local treatment Mould be used, no such
successes could be achieved.
47. G. WILLIAM, Linzh Austria
Erfahrungeh fiber die praktische Arbel.t an
300 Ultraschall-Therapiestellen. (Ea:perien-
ces in Practice at 300 Ultrasonics Therapy
Stations.)
Survey on practice and; efficiency of ultra-
sonics treatment. After the judgement of
85% of physicians, active in therapeutic
practice, the result of ultrasonics treat-
ments are very good, further 9% regard it as
useful. Only 6% come to negative judgement
about it. Dosing and goupling closely
connected with it are essential factors. In
practice best results were achieved by slow-
ly raising the intensity up to the final suc-
cessful dose, because the reactive stage of
inflammatory processes as infiltrates,
h.ydrarthrosis,-paronychia, lymphomas, chron-
ic osteomyelitis, thrombophlebitis and sim-
filar. Also phlegmons, endangeitic or dia-
betic gangrenes sinusitis and catarrh of
Eustachian tubes, suppuration in middle ear
are indications for successful treatment.
In practice, results are not so good at
chronic inflamation of joints, because then
universal treatment is important.
ZACH: Reports about a pa,naritium which
has been healed after 2 ultrasonics
treatments with pulsed sound 1.2 me
at 0.1 W/sacm.
processes because of growing number of
progressive inflammation, as has been
shown by experiments.
7 DNESDAY, September 10, 1952 Afternoon
Session
P esiding: F. SEIDL - F. LETTOWSKY
48. J.J.WILD, J.M. REID, Minneapolis,USA
F fteen Megacycle Pulsed Ultrasonic Reflec-
t on Studies on Biological Tissues.
A ultrasonic beam of 15 me pulsed ultra-
s and of 0.5 microseconds duration at a
f equency of f 600-4000 pulses per second was
a
plicated on tissue. Peak intensity on
t e crystal l was less than 644 W/sqcm. Thick-
n ss of ultrasonic beam was 3 mm. The emit-
t d pulses were received with the same
q artz as emitted. The most important re-
8 It is that malignant tumors show distinct
di ferences in received intensity against
no mal tissue, and also against benign ones.
Th re were 19 cases of tumors of the female
br ast clinically established as all of
th m being malignant ones, that is 11
to ors correctly were recognized. Hypo-
th tically there has been assumed, that
su pression of echo at malignant tumors was
ca sed by stronger concentration of cell
nu lei in malignant tissue.
9. R. H. BOLT and T.P.HUE,TER, Cambridge,
USA
So IT aspects of Transcranial Ultrasonic
Tra smission.
Alt ough many ultrasonograms '.have shown a
def nite gestalt similarity to X-ray pictures
obt fined with air filled ventricles, we must
als face the fact that two groups of inves-
ts tors (at Erlangen and MIT) have obtained
lat ral ultrasonograms on water-filled
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SCIENTIFIC
skulls which show a characteristic gestalt
likeness to the ventricles. Nevertheless,
there have been obtained at MIT (using
apparatus developed there) ultrasonograms in
the A-P direction on two cases that showed
abnormalities, in general agreement with
operative findings which established the
presence of a tumor. The A-P sonogram is
easier to interpret than the lateral pic-
tures obtained by DUSSIK because of its
symmetry and because I of ventricle is with-
in access of the parallel portion of the
transmitted signal. Some noise problems
(electromagnetic noise, cross-talk, tube
input noise, ground loops, acoustic trans-
mission around head, reverberation in tank,
relative motions of transmitter, receiver
and head, variations in contact of coupl-
ing water with head, grease, hair, air
bubbles) can be solved within the general
limits on intensity, frequency and beam
width of signals which can be safely gener-
ated and transmitted into the patient's
head, but there are major noise problems,
variations arising from scattering and re-
fraction in brain tissue, non-homogenous
folds, and especially the undesired skull
information, influencing the acoustic sig-
nal ( a) Thickness variation b) shape varia-
tion c) Internal structure) on which the
entire method will stand or fall. Bone
attenuation can be compensated by the
following methods: (1) 2-frequency differ-
entiation, (2) X-ray (3) Differentiating to
show slopes at edges of ventricles (4) Radio-
active absorption. Other possible kinds of
signal processing are (a) Averaging over
space and/or over frequency to smoothen out
interferences. (Frequency modulation of
noise band will help reduce fluctuations.)
(b) Pulse-gating. (Signals not coming along
minimum path are minimized) (c) Correlation
and filtering methods. (d) Compression and
expansion in presentation. First, one must
try to see all the information, conveyed by
any given type of transmitted signal. No
amount of processing can add new information.
The lecturer emphasizes that the desired
signal is: "Normal" "Abnormal". Even
X-rays have distortion. All information
wanted may be obtained merely by a "pip" on
the oscilloscope. Considering all recent
advances in the processing of information to
extract weak signals from noise, there cannot
yet be said that, even with help of these
techniques, the sonogram will become a
reliable diagnostic tool for the neuro-
surgeon.
50. K.Th. DUSSIK, Boston, USA .
Entwicklung and Aussichten der Ultraschall-
diagnostik mittels Durchschallung (Hyper-
phonographie) (Development and Chances of
Ultrasonics Diagnosis by Means of Sound
Transmission (Hyperphonography) )
The transmission method for achieving pic-
tures of living human objects, especially
the cranium, first has been brought before
the ultrasonics congress in 1949 at Erlangen
to be discussed. Since this method has been
worked out at two places outside of Bad Ischl,
and that by PAETZOLD, FIEDLER and GUETTNER
in the laboratories of the "Siemens -
Reininger Works" then by a research team of
the General Hospital at Boston and of the
Massachusetts Institute of Technology at
Cambridge. The method has to meet with con-
siderable experimental difficulties, as has
already been emphasized at Erlangen, and as
has become yet more clear in course of fur-
ther testing and developping the method.
The lecturer could not make use of any
larger experimental possibilities, needed
for answering and solving different quest-
ions. Therefore he can show only the hyper-
phonograms which were achieved until 1949
against the results from Erlangen and
Boston - Cambridge. While the group at
Erlangen in consequence of their measure-
ments and conclusions has come to the re-
sult that this method would not make possib-
le to get any pictures of true shape of the
ventricles because of 'different disturbing
effects, especially because the skull is
varying in thickness. the American team too
has established such effects, but they have
sought possibilities to compensate them. In
case of 2 tumors clinically serviceable
results were achieved. The ultrasonic pic-
tures, which have been obtained by means of
the transmission method of the lecturer in
anterior - posterior direction to the skull,
could be verified by operation. The lectur-
er points out that some pictures obtained at
Bad Ischl also have been verified clinically.
Especially there was discussed about pictures
before and after cranial operation, showing
such differences that they could be regard-
ed as full proof for the conclusion, that
information obtained by ultrasonic pictures
is in good agreement with internal cranial
details. While in this case from the same
cranium necessarily different results were
obtained, there are otherwise ultrasonics
pictures well reproducible, if they have
been obtained at the same conditions. The
author, however, has observed that distinct
pictures were not obtained for every adjust-
ment of the apparatus. Because adjustment
of the apparatus in Bad Ischl is very subtle,
intensity, frequency (in limited degree)
and modulation being variable, and because
in operating the apparatus in Bad Ischl the
optimal contrast between the ventricular
region and its environ always was establish-
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S C I E N T I F I C ULTRA ONICS SOCIETY
ed, the lecturer assumed until 19,+9 that
failure of this method in the mentioned
cases was due to not sufficient accuracy of
adjustment. Results from Erlangen. and from'
Boston-Cambridge, however, indicated that
there were certain anatomical circumstances,
leading sometimes to applicable results, but
sometimes to non-applicable ones. Therefore
practical serviceability of the method dep-
ends on compensation of the chief factor
causing disturbances, that is of varying
thickness of skull. The lecturer declares
that such compensation could be reached by
coupling the ultrasonic beam with a corres-
ponding one of X-rays. Electroencelography
and radioisotopic techniques have been devel-
oped since 1937, when first the method was
known, but they did not solve the problems
inasmuch that concerning pathological values
of elasticity and viscosity no further
progress could be made in determining them,
and so the lecturer believes that in spite
of the objections of the Erlangen group fur-
ther work in inproving the transmission
method, especially by means of compensating
the disturbing factor that is the thickness
of the skull bones stands a chance and will
have success. Finally there is irrefutable
clinical evidence, which cannot be explained
by self deceiving, that at least a consider-
able amount of information, contained in
ultrasound pictures, taken in Bad :Lschl is
not caused by bone attenuation, but is
informing about essential internal details
of the brain. Against the said arguments
theoretical considerations and investigation
on details are less convincing, especially
in a field that is new and physically diffi-
cult. Also in case of other diagnostic
methods, based on physics, first there had
been told by therapeutists, that i,; were
impossible to get any results from it (for
instance electrioencephalography, electron-
microscopy a.a.), while nevertheless fur-
ther development proved, that these methods
are useful. Concerning the questioned
ultrasound transmission method, the lecturer
did not change his opinion, that there
indeed were difficulties in developing the
method, but that nevertheless a valuable
enlargement of diagnostics will result from
this method.
51. W. GUTTNER, Erlangen, Germany
etrachtungen zur Mtglichkeit der Ultras-
c?allabbildung am menschlichen Schadel.
Considerations about the Possibility of
chievin Ultrasound Pictures of the Human
ranium.)
areful considerations of DUSSIK's transcr
al ultrasonic transmission method lead to
eries of acoustical. problems, which seem
lmost impossible to solve. Measure of
ropagation, speed, wave resistance .and aco
tical attenuation on liquor, brain and
ones show that 1) Refraction of brain
gainst liquor is of negligible amount, an
ound transmission Is practically without
ny reflection. 2) There are actually
ifferences in attenuation between brain
nd liquor, but they are very small compar-
d with attenuations caused by bones.
) Transmission through bones depends on
ngle of incidence. Therefore it follows
nd can be experimentally proved, a) Refrac
ion of sound caused by the external surfac
of the human cranium which approximately ca
1 e regarded as spherical, leads to distor-
ion of pictures b) The skull bones, varyin
in thickness from point to point, cause
already some very distinct structure in
attenuation pictures, whereby the thickness
o the bones remains unknown, so that addit
i nal decrease in attenuation, caused by th
ventricles, can not be differentiated
c) The attenuation picture does not show
proportionality to length of path travelled
b ultrasound. From these investigations
i can be concluded, that ultrasound pictur
w,re incomparably inferior as to true shape
a d precision to pictures obtained by X-ray
m thods.
The lecture was followed by a very lively
d scussion whereby different views were
exchanged, questions answered and details
explained but there did not result any new
a pects of the problem itself. In the
d scussion participated: DRUM, F. DUSSIK,
E KEL, v.GIEE3KE, LET' OWSKY, PAVEL.EA,
P HLMAN, SEIDL.
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